A 12-year-long hunt for answers began just after Fremont, Neb., set off its Fourth of July fireworks in 2002.
That day, Fremont's Dr. Tom McKnight took a deep breath and walked into the office of Dr. Tahir Ali Javed, Fremont's sole oncologist. He needed to confront Javed about a problem.
Five Fremont-area residents, including McKnight's own wife, Evelyn, had recently tested positive for hepatitis C — a dangerous and sometimes deadly virus.
The positive tests befuddled McKnight. But members of the group did have one terrifying thing in common: All were cancer patients being treated inside Javed's clinic.
This uncomfortable conversation between doctors felt doubly awkward because Javed, his wife and the McKnights had grown close during Evelyn McKnight's two bouts with breast cancer. They had dined together on Saturday nights. They had shared hopes and fears. When Evelyn McKnight got sick, Javed's wife took casseroles to her house so she wouldn't have to cook.
Now Tom McKnight, as gently as he could, broached the idea that Javed's office might be the cause of a hepatitis C outbreak and a potential public health nightmare.
Javed listened and then promised that, together, they would get to the bottom of this medical mystery.
Two days later, the well-liked oncologist boarded a plane in Omaha bound for his native Pakistan. He had told Fremont hospital administrators and his office staff that his mother had fallen gravely ill and he needed to care for her.
I will be back in two weeks, Javed promised.
He never returned.
Javed's international flight left a series of uncomfortable questions in its wake: What exactly had happened? Who was to blame? And, as the hep C cases mushroomed into the worst outbreak of its kind in U.S. history, another question emerged. Would the doctor running the clinic ever be held responsible?
The answer has been no for a dozen years. Even as 99 people tested positive for hepatitis C and five people died, Javed faced no criminal charges. And even as old medical records, several of Javed's nurses and several of his victims suggested that the oncologist had long known of the danger — that he had presided over a clinic whose employees repeatedly committed serious safety errors — Dr. Tahir Ali Javed got elected to a new post in Pakistan.
He became a public health minister.
“It grinds me that despite what he did, he has that kind of influence,” Evelyn McKnight said. “I guess, in that way, I have no closure.”
The Nebraska Attorney General's Office appears newly interested in examining the questions swirling around the infamous Fremont hep C outbreak.
The Attorney General's Office confirmed last week that it has restarted an investigation into Javed and the circumstances surrounding the outbreak. Shannon Kingery, communications director for Attorney General Jon Bruning, confirmed an “open, ongoing investigation regarding Dr. Javed.”
She didn't respond to further questions, including why prosecutors have decided to pursue Javed so long after the outbreak, or what criminal charges, if any, the office might be pursuing.
News of the new investigation cheers Evelyn McKnight, the outbreak's most outspoken victim. She has spent the past dozen years on a strange journey from cancer patient and silent hep C sufferer to author and activist. Even after writing a book on the case, McKnight still has a couple of questions of her own.
How could she have so fully trusted her oncologist? Did Javed or his employees know they were putting her at serious risk? If so, why did they do it?
Evelyn's own slow-motion tragedy began six days before Valentine's Day 2002. A breast cancer survivor, she had recently received awful news: You have breast cancer again. Then a routine blood test at the University of Nebraska Medical Center revealed something more shocking. You have hepatitis C, a med center doctor told her.
The diagnosis carried with it a special stigma. Nearly 200 million people worldwide are infected with hep C, but in the United States it's most commonly associated with drug users who share needles.
Evelyn McKnight, an audiologist, suffered from symptoms related to hepatitis C long after her cancer went into remission. She describes it as battling the flu, except instead of battling it for a day or two, you wake up each morning with the flu, and go to bed each night with the flu, and repeat that over and over.
“It was years before I felt like myself,” she said.
As her husband, a family doctor in Fremont, tried to get to the bottom of the outbreak, Evelyn McKnight continued to believe for months that Javed had nothing to do with her new illness.
In fact, weeks after Javed flew to Pakistan, she took Javed's wife and children to see a dinosaur exhibit at the Durham Museum. She believed that Javed was coming back to Fremont. That he would never consider skipping the country to avoid dealing with the hepatitis C outbreak.
“I trusted him,” Evelyn McKnight said.
Investigators eventually determined that Evelyn and at least 98 other people had been infected after Javed's nurses repeatedly didn't change the syringe while flushing cancer patients' ports using saline from a community saline bag. Patients told state investigators the saline bag would be clear in the morning, and swimming with pink particles in the afternoon.
Shoddy medical practices, including reused syringes, had earlier been present in Javed's oncology clinic, known as the Fremont Cancer Center, according to an earlier audit done by the Missouri Valley Cancer Consortium. That investigation's results were shared with Javed in 2001, and then became public during the civil litigation that followed the outbreak.
A state-run liability fund eventually paid McKnight and more than 80 other Fremont-area victims a combined total of $12 million in damages. (A judge had earlier ruled that payouts would come from the fund, which is paid for by hospital fees and meant to serve as a type of supplemental insurance in cases like the outbreak.)
That $12 million, when split up, comes to an average of roughly $150,000 per victim, though the size of the confidential payouts differed based on the victim.
McKnight took her part of the settlement and started HONOReform, a patient advocacy group that now works around the country educating people about the risks of hepatitis C outbreaks caused by shoddy medical practices.
|Columnists Michael Kelly, Erin Grace and Matthew Hansen write about people, places and events around Omaha. Read more of their work here.|
On a recent Friday, Evelyn sat at a conference table in Columbus, Neb., with Rep. Jeff Fortenberry, who has championed her case in Congress. Also present were a dozen executives of Becton, Dickinson, a multinational company with a Columbus, Neb., manufacturing plant. BD is the world's leading producer of a new kind of syringe — one designed so it can't be reused.
When it was her turn to talk, Evelyