Organizers assail care for doctor in TB case

Community organizers criticized yesterday hospital authorities' handling of a junior doctor infected with tuberculosis, and US Representative Stephen F. Lynch urged a more aggressive approach to alerting patients that they may have been exposed to the contagious physician.

A skin test first suggested that the doctor, a surgeon-in-training, might be infected with TB last summer, and officials at Boston Medical Center then ordered the woman to get an X-ray for confirmation. But a federal memo obtained by The Boston Globe showed that the physician did not appear for her July 2004 X-ray appointment, that she continued to treat patients, and that her infectious case of TB was not confirmed until Monday.

Nancy Achin Audesse, executive director of the Board of Registration in Medicine, said she was concerned about the delay detailed in the memo, which was prepared by the Department of Veterans Affairs for congressional committees. The board overseen by Achin governs the licensing of physicians.

''If somebody who is a healthcare professional is made aware there is a potential that he or she has tuberculosis, there is a duty to protect patients that would require vigilance on their part," said Achin, adding that she also has questions about whether the doctor who ordered the woman's X-ray effectively followed up to make sure it was taken. ''Those would be issues that the board would want to look at."

But Achin said regulators' focus is now on making sure that potentially exposed people are tested and treated, if necessary. ''Then, we can all look together at what happened and look at what role various agencies might play in the future to make sure it doesn't happen again."

Boston Medical Center authorities declined to discuss details of the woman's case, citing federal patient privacy laws. But they said that they are conducting an incident analysis to determine details of what happened and whether corrective measures need to be adopted.

Leaders of the activist group Safety Net said Boston Medical Center's handling of the doctor's case provided fresh evidence showing why Boston University, which is affiliated with the hospital, is ill-equipped to operate a proposed laboratory where scientists could study the world's deadliest germs.

The activists said the physician's failure to show up for the July 2004 X-ray and her continued care of patients demonstrated a disregard for safety. They also questioned the actions of hospital authorities, saying that those officials should have been aware that the doctor, a surgical resident, failed to keep the X-ray appointment.

Public health authorities said Thursday that they now believe the woman was contagious from Dec. 1, 2004, until June 2, 2005, when she was removed from seeing patients.

Despite signs nearly a year ago that the woman might have been infected with TB, her illness was not confirmed until Monday.

Authorities said yesterday that the doctor had rotated through a fifth hospital, the VA medical center in Jamaica Plain, where she treated patients for two days in May. Previously, officials had identified four hospitals where the physician worked: Boston Medical Center, the VA hospital in West Roxbury, Brockton Hospital, and Cape Cod Hospital.

Klare Allen, community organizer for Safety Net, said the tuberculosis case has echoes of another issue that rocked the South End campus shared by the BU medical school and its main teaching hospital.

Earlier this year, it was disclosed that three BU laboratory researchers had fallen ill in 2004 while working with contaminated samples of an infectious pathogen called tularemia. University and hospital authorities became aware of those infections as early as October, but the cases came to light in January.

''What is it going to take for people to stop and take notice?" Allen asked. ''They weren't forthcoming with the tularemia cases. Now here we go with this woman, this doctor, who's been working there, who's been treating patients, who's been all over the place with tuberculosis. This needs to be stopped."

Ellen Berlin, a spokeswoman for Boston Medical Center and the BU medical school, said, ''The recent TB exposure at Boston Medical Center and three other hospitals is not connected, in any way, to research or the proposed laboratory at Boston University."

Letters continued to be sent yesterday to patients who may have had contact with the doctor, urging them to come to the hospitals for free TB skin tests.

As the hospitals completed their plans for testing, the roster of patients and employees being offered exams swelled to more than 5,700.

That figure, though, was inflated by Brockton Hospital's decision to offer TB testing to all of its 1,800 employees, regardless of whether they might have interacted with the doctor when she was there in December 2004.

Union leaders representing healthcare workers at some of the hospitals said yesterday that employees believed their risk of becoming ill was minimal.

Lynch, a Boston Democrat, sent a letter yesterday to the director of the VA Boston Healthcare System saying that efforts should be intensified to reach patients who might have been exposed to the doctor.

''Specifically, I believe that each individual veteran and their family should be contacted by telephone and/or in person by VA personnel," Lynch wrote in the letter.

That will happen if it has to, said Dr. Michael Charness, chief of staff of the VA health system in Boston. Letters were mailed to affected patients yesterday.

''If we have not heard from patients on our list by midweek next week, we will attempt to contact patients by phone," Charness said. ''If we can't find people by phone, we'll send a dog team to Alaska if we need to."

Stephen Smith can be reached at stsmith@globe.com.