Doctor in endoscopy trial testifies vials of sedative were too large

The 50-milliliter vials of anesthetic linked to a hepatitis C outbreak would have been enough to knock out a 600-pound gorilla during a colonoscopy, an anesthesiologist testified Tuesday.

Using the example to show why the large vials of propofol were unnecessary in an endoscopy center, Dr. Nicola D’Attellis said only 35 milliliters of anesthetic would be required to sedate an ape for the typical 14-minute endoscopy procedure.

“I might give him the extra 15 (milliliters),” he joked. “I wouldn’t want to be the first person he sees when he wakes up.”

D’Attellis, from Cedars-Sinai Medical Center in Los Angeles, was the first witness in the trial of Henry Chanin, who along with his wife, Lorraine, is suing Teva Parenteral Medicine and Baxter Healthcare Services on several product liability claims.

Chanin, headmaster at The Meadows School, was infected with hepatitis C during a 2006 colonoscopy at the Desert Shadow Endoscopy Center, one of the clinics linked to Southern Nevada’s hepatitis C outbreak.

Public health officials said the outbreak was caused by nurse anesthetists using single-dose medicine vials among patients after the vials had become contaminated by nurses reusing syringes on the same patient.

The lawsuit claims the companies made and sold vials of propofol that were much larger than needed for colonoscopies, which tempted medical workers to reuse vials among patients instead of throwing away unused anesthetic.

Testifying on behalf of the Chanins, D’Attellis told the jury that the typical procedures at the endoscopy centers would require between 10 and 20 milliliters of propofol, which is based on a patient’s weight and the length of the procedure.

Chanin’s 17.5-minute colonoscopy required 25 milliliters.

No endoscopy center should ever use 50 milliliter vials because medical workers would be tempted to reuse vials between patients instead of throwing away unused anesthetic, D’Attellis said.

“There is no place for this in an endoscopy center,” he said, holding a 50 milliliter vial.

At Cedars-Sinai, 50 milliliter vials are banned from all surgery areas to avoid their misuse, he said. The larger bottles are only used for long-term sedation in intensive care units, he said.

In a videotaped deposition, Teva executive Craig Lea said the company knew the risks of the larger vials when it sought federal approval to make the 10 milliliter vials in 2000. Lea said the smaller vials would be safer and reduce the temptation to reuse a vial between patients.

Based on that knowledge, the company never should have supplied the larger vials to endoscopy centers, D’Attellis testified.

“They knew what the risk was, and they did it anyway,” he said.

The lawsuit originally named the doctors and nurses who performed Henry Chanin’s endoscopy, but their insurance company settled the medical malpractice claim last month.

Contact reporter Brian Haynes at bhaynes@review
journal.com or 702-383-0281.