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HEPATITIS B
MALPRACTICE RISK - FAILURE TO DIAGNOSE AND TREAT
May, 2003

Epidemiology: Chronic infection with Hepatitis B virus (HBV) is a leading cause of cirrhosis, liver failure, and hepatocellular cancer in the US. An estimated 1.25 million persons in the U.S. are infected with the Hepatitis B virus with over 70,000 new infections every year. The risk factors for HBV infection are: unprotected sex or needle sharing with infected persons, a child born to an infected mother and persons born or living in areas with high infection rates. Unvaccinated health care workers and public safety personnel are also at increased risk.

Physicians should consider screening for chronic infectious hepatitis B (example: Hepatitis B surface antigen {HBsAg}) in patients with risk factors. Patients with a blood test showing a positive HBV surface antibody {Anti-HBs} along with a positive HBV core antibody (anti-HBc) are generally felt to have resolved their acute infection and are not chronically infected.

Antiviral therapy is a general form of treatment to slow the course of chronic hepatitis for patients with a positive HBeAg and detectable HBV viral load for greater than six months along with persistent elevated aminotransferase levels and evidence of chronic HBV on liver biopsy.

Research data indicates that five to ten percent of people infected with chronic active HBV can progress to cirrhosis and/or hepatocellular carcinoma. A biopsy is sometimes needed to help define the disease stage. Patients most in need of treatment are those who demonstrate active replication even if their current degree of inflammatory liver disease is not impressive.

Liability Risk arises in those patients for whom there is a delay in diagnosis or who are not treated with effective drugs. The medical management of HBV is progressing rapidly and all patients should be informed of their treatment options and appropriate referrals offered to avoid the allegations of failure to treat. Liability risk also exists in a workplace that does not conform to OSHA standards for blood borne pathogens protections.

Hepatitis C
MALPRACTICE RISK - FAILURE TO DIAGNOSE AND TREAT
May, 2003

Epidemiology: 3 to 4 million people in this country are infected with Hepatitis C Virus (HCV) and there may be 25,000 new cases per year. Fewer than half of infected persons are aware they are infected. Hepatitis C Virus (HCV) is a leading cause of cirrhosis, hepatocellular carcinoma and liver transplantation. The incidence of newly identified cases will increase by over three fold in the next ten years as persons infected in the 1960s and '70s are now becoming symptomatic with chronic liver disease and as routine blood screening is being done in blood banks and for high-risk persons. Risk factors for HCV include: blood products (including transfusion/solid organ transplant) before 7/92, any (even once) IV drug use with needle sharing, perinatal transmission, tattooing, body piercing and intranasal cocaine usage. HCV is potentially transmitted by unprotected sex, but the risks are not as high as HBV. Physicians should identify and screen at-risk patients.

Physicians should conduct a brief but careful risk assessment and consider offering HCV blood screening to anyone with a history of HCV risk behaviors. Unexplained mildly elevated liver enzymes can be caused by chronic HCV and should prompt blood testing for viral hepatitis.

Many patients with chronic Hepatitis C are candidates for antiviral therapy. Early diagnosis and treatment can prevent the serious sequelae. Along with measuring the HCV 'viral load," a liver biopsy is often required to establish the stage of disease and potential benefits of therapy. Antiviral therapy is often associated with mild to moderate side effects and may be contraindicated for some patients.

Eighty-five percent of those infected will go on to develop chronic hepatitis over years or decades and the sequelae are similar to chronic active HBV. Those with the HCV antibody but undetectable viral load have likely recovered.

Liability Risk arises when there is a delay of diagnosis and treatment. HCV patients who were diagnosed or treated years ago should also be reevaluated and counseled regarding current treatment options. The medical management of HCV is progressing rapidly and all patients should be informed of their treatment options and appropriate referrals offered to avoid the allegation of failure to treat. Liability risk also exists in a workplace that does not conform to OSHA standards for of blood borne pathogens protections.

For those patients at risk for Hepatitis Band C, screening, counseling, appropriate referrals and DOCUMENTATION of all issues is extremely important.

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