County Finds Mercy in Violation in Case of Reuse of AIDS Needle : Health care: The finding citing six infringements could lead to penalties as high as $5,000 per violation.

Mercy Hospital has received a “notice of violation” that cites six infringements stemming from a case in which a woman received an injection from a syringe used previously on a patient with AIDS, investigators said Friday.

The notice comes from the radiology division of the San Diego County Department of Health Services and follows a state report that blamed improperly trained technicians, sloppy lab techniques and a lack of written procedures for the Sept. 25 incident.

The county report, pertaining solely to the misuse of radioactive materials, could lead to penalties as high as $5,000 per violation, Edgar Bailey, chief of the radiologic health branch of the State Department of Health Services, said Friday.

The county has a contract with the state to monitor the use of radioactive materials, Bailey said. He noted that the county report precedes a more involved state investigation, which could result in findings of criminal as well as civil violations.

The previous state inquiry, conducted by the bureau of licensing and certification, focused on why a 23-year-old San Diego woman was given an injection with a syringe used previously on an AIDS patient.

The woman, whose name has not been revealed, was notified by doctors at Mercy 36 hours after being treated for job-related back pain that she had been exposed to the human immunodeficiency virus (HIV), which causes AIDS.

Because a bone scan was ordered, requiring an injection of radioisotope dye, the state is now looking at Mercy’s policies involving nuclear materials, Bailey said.

One of the more serious of the six violations cited by the county involves the failure of medical technicians to “assay,” or measure the dose of radioactive material in a calibrator, before injecting it into the patient, said Frank Bold, senior health physicist for the radiological health division of the County Department of Health Services.

The information provided by such a procedure might have prevented the incident, Bold said. But, he added, the most serious violation was a hospital technician’s failure to dispose of a used syringe.

The other four violations dealt with the lack of promptness in investigating the incident; not having a position of nuclear medicine manager, as required by law; a lack of records showing the qualifications of one technician in the field of nuclear medicine, and not forwarding requested paperwork within a 36-hour time limit.

In reference to the more serious violations, Bold said, “If they had assayed the dose, which they’re required to do, and properly disposed of a used syringe, we wouldn’t be going through all this right now.”

Laura Avallone, a spokeswoman for Mercy, said Friday that the hospital concedes the more serious violations.

“Hospital procedures were not followed by the technician involved,” Avallone said. “We see this as a very unfortunate incident, but the concerns of the state and county have now been appropriately addressed.”

Hospital officials refuse to name the two technicians involved in the incident. One administered the injection and the other failed to dispose of the used syringe, but only one has been fired, Avallone said. She declined to say which of the two that is.

Harvey Levine, the attorney representing the woman who received the injection, said his client “doesn’t sleep at night. The one thing you want the doctor to say is that you’ll be OK, but she’s at risk for the rest of her life.”

Levine said his concern about the county’s findings is that, because of hospital mismanagement, other patients are at risk as well, meaning they could have been damaged with radioactive materials.

“What it means to me is that, if you’re violating license requirements for what appears to be three years, a lot of people have been exposed to whatever risks are attached to those license violations,” Levine said.

“That’s totally his conjecture,” Avallone said. “He can make that statement, but we do feel we have policies and practices in place. We don’t feel other patients have been put at risk.”

Bold said Mercy has 10 days to respond to the notice of violation after it is received. Since it is dated Jan. 4, he said that means the middle of next week.

The next step by the state, said health official Bailey, is to forward the county report to state attorneys and complete the state investigation.

Asked the worst that could happen to Mercy, Bailey said, “Their certification could be revoked, or their license (to deal with radioactive materials) could be revoked. Some people could be required to take additional training . . . . All kinds of things could happen.”

Bailey said investigators will try to determine whether the incident was the outgrowth of negligence or criminal intent.

Criminal violations would carry a maximum penalty of $1,000 each, in addition to 180 days in jail, he said.

Civil violations--and these would most likely fall in that category, he said--carry a maximum fine of $5,000 each.

“In this particular case, I don’t know that anything could have been done to prevent it from happening,” Bailey said. “But two or three procedural steps should have been taken to prevent it from happening. All kinds of safeguards are built in, but for some reason, they were ignored.”