Warn the Public or Supervise the Doctor?

Days after a cluster of hepatitis cases in 2002 led health investigators to a clinic in Norman, Okla., the state’s chief epidemiologist held a news conference to urge anyone who had been a patient there to get tested immediately for blood-borne diseases. A nurse’s improper use of syringes was said to be the cause.

In contrast, when the New York State Health Department mailed out letters to 628 patients last week, telling them that they were at risk from a similar faulty use of syringes by Dr. Harvey Finkelstein, an anesthesiologist on Long Island, 34 months had passed since investigators identified Dr. Finkelstein’s office as the source of two hepatitis cases.

The delay, health officials said, was in part caused by prolonged negotiations between the doctor and the Health Department over access to his patient records — involving objections by him and his lawyers over which patients needed to be notified, and which were unlikely to have been exposed.

Experts said yesterday that the New York department’s handling of the case opened a window on a longstanding debate: Should doctors who create public health risks by using unsafe practices be treated any differently by the health department than, say, restaurant owners or hot dog vendors who do the same thing?

Dr. Finkelstein’s case was reviewed by the Office of Professional Medical Conduct. But the review took place about nine months after state health inspectors first learned that he was reusing syringes when he drew medication from multiple-use vials. Although a syringe is used on just one patient, the vials are used for many patients. Used for more than one vial, one patient’s contaminated syringe can contaminate the vials even though a new syringe is used for each patient.

By the time the review took place, Dr. Finkelstein had changed his methods to comply with standard practice, as recommended by the Centers for Disease Control and Prevention. The review board ruled that because he was currently in compliance there was no basis to discipline him.