Proposed Testing for Hepatitis C Prompts Debate in Medical Community

Andrew Kitchenman | March 13, 2014 | Health Care
Bill aims to put CDC recommendation to test baby boomers into practice

Sen. Joseph F. Vitale (D-Middlesex)
Hepatitis C, a viral infection that can destroy people’s livers over decades and ultimately kill them, can be treated successfully in about 70 percent of cases. But many residents are unaware that they have the disease.

That’s why state legislators have introduced a bill, S-876/A-2555, that would require all hospitals and healthcare professionals to offer hepatitis C tests to all patients born between 1945 and 1965, the age group that’s most likely to be infected.

The bill, sponsored by Sen. Joseph F. Vitale (D-Middlesex), is based on a U.S. Centers for Disease Control and Prevention recommendation.

Hepatitis C led to 16,627 deaths nationally in 2010 and has surpassed HIV/AIDS as a cause of death. Three-quarters of 2.7 million to 3.9 million people with the disease are baby boomers. In most cases, the blood-borne infection was contracted through needle sharing or from blood transfusions or organ donation before screening began after hepatitis C was identified in the late 1980s.

Dr. Andrew de la Torre, a Clifton liver specialist and surgeon, said requiring that the tests be offered would be a positive step. He noted that New York already has enacted a similar requirement.

“There’s plenty of data that shows that you ultimately save money and better utilize resources to avoid liver failure and liver cancer” by offering the test, said de la Torre, who serves on a state hepatitis advisory board.

The proposal, however, is meeting resistance from some groups that oversee or represent healthcare providers.

Members of the State Board of Medical Examiners are opposed to adding a requirement to offer the test, although most board members supported the concept of increasing testing at a board meeting yesterday.

Board member Dr. Elliot Krauss, described it as a “costly, burdensome, unfunded mandate,” adding that it would be onerous for hospitals to follow up on the initial test to ensure that the patient — who may have left the hospital — had seen the result and that those who test positive receive a second test to confirm the result and were referred for follow-up treatment.

Board member Dr. Sindy M. Paul, a state Department of Health official as well as the president of the Infectious Diseases Society of New Jersey, said she agreed that CDC recommendations should be complied with, but questioned whether hospitals are prepared to follow up on test results with patients.

Board member Dr. Paul Jordan supported a state policy of offering testing, if not a mandate, but his motion on that position didn’t receive enough votes to pass.

“There are 2 to 3 million people (with hepatitis C) and offering testing to find it can’t be perceived as a bad thing,” Jordan said. “I don’t think we should lose the good here striving for the perfect.”

Since the board members couldn’t agree on how to word the official position on the bill, they referred the issue to the executive committee.

Sen. Vitale described objections based on the burden placed on hospitals as “absurd,” considering the lives that could be saved and hospitals’ mission to serve public health.

“There’s a rapid test that’s available — it’s quick, it’s easy, and it could save somebody’s life,” Vitale said. CDC officials “recommend this, and if we just left it up to hospitals and other providers to do this through their good will, then many individuals would go untested and likely untreated.”

The CDC recommended in 1998 that those at a higher risk of infection — such as intravenous drug users — be tested. But the agency broadened the advisory in 2012 to everyone born between 1945 and 1965 after finding that the earlier recommendation hadn’t reached enough people. Vitale pointed to this as a reason why anything less than a statewide requirement for that age group would be ineffective.

New Jersey Hospital Association government relations and policy director Neil Eicher said there would be logistical challenges to implementing the bill — such as determining who is responsible for contacting patients about test results. He also suggested that the tests are better handled by primary care providers, not hospitals.

Medical Society of New Jersey Chief Operating Officer Mishael Azam said in a letter to Vitale that doctors had several concerns with the bill. They included that it would be unclear to a doctor whether a patient had already received the test; that some appointments are an inappropriate time to raise the issue of hepatitis C; and that doctors should have discretion to determine what is appropriate for a patient.

Azam also questioned whether insurers would pay for the test and raised the possibility of a state public health awareness campaign.

Vitale said he was willing to listen to proposals that would improve implementation of a statewide requirement. But he said hospitals should be required to offer the tests because many hospital patients either don’t have primary care providers or visit them rarely. He strongly objected to the idea that a public health campaign should be used instead of a requirement to offer testing. “Good public health should not be provided by offering bumper stickers and balloons,” Vitale said.