The Los Angeles County Department of Public Health
(LACDPH) is investigating viral hepatitis infections in
people who received intravenous medication (injection of
medications into the vein) while receiving procedures at the
Advanced Pain Treatment Center in San Pedro, California
between January 16, 2006 and August 18, 2010. LACDPH recommends that patients
who received intravenous medication at this clinic
during that time to
contact their primary care physicians or health care
providers to get tested for hepatitis B and hepatitis C
and HIV.
What is the role of the Los Angeles County,
Department of Public Health (LACDPH)
regarding reports and investigation of communicable
diseases?
Why did you investigate
this situation?
Where did this happen?
What did the investigation at the pain clinic find?
What is being done to prevent this from happening again?
Who performed the unsafe injection practices?
Were other cases of hepatitis discovered during this
investigation?
How long has this been going on?
Why did it take some time for this to come attention to
the public?
Have there been previous occurrences of hepatitis B,
hepatitis C, or HIV transmitted during the
administration of intravenous medication at an out
patient clinic?
How many people will be diagnosed with hepatitis B,
hepatitis C, or HIV from this investigation?
How does the Department of Public Health know which
patients to notify?
What should I do now that I received the letter of
notification?
I was a patient who received intravenous medication
between January 2006 and August 18, 2010 at this clinic
but I didn’t receive a letter from Public Health – What
should I do?
Why are you recommending testing for hepatitis B and HIV
in addition to hepatitis C?
Why should I get tested for these infections if I don’t
feel sick?
How can I stop the spread of these viruses if I have any
of them?
How serious
are these illnesses?
What should I do if I am feeling worried about getting
tested?
What if I
decide not to be tested?
What if I already was diagnosed with hepatitis B,
hepatitis C, or HIV before this investigation?
Where can
I go to get tested?
How do I get to
the clinics?
Where will the blood be sent for testing?
How will
I find out my test results?
Will anyone other than the L.A. County Department of
Public Health and my doctor be told of my results?
Who pays for
laboratory testing?
If I test positive for hepatitis B, hepatitis C or HIV,
does this mean I was infected at the clinic?
If I test positive for hepatitis B, C or HIV, what are
my rights? Am I allowed to sue? Who is liable for this?
What should I do if my blood test results indicate
hepatitis B, hepatitis C, or HIV?
If I need treatment for hepatitis B, hepatitis C, or
HIV, who pays for these treatments?
Will you test my immediate family and anybody else that
I have come into contact with?
In the future, how can I protect myself from getting
these bloodborne infections when receiving injectable
medications?
Who do I contact if I have more questions or concerns?
How do I get a copy of the final report?
What is the role of the Los Angeles County,
Department of Public Health (LACDPH) regarding reports
and investigation of communicable diseases?
-
LACDPH is responsible for investigating reports of
communicable diseases in the community. This is done to protect the health and wellbeing of the public.
- In the course of the investigations, investigators from LACDPH stop any practices that allowed an outbreak to happen and make recommendations to help prevent outbreaks from occurring again.
Why did
you investigate this situation?
-
LACDPH was notified of a person with acute hepatitis C who reported receiving treatment at a pain clinic in Los Angeles County
- Being treated at the pain clinic was the only risk factor this patient had for acquiring acute hepatitis C.
- During the time the patients could have been exposed
to the virus, treatments were received at the pain
clinic during the incubation period for hepatitis C.
- Based on these facts, LACDPH initiated investigation
of the pain clinic.
Where did this happen?
-
Advanced Pain Treatment Medical Center located at 1412
West 7th St. in San Pedro, CA.
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What did the investigation at the pain clinic
find?
-
LACDPH investigators identified unsafe injection practices.
(See Diagram of Potential Exposure
/ Adapted from Centers for Disease Control and
Prevention)
- During the investigation at the pain clinic, it was discovered that a syringe and needle, which had been used to inject intravenous medication into a patient, was then used to obtain medication from a vial that could be used for other patients. Using a needle and syringe, that had previously been used on a patient could have contaminated the vial with the blood of the patient.
