Hepatitis C Virus (HCV) Information

Recently, a scrub tech employed by the Audubon Surgery Center at Union and Circle in Colorado Springs was arrested after admitting that she had taken syringes containing the powerful opioid Fentanyl and replaced them with syringes that she had used herself and then filled with saline or water. The scrub tech, Kristin Diane Parker, has tested positive for the Hepatitis C Virus (HCV). Prior to working at Audubon, Ms. Parker was employed in a similar position by Rose Medical Center in Denver.

It is estimated that more than 1,200 patients of Audubon, and 5,000 patients at Rose, had surgery and were potentially exposed to the disease during the relevant time period. Patients who had surgery at Audubon at Union and Circle in Colorado Springs between May 4, 2009 and July 1, 2009 are at risk.

The following information is provided regarding HCV and what to do if you think you were exposed.

1. What is hepatitis C?

Hepatitis literally means inflammation of the liver. It is a disease in which viruses produce inflammation in liver cells, resulting in cellular damage. The most common forms of hepatitis are hepatitis A, B and C (HAV, HBV and HCV), but there are also other types (HDV, HEV, HFV and HGV).

2. How serious is hepatitis C?

Hepatitis C is usually classified as either "acute" or "chronic." Acute hepatitis C is short-lived, usually going away after a few months. Unfortunately, the majority of people who contract HCV get the chronic form of the disease. If the disease is still present 6 months after exposure, it is considered to be chronic. About 2/3 of people who get chronic HCV will eventually develop chronic liver disease, and a significant minority will actually get cirrhosis over the course of 20-30 years. Of the patients who develop cirrhosis, about 4% will also develop liver cancer and somewhere between 1% and 5% will die.

3. How is hepatitis C transmitted?

The only way you can get hepatitis C is from contact with infected human blood. Most often, this occurs when a person uses a needle that has been previously used by an infected person. Probably the most common situation involves sharing of needles, but inadvertent needle sticks have also resulted in transmission of the disease. Prior to 1992, hepatitis C was sometimes transmitted by blood transfusions. In rare cases it can be transmitted through sexual contact or through sharing common household items such as toothbrushes.

4. What are the symptoms?

There may not be any symptoms at all. In fact, most patients with hepatitis C will not have symptoms even for many years. Sometimes, the patient first finds out that he or she has hepatitis C only when liver failure occurs. If the patient does get symptoms, they are often very non-specific and may be written off as the flu. The most common symptoms are nausea, loss of appetite, fever, fatigue, headaches and abdominal pain, especially in the upper right part of the abdomen where the liver is located. If a person does develop symptoms they will usually begin a couple of months after exposure. It is important to keep in mind that even though you may not have symptoms, you can still pass the virus on to other people.

5. How is hepatitis C diagnosed?

The standard test for hepatitis C is called the "enzyme-linked immunosorbent assay," or ELISA, which checks for hepatitis C antibodies. There are other tests, called RNA assays, that may be run to confirm the diagnosis if the ELISA test is positive or equivocal. Also, if a patient is suspected of having hepatitis C, doctors will usually run "liver function tests," which measure the amount of bilirubin and liver enzymes in the blood. Bilirubin is a reddish-yellow pigment that is usually processed in the liver and then excreted from the body through the urine. If the liver is damaged, it cannot process bilirubin. Bilirubin will then collect in the blood and cause a yellowish skin tone (called jaundice). Liver enzymes are released when the liver is damaged. There are several liver enzymes, but the most sensitive for hepatitis C is called alanine, or ALT. Rising levels of ALT or the other main enzyme, aspartate, or AST, may indicate liver damage.

6. Can hepatitis C be detected immediately after exposure?

Sometimes, but not always. The ELISA test, for instance, will not detect the HCV for 4-10 weeks after infection. RNA assays may detect the disease earlier. Therefore, even if you have a negative initial test for hepatitis C, you may still require a second test several months down the road.

7. Is hepatitis C curable?

It depends on what you mean by "curable." Some people who get infected with the HCV will develop the "acute" form of the infection which will resolve in about 6 months. For the vast majority of patients who get hepatitis C, the disease will become chronic. These patients will require long-term (24 weeks) of antiviral medication treatment. Pegylated interferon, or Pegasys, and ribavin are the standard drugs of choice for the treatment of hepatitis C. Pegasys is given weekly by injection and ribavin is taken in pill form. Something less than half the people treated with this combination will be "cured," meaning that the HCV will remain absent on testing for more than 2 years, but the so-called "cure rate" can be higher depending on the specific hepatitis C genotype involved. For most people whose lab tests show no evidence of hepatitis C for 2 years, the virus will remain undetectable. However, some patients will later test positive. In other words, although some researchers now consider hepatitis C "curable," the fact is that the "cure" probably applies to less than half the patients treated.

8. What should I do if I had surgery at Audubon at Circle and Union between May 4 and July 1?

You absolutely should get tested. Early treatment may help prevent acute hepatitis C from becoming chronic. Also, if you are HCV positive you may pass the virus on to others through transference of blood. Therefore, you should practice safe sex and use a condom, avoid sharing personal grooming items, like toothbrushes and razors, do not share needles or other drug paraphernalia and clean up blood spills with bleach and water. If your first test is negative, and it has been at least 6 weeks since your surgery, you are probably safe. However, if your first test is performed within 6 weeks of your surgery, you will need to be tested again.

9. What legal recourse do I have?

If you had surgery at Audubon during the relevant period, May 4 through July 1, 2009, you may have a claim against Audubon for emotional distress and for the costs of testing. You should consult an attorney. If you test positive for HCV, you will need to prove that your HCV was contracted at Audubon at a time when the needles substituted by the scrub nurse were in use. This will require an investigation into your pre-surgical medical condition to make sure that you were not already infected with HCV from some other source, and review of your Audubon records to determine the exact date and time of your surgery and your use of fentanyl. Again, you should consult an attorney.

 For a free consultation, contact Cross & Bennett.