Doctor At Knee Clinic, Site Of 40 Infections, Did Not Wash Hands: State

WALL, NJ — Cecelia Negron loves to spend her days going to the pool or hopping on an exercise bike for some exercise, and teaching her neighbors how to paint.

"I played bocce for eight weeks every year for three years," Negron, 76, said Tuesday in a telephone interview. "I taught painting in the community clubhouse. I had to cancel my classes that were supposed to start up this month."

These days, Negron spends much of her time icing her left knee and taking Aleve to manage the pain she's been left with following an injection she received in early March that resulted in septic arthritis — an injection she received at Osteo Relief Institute Jersey Shore in Wall.

Negron is one of 40 people who were infected at the clinic in March, according to a report by the state Department of Health. Those septic arthritis infections have left patients with severe pain, joint damage requiring surgery and, in Negron's case, in need of knee replacement. Negron is among 18 patients so far who have filed lawsuits against Osteo Relief Institute Jersey Shore and its parent company, Medical Offices of New Jersey Shore, this week in Monmouth County Superior Court, said Joshua Kincannon, an attorney from Freehold who represents Negron and seven others.

According to the health department report, which Kincannon provided, investigators found a number of areas where the staff at Osteo Relief Institute, which treated as many as 85 patients a day was not following standard infection prevention practices, including:

• Sterile needles and syringes opened well in advance of procedures and stored in bins under the preparation table
• Supplements in prefilled syringes unwrapped and placed in bins ahead of treatment
• Multiple-dose vials not labeled with the name of the medication or the beyond-use date after opening
• Single-dose packages of Omnipaque 300, a contrast agent used in knee injections, used repeatedly on multiple patients
• Multiple dose vials of lidocane stored in a patient care room closet
• Exam table cleaned once a day at most with Clorox wipes
• As many as 100 "kits" of syringes of lidocaine and contrast prepared daily. Leftovers were used the following day or even the following week.
• Staff prepared them without wearing masks or gloves and though they told inspectors they used hand sanitizer but none was found in the room.
• The doctor administering the shots did not wear a mask or sterile gloves and admitted to not washing her hands before administering them.

The doctor also threw syringes with needles attached into the trash instead of putting them in regulated medical waste containers, according to the report.

One medical assistant who had been responsible for preparing injections resigned as of March 6, the report said. A follow-up inspection on March 21, when the clinic reopened, found the doctor who had admitted not washing her hands and another doctor were no longer working at the clinic, the report said.

A report by Philly.com said the treatments at the clinic include injections with a fluid containing a substance called hyaluronic acid. Some studies have suggested it can help patients suffering knee pain, but in 2013, the American Academy of Orthopaedic Surgeons found there was not enough evidence to support its use.

The health department report said the infections appear to be the result the lack of infection prevention and not the result of tainted medication, as no other reports of illness or infections related to the medications were reported at other facilities.

The health department said the 40 people infected all received injections in their knees at the clinic of lidocaine with Omnipaque 300, a contrasting agent, the report said. Of those 40, fluid from the knees of 15 patients tested positive for strains of staphylococcus and streptococcus bacteria, along with several others. Those bacteria inhabit the mouth or upper respiratory tract, the report said.

Negron said she was diagnosed with a staph infection in her knee as a result of the treatment she received at Osteo Relief Institute, where she had been seeking treatment after a knee injury she suffered at her Heritage Pointe home in Barnegat. A Feb. 27 treatment didn't provide relief, so she went back a couple days later, she said.

On that trip, she said, the doctor gave her another injection, and this time, "It felt like she hit the bone," Negron said. She had trouble walking out of the clinic's office, and from there the situation quickly worsened. She arrived home, took a nap and when she woke up, the pain was so intense she could not walk, she said.

The next day her son took her to the emergency room — the start of a 26-day stay in the hospital and rehabilitation facility, Negron said, and 21 days of home care after that. She cannot stand for more than 15 minutes without excruciating pain, and cannot sit for long periods because that causes pain as well.

She said it was staff at the clinic who called her and told her about the contaminated injection, and told her she was one of six people who receive them. "They told me they felt terrible about it," Negron said.

"I can't go out to lunch with friends because I have to get up and walk around the restaurant when the pain becomes too much," Negron said. On Tuesday, she had to cut short a visit to a tea party at her granddaughter's school because the pain was so intense. She was informed this week that she has to have knee replacement surgery because of a hole in the cartilage in her knee and because of the damage caused by the staph infection. At least 29 of the 40 people who suffered infections needed surgery to address the infections, the health department report said.

In the meantime, Negron keeps icing her knee repeatedly during the day, and taking Aleve to try to mitigate the pain.

"It's absolutely awful because you can't get away from it," she said. "I want to be independent again."

Kincannon said each of the patients has different levels of injury as a result of the outbreak, and he and the other law office representing patients are still investigating the matter.

Before the March injection, "I walked to stores, I did whatever I wanted. I was a caregiver for my husband for five years," Negron said. "I want to be independent again."

A phone call requesting comment from Paul Werner, the attorney representing the clinic, was not immediately returned.

Shot, by Blake Patterson, via Flickr under Creative Commons license