- If this vial was contaminated with the blood (and potential viruses) of the first patient, subsequent patients that receive medication from this vial could
have been exposed to these potential viruses.
- These kinds of unsafe injection practices have been associated with outbreaks of hepatitis B and C in the United
States and worldwide.
- With specialized laboratory tests conducted at the
Centers for Disease Control and Prevention (CDC), LACDPH investigators were able to
prove transmission of viral hepatitis to at least one
patient from another patient due to unsafe injection
practices.
What
is being done to prevent this from happening again?
-
LACDPH investigators immediately notified the clinic
director, who corrected the unsafe
injection practices at this pain clinic.
- LACDPH will provide educational materials to
medical facilities in an effort to educate health
care providers about how to prevent these kinds of
infections.
Who performed the unsafe injection practices?
- We cannot comment as this is an on-going
investigation
Were there other cases of hepatitis discovered during
this investigation?
-
To date, LACDPH identified two cases of acute viral
hepatitis in patients at this clinic.
- One patient had acute hepatitis C and the other
patient had acute hepatitis B.
- Both patients had onset of their infections in
2010.
- The investigation is on-going. There may be other
cases of acute viral hepatitis that have not yet been
reported to LACDPH.
How
long has this been going on?
-
Investigators believe that the unsafe practices may have
begun in 2006.
- To be safe, LACDPH encourages all patients who
received intravenous medication at this clinic at any
time since January 2006 to be
tested for exposure to bloodborne pathogens.
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Why did it take some time for this to come to the
attention of the public?
-
The investigation was prompted by a report of acute
hepatitis C. LACDPH quickly investigated the pain clinic
when the case was reported.
- The unsafe injection practices were only identified
when LACDPH made its investigation of this clinic.
- LACDPH investigators immediately stopped the unsafe
injection practices when they were identified.
- LACDPH worked with the personnel at the pain clinic
to improve infection control practices.
Have there been previous occurrences of hepatitis B,
hepatitis C, or HIV transmitted during the
administration of intravenous medication at an
outpatient clinic?
-
Yes, there have been many reports of hepatitis B or
hepatitis C spread due to unsafe injection practice in
the United States and in other countries. However,
compared to number of injections given each year, it is
very rare to get hepatitis from an injection.
-
There are no known outbreaks of HIV due to unsafe
injection practices in the United States.
-
Because of all the outbreaks reported, public health
officials nationwide work hard to alert the healthcare
community about the best practices to give injection
medications.
How many people will be diagnosed with hepatitis B,
hepatitis C, or HIV from this investigation?
-
We don’t know how many people will be diagnosed with
hepatitis B, hepatitis C, or HIV from this
investigation.
- Cases of hepatitis B, hepatitis C, and HIV are routinely
found in the population.
- A significant number of people might have been
infected prior to their procedure at the pain clinic.
- Although testing can determine if a person is
infected, it cannot determine the source of the
infection nor how long ago a person got infected.
How does the LACDPH know
which patients to notify?
-
The pain clinic director provided all available patient
contact information to Public Health.
- LACDPH mailed notification letters to all patients
who received intravenous medication (injection of
medication into the vein) between January 2006 and
August 18, 2010.
- Patients who received intravenous medication from
that clinic between January, 2006 and August 18, 2010,
should have received a letter encouraging them to be
tested for hepatitis B, hepatitis C, and HIV
What should I do now that I received the letter of
notification?
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-
LACDPH recommends that patients who received intravenous
medication between January, 2006 and August 18, 2010 at
the pain clinic should get tested for hepatitis B,
hepatitis C, and HIV
- A blood test is the only way to determine if a
person has been infected with hepatitis B, hepatitis C,
or HIV
- Patients should talk to their personal healthcare
professional about being tested and the treatments that
are available
I was a patient who received intravenous
medication between January 2006 and August 18, 2010 at
this clinic but I didn’t receive a letter from LACDPH – What should I do?
-
If you did not receive a letter but you know that you
received intravenous medication at the Advanced Pain
Treatment Medical Center in San Pedro, you should call
ACDC 213-240-7941 to verify you are on the patient list.
- You can obtain a copy of the letter that was sent
to the other patients, with an accompanying letter to
your doctor. Letter to Patients:
English /
Español
----- Letter to Doctor: English /
Español
Why are you recommending testing for hepatitis B and HIV
in addition to hepatitis C?
-
We are recommending this as a precaution, because all
3 viruses can be spread through blood exposure (for
example through possible unsafe injection practices).
Why should I get tested for these infections if I don’t
feel sick?
-
Many people infected with these viruses do not feel sick
for a long time.
- Getting tested is important because you can be
infected with hepatitis B or hepatitis C or HIV and not
feel sick.
- Knowing you are infected is important because the
earlier you treat and manage your infection, the better
you will be.
- If you are infected with these viruses you can take
steps to stop the spread of these viruses to other
people.
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How can I stop the spread of these viruses if I have any
of them?
- Hepatitis B, hepatitis C, and HIV are spread
through contact with blood. If you are infected with
any of these viruses you can and should take steps to stop the spread of
these viruses to other people by:
-
Avoiding sharing razors, toothbrushes, or other household items
that may be contaminated with blood;
-
Never sharing needles, syringes, or any injection equipment;
-
Abstaining from sex, or using condoms every time you have sex.
How serious are these illnesses?
- Hepatitis C, hepatitis B, and HIV can result in a range of
disease severity, and can eventually result in death.
What should I do if I am feeling worried about getting
tested?
-
You should discuss this with your health care provider.
-
Medical professionals understand your fears.
-
Medical professionals are used to dealing with people who are worried
about tests and are trained to help you make the right
decisions.
- It's natural to be worried about getting tested. It's the
'not knowing' that most people find hardest.
- The vast majority of people who get tested find they are not
infected.
- Even getting a positive result can be a relief and a good thing
in the longer term
- It may come as a bit of a shock at first, but
knowing what you have is the first step to getting
treatment and getting better or protecting your
health for the future.
- The earlier you find out, the better it will be.
Even if you have something that can't be cured, serious infections can be managed effectively
if they're discovered early enough.
- Knowing about infections means you can protect loved ones.
-
If you do test positive, you'll be able to take steps to protect
your partner, family members and other people you're close to
and any children you might want to have in future.
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What if I decide not to be tested?
-
If you choose not to be tested, you may miss an
opportunity to receive treatment or to prevent the
spread of these viruses to your close contacts.
- Finding out your status is beneficial.
- If you
are aware of your hepatitis B, hepatitis C, and HIV
status, you can better maintain your health.
- If you test positive for any of these infections, there are medicines and
treatments available to help you.
- LACDPH will not follow up with you to see whether
you followed its advice to be tested.
What if I already was diagnosed with hepatitis
B, hepatitis C, or HIV before this investigation?
-
If you were already diagnosed with hepatitis B,
hepatitis C or HIV, then you do not need to be tested
for that particular virus, but you should still be
tested for the other viruses.
- If you do not know if you were diagnosed in the
past, ask your health care provider.
Where can
I go to get tested?
-
It is recommended that you seek testing with your
personal doctor.
- If you do not have a doctor that you see regularly,
the following is a list of local participating clinics
that can test you at no or low cost:
Westside Neighborhood
Clinic
2125 Santa Fe Ave.
Long Beach CA 90810
562-432-9575
|
Harbor Community Clinic
593 West 6th St.
San Pedro, CA 90731
310-547-0202 |
Wilmington Community
Clinic
1009 N Avalon Blvd.
Wilmington, CA 90744
310-549-5760
|
Torrance Public Health
Center
711 Del Amo Blvd.
Torrance, CA 90502
310-354-2300 |
Long Beach Comprehensive
Health Center
1333 Chestnut Ave.
Long Beach, CA 90806
562-599-8787 |
South Bay Family
Healthcare
Gardena
742 W. Gardena Blvd.
Gardena, CA 90247
310-802-6170 |
South Bay Family
Healthcare
Redondo Beach
2114 Artesia Blvd.
Redondo Beach, CA 90278
310-802-6170 |
|
|
How do I
get to the clinics?
-
Transit routes are listed at:
www.metro.net
- Call Metro information at: (213) 626-4455 and (800)
266-6883.
Where will my blood sample be sent for testing?
-
Your doctor or participating clinic will send your blood
sample to the laboratory they use.
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How will I find out my test results?
-
Your doctor or participating clinic will give you that
information.
Will anyone other than the LACDPH and my doctor be told of my
results?
-
No, results are confidential like all the rest of
your health information.
- If your blood sample tests positive for hepatitis B,
hepatitis C, or HIV, it will be reported to the LACDPH as required
by state law.
Who pays for laboratory testing?
-
Talk to your health insurance provider if you plan to
see your doctor.
- You may also receive free or low cost testing at
community and public health clinics near your home.
If I test positive for hepatitis B, hepatitis C or HIV,
does this mean I was infected at the clinic?
-
If you test positive for any of these viruses, it does
not mean that you were infected at this clinic.
- Less 1% (one percent) of the general population are
already positive for chronic hepatitis B or HIV, and
1-2% percent of the general population are already positive for
hepatitis C.
- These viruses are more common among people who
received blood transfusions prior to 1990, had multiple
sexual partners, or used intravenous drugs.
- Many people carry these viruses for many years
before they get sick.
- Therefore, it will not be possible to determine if
patients who test positive were infected at the clinic
or were infected before or after they went to the
clinic.
If I test positive for hepatitis B, C, or HIV, what are
my rights? Am I allowed to sue? Who is liable for this?
- We are not authorized to give legal advice
- You will have to speak to an attorney about your
rights.
What should I do if my blood test results indicate
hepatitis B, hepatitis C, or HIV?
(BACK TO TOP)
- Discuss the results with your doctor or the clinic
where you got tested
- Disease management and/or treatment are available;
consult with your doctor or clinic where you were
tested.
If I need treatment for hepatitis B, hepatitis C, or
HIV, who pays for these treatments?
- Your health insurance should cover the cost of
treatment for these infections.
- If you do not have
health insurance contact L.A. Care at 1-888-452-2273 or
http://lacare.org for a
referral to low cost medical care.
- You may also
receive treatment, if necessary, at a Los Angeles County
Department of Health Services clinic. You can find the clinic
nearest you by going to the following website:
http://www.ladhs.org/wps/portal/Patient or by
calling 211.
Will you test my immediate family and anybody else that
I have come into contact with?
- LACDPH does not routinely test contacts of people
with hepatitis B, hepatitis C, or HIV.
In the future, how can I protect myself from getting
these bloodborne infections when receiving injectable
medications?
- All health care professionals and medical
facilities should follow safe injection practices and
infection control procedures.
- Patient guidelines for
safe injection practices can be found at the CDC website
here:
www.cdc.gov/injectionsafety/patients.html
-
Patients can and should ask their providers
about the practices used in their facility.
- If you are concerned about the practices used by
your medical provider, please let them know.
Whom can I contact if I have more questions or concerns?
- Contact your personal health care provider for follow-up care.
-
Call 211 for general information.
- Learn more about hepatitis B, hepatitis C,
and HIV at the Centers for Disease Control and
Prevention (CDC) website:
www.cdc.gov or at the LACDPH website:
www.publichealth.lacounty.gov/acd
How do
I get a copy of the final investigation report?
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