Drug addicts are patients, too
Montero points out that another vexing issue is that drug addiction itself is a disease and those who suffer from it are patients, too. "You try to reach a balance between helping someone with a disease and protecting the public. It's extremely tricky, and I'm not sure I have the answer.
"When something like this goes on your record, it never goes away, and people will think you're a drug user all your life. People do make mistakes, but how much should we accept or tolerate?"
Maybe, he says, if such incidents are always reported to a registry as he suggests under a strong national policy, a person could return to work "if they can prove they had treatment and are no longer users."
Not the first case
Clearly better policies are needed because similar cases have popped up around the country. In Colorado, a 26-year old surgical technician injected herself with fentanyl three years ago, and then replaced it with saline for reuse in patients. At least 36 patients were infected with hepatitis C, and hospitals had to find 5,700 patients with whom she could have exposed.
Several weeks ago I asked Montero if he thought Exeter Hospital's small, 100-bed size and rural setting led to the discovery of the problem that eluded those in more urban settings. He didn't think so.
But this week, he's changed his thinking. "In New Hampshire we were able to stop this national problem because of the confluence of several things. First, we had a clinician who thought about it when he saw these infected patients with no risk factors whatsoever. And second, we (the health department) had a good relationship with the hospital and were immediately notified."
At a bigger hospital in a bigger state, patients may not be seen by the same providers, so no one draws the link, "no one talks to each other," Montero says. That's a scary thought.
Montero hopes that the painful episode may teach the nation's hospitals and policymakers an important lesson.
"There's a need for systemic improvements, not just a patchy remedy that we do state-by-state and hospital-by-hospital," he says. "Healthcare is a system and we need to work with it as a system."
"But there I go on the soapbox, preaching again."