Last week, I convened a public hearing at Farmingdale College investigating the response of the State Department of Health, the Nassau County Department of Health and the Office of Professional Medical Conduct to the Long Island anesthesiologist reusing syringes and infecting patients with hepatitis.

In this case, patient care and protections were disregarded, due to bureaucracy. In all cases, patient safety should be the priority.

To better serve the public health, I want to share with you my thoughts and focus regarding the improper procedures by Dr. Finkelstein, and the current disciplinary oversight and monitoring processes and procedures.

Foremost, the facts show a severe unexplained delay in both the public health system and the professional conduct system.

It is incomprehensible that immediate notice to prior patients was not given as soon as the overseers from the state and the county health departments witnessed improper procedures by Dr. Finkelstein.

It is incomprehensible that the Office of Professional Medical Conduct (OPMC) allowed this physician to continue to practice despite the current statutory provision stating the failure to adhere to sanitary practices is professional misconduct.

New York's existing statutory and regulatory infrastructure should have prevented this from happening; but we did not have sufficient monitoring/surveillance.

For instance, we have infection control standards from the Centers for Disease Control and Prevention requiring sterilization of reusable medical devices, from 1996 prompted by AIDS/HIV; and we have, since 1992, required infection control training. A policy problem here is allowing doctors only to attest to their training at the time of re-registration every four years.

Also, there is a prescribed syllabus prepared by State Department of Health (DOH)/Department of Education which has as its first Core Element - "Professional Responsibility for Infection Control." The syllabus training appears to be adequate. We, the public, need certainty the doctors and their staffs actually understand it and will utilize it in practice.

We need to consider an actual on-site competency for doctors, especially those practicing outside of the hospital arena, as part of registration. Other states do this. Or we could require random on-site evaluation during the four-year registration period. Or we could consider extending the Office Based Surgery law to cover medical practices who frequently administer medicine by injections.

The next policy issue is determining how quickly the department acts once the department is aware of a contagious disease. Who does it assemble and who does it inform? And when, and how, do patients get notified? The State Department of Health's internal practices and processes appear to be informal, intricate and arcane, begging for a clear and transparent structure so that doctors, county health departments, patients and other providers all know and understand the sequence of events once something is reported.

Yet another policy issue is the department's published concern about being reluctant to subpoena records. That concern is not well-founded. When public health or safety is at stake, then DOH has clear legal authority to obtain the records. The policy issue here is to examine this process and to reinforce this authority so the public's health is never put in jeopardy again.

Shifting to an analysis of the Office of Professional Medical Conduct (OPMC), the policy concern is the lack of anyone "policing" the physician profile. If a doctor continues to have medical malpractice settlements, especially if a substantial portion of them are "above average," it is incumbent upon somebody to review the situation. A standard should be established to trigger a Department of Health review with a possible OPMC intervention.

The Patient Safety Center could monitor the physician profile website. And if there is a cause for DOH to investigate a rogue doctor, then there should be a formal notification to OPMC and vice versa. If OPMC receives a complaint that it can reasonably ascertain has a public health threat, then it should notify DOH. The vagueness of the existing system cannot continue.

Note, the Patient Safety Center already has the authority to issue best practices; but to my knowledge has never done any of that type of work. It should be offering refresher information about infection control. This kind of information can be web-based and transmitted to the trade organizations that can get the information out. Clearly, the education potential of the Patient Safety Center has been left unrealized; although the Center could be the clearinghouse for the latest CDC policy recommendations.

In the end, the procedures for oversight and monitoring of health care in non-hospital settings are inadequate. The policies above must be amended to make the entire system, not reactive, but proactive. That is my focus to ensure quality health care and protection from harm for New York's patients.

Senator Kemp Hannon

Chair of the Senate Health Committee