By A.C. Thompson

Late last year health care giant Kaiser Permanente was forced to reveal an embarrassing and potentially lethal situation that had developed at its Redwood City hospital.

The hospital was apparently using dirty endoscopes – the flexible digital cameras used to examine the colon and other hard-to-reach body cavities – to probe the bowels of patients. In other words, the scopes weren't properly sanitized after being yanked out of one person's anus and inserted into the next person, possibly spreading nasty organisms from patient to patient.

Kaiser blamed the problem on faulty disinfectant equipment and mailed out letters to 2,116 patients who'd undergone colonoscopies and sigmoidoscopies (the latter a scan of the large intestine), informing them they might have been exposed to the blood-borne hepatitis virus. One liver-wrecking variant of the bug, hepatitis C, is incurable and can be fatal.

"We've tweaked our systems, and we've become very vigilant [since the incident]," Kaiser spokesperson Kathleen Barco told the Bay Guardian.

The screwup was treated as an isolated incident by the local media, which devoted a few quick stories to the matter before moving on to juicier scandals. But the true dimensions of the problem extend far beyond Kaiser – and, according to state hospital inspectors, far beyond what's been reported in the press.

• • •

You clean an endoscope by taking a brush or sponge to the snakelike camera and then placing it in a machine that looks something like a dishwasher and uses disinfecting blasts of enzymatic detergent and germicide to purge grime from the scope.

That's the concept, anyway. Experts say in some cases hospital technicians aren't following even basic safety procedures. "What we've uncovered is a whole variety of different problems, from faulty [disinfecting] machines to operator error to people who just choose not to do what they're supposed to do," says Dr. Jon Rosenberg, a medical epidemiologist with the California Department of Health Services.

Working out of a Berkeley office, Rosenberg is the state's endoscope guru, the guy hospital officials call when they're having trouble with the devices. During the past two years, Rosenberg has learned of contamination cases in 10 hospitals across the state involving more than 5,000 patients. Only four of these incidents ended up in the newspapers – those at Kaiser's facilities in Redwood City and South Sacramento, as well as two other hospitals in the Sierra foothills – and Rosenberg is reluctant to name the six other hospitals.

Worried by the rash of incidents, Rosenberg and colleagues circulated a warning about endoscope cleaning, marked "Priority: High," in October 2004. The warning states that the glitches might have exposed patients "to hepatitis B or C viruses, and, in some instances, human immunodeficiency virus (HIV)" and "strongly recommends that, as soon as possible, all healthcare facilities" implement new department-generated guidelines for sanitizing endoscopes.

Rosenberg blames the surge in screwups partially on our increasing reliance on endoscopes. These days doctors encourage all men over the age of 50 to undergo periodic colonoscopies to check for colon cancer, which is prevalent among older males.

"The public needs to be aware that this is an extremely safe procedure," says Dr. Douglas Nelson, a Minneapolis gastroenterologist and researcher affiliated with the Veterans Administration and the University of Minnesota. "Is this something you should lay awake at night worrying about? Probably not."

Nelson fears hype about dirty endoscopes will deter men from getting checked for colon cancer. By his calculations, the public should be way more concerned with cancer. In a 2003 study published in a medical journal, Nelson notes, "although over 10 million endoscopic procedures were performed annually in the United States over the last decade, only 35 cases of transmission of infection have been reported."

• • •

If you talk to Jamie L. Sheller, she'll tell you Nelson's numbers mean nothing. "They have no data to know if there's an increased incidence of hepatitis within this population," she tells us.

Sheller, a Pennsylvania-based plaintiff lawyer, got well acquainted with endoscope technology when the Virtua hospital system in New Jersey notified patients who'd been scoped in 1999 and 2000 that they might have been exposed to hepatitis and HIV. The problem apparently lay with a defective sanitizer manufactured by a company called Custom Ultrasonics.

Sheller eventually represented a nurse "who contracted hepatitis C from touching one of the scopes," as well as several patients, all of whom sued Virtua, Custom Ultrasonics, and the company hired to maintain the sanitizers.

Her point about the dearth of statistical data on the subject isn't mere rhetoric: for example, here in California, Rosenberg admits, the health department has decided not to track the incidence of infections connected to endoscopic procedures. The department has no idea how many of the 5,000-plus people placed at risk by dirty scopes have fallen ill. "We choose not to follow the results of the testing that's done" because there's a low risk of infection, Rosenberg says, adding it's unlikely that Californians have contracted hepatitis or HIV from dirty scopes, "but there's simply no way to say."

"I don't have figures on what we've found," Kaiser spokesperson Barco says when asked if any patients tested positive for hepatitis.

Experts say lung examinations, which are conducted with both endoscopes and lung-specific bronchoscopes, are riskier than rear-end sightseeing. That's because bugs that aren't likely to cause any harm while living in the colon and guts – like the pathogenic Pseudomonas aeruginosa bacteria – can be fatal if they colonize the lungs or bronchial passages.

The most serious outbreaks in recent history involve lung exams. In 2002 two patients at the John Hopkins Hospital in Baltimore and at least nine patients at a Pittsburgh hospital died of lung infections contracted from endoscopes. A recent Wall Street Journal exposé tied the Pittsburgh deaths to a scope sterilizer made by an Ohio company called Steris; according to the Journal, the Food and Drug Administration has concluded faulty water filters on the machines were the "probable cause" of the outbreak.

Steris, which is currently under investigation by both the FDA and the Internal Revenue Service, denies any connection between its product and the fatalities.

"This is happening all over," Sheller says. "It's happened on the East Coast. It's happened on the West Coast. It's happened in Ireland. The BBC did a big story on it about six months ago."

In Sheller's view, this quiet plague of screwups is, in part, a by-product of the commodification of medicine. "The scopes themselves are expensive" – from $10,000 to $70,000 a pop – "so there's a pressure to get these things cleaned and back out there for the patients."

Rosenberg has a similar take. "Better training could help to minimize these problems," he says, adding that hospital staffing levels "are cut down to the bone right now."

E-mail A.C. Thompson