New York City health officials investigating a hepatitis C outbreak in 2002 found that the 12 patients who contracted the virus within a six-week period had two things in common:

• They had undergone gastrointestinal endoscopy at the same facility in Brooklyn, N.Y., and
• they were IV-sedated by the same anesthetist.

Epidemiologists narrowed the outbreak's culprits to either a failure to sterilize the biopsy forceps or properly reprocess the colonoscopes, or to some other violation in aseptic technique. It was evident from the facility's policies, procedures and meticulous records that the GI center had been following the appropriate sterilization procedures. Investigators turned their attention to the anesthesiologist the facility had recently hired as a sub-contractor.

Reusing syringes and needles
The anesthesiologist was contractually required to provide his own medications and equipment. A review of his purchasing records revealed the anesthesiologist had purchased far fewer syringes and needles than would have been required had he used a new syringe for each patient who received sedation at the facility. Investigators blamed the hepatitis C outbreak on contaminated multiple-dose medicine vials the anesthesiologist used during the administration of IV sedation.

His explanation was quite interesting. He'd recently taken over the sedation practice from another anesthesiologist, who had left behind his supply of needles and syringes. The accused anesthesiologist testified that he'd used the leftover supplies in lieu of purchasing new ones.

Health officials recommended that the anesthesiologist's license to practice medicine be suspended for six months and that he be required to undergo training in infection control procedures before his license be restituted.

Is the anesthesiologist or facility liable?
When the information regarding the outbreak became public, many of the patients who had contracted hepatitis C brought suit against the anesthesiologist and the facility. The judge denied a motion to join all the suits as a class action; eventually four patients brought suit against the anesthesiologist and the facility, seeking compensation for lost income, medical expenses and the apprehension that they might develop cancer of the liver or cirrhosis of the liver requiring liver transplantation (20 percent of patients with hepatitis C will develop one of these two complications).

Some facilities that use independent anesthesiologists attempt to shield themselves from liability by posting signs indicating that certain physicians are independent contractors or by having patients sign statements signifying that they're aware of the independent-contractor status of certain physicians. These measures don't always work.

Do you think the jury found the anesthesiologist liable or ruled that the facility should be held responsible for the actions of its independent contractor anesthesiologist?

Answer and Explanations
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