State health officials say they are not sure exactly what caused several cases of hepatitis B and C that have been linked to a heart clinic in Beckley. The viruses have been linked to injectable medications given during cardiac stress tests at the Raleigh Heart Clinic.
State Health Commissioner Dr. Rahul Gupta said an investigation turned up no "smoking gun," as a reason for the viruses being transmitted, but there are a number of factors that could have caused it.
"It's not just [not reusing] the needle but there are a host of other precautions that one must take when you're doing the procedure and that's part of the infection control," Gupta told reporters Thursday.
Letters went out this week to 2,300 patients of the Raleigh Heart Clinic telling them they may have been exposed to the viruses and encouraging them to be tested for hepatitis B and C as well as HIV. The letters went to patients who underwent a stress test with injectable medicine between March 1, 2012, and March 27, 2015.
A total of 12 cases of hepatitis have been linked to the clinic. These include eight patients who got hepatitis C after a heart stress test on three different days and four patients who got hepatitis B after getting a heart stress test on two different days, according to health officials. There has not been any evidence of HIV transmission, but because the virus is transmitted the same way as hepatitis, patients are recommended to get tested, health officials say.
Gupta said besides reusing needles, the viruses could also have been transmitted by medical staff re-using single-use vials of medicine, not wearing proper equipment or not cleansing the area of the injection site.
The heart clinic is private, and Gupta said officials did not know whether anyone from the clinic had been disciplined or fired as a result of the investigation.
A woman answering the phone at the Raleigh Heart Clinic on Thursday said the staff was not commenting at that time.
The clinic was closed from March 27 until March 30, 2015, while the clinic adhered to several instructions from state officials, Gupta said. Those instructions included only using single-use medications, switching to needleless injection systems and having the staff and physician undergo injection safety practice training and other training, Gupta said.
Gupta said the clinic has been cooperative with the investigation.
As of Thursday afternoon a class-action lawsuit has been filed by patient Pamela Vines against the clinic on behalf of patients who had cardiac stress tests at the clinic during the three-year time period outlined by state health officials.
The lawsuit names the clinic as well as clinic president Dr. Thair Bargouthi and secretary/vice president Nahla Bargouthi.
Attorney Stephen New, who represents Vines and filed the lawsuit in Raleigh County Circuit Court, said he has hired "a leading national infectious disease expert" from the Washington, D.C., area to help in the investigation. New said he also plans to file Freedom of Information requests and set up meetings between his client and officials with the DHHR, including Gupta.
The investigation started in November 2014, after a patient with no risk factors for hepatitis C was diagnosed with the virus. A primary care physician diagnosed the virus and notified state health officials, Gupta said. That led to health officials looking into clinics that had treated the patient, including the Raleigh Heart Clinic, where the patient had a stress test. Health officials finished the investigation in September 2015, he said.
More than 95 percent of the 2,300 people who were exposed to the viruses are from the southern part of West Virginia, Gupta said. Part of the investigation included testing and clearing the staff members for hepatitis and HIV, Gupta said.
People with hepatitis C, hepatitis B and HIV may not have symptoms for years, so health officials say testing is important even for patients who do not feel ill.
Testing is available through the Raleigh Heart Clinic, patients' own health-care provider or through a local health department. Patients are asked to bring a copy of the letter they received to the staff performing the test.
Clinic patients can also call an information line at 800-642-8244 or see a list of frequently asked questions for more information.
Reach Lori Kersey at lori.kersey@wvgazettemail.com, 304-348-1240 or follow @LoriKerseyWV on Twitter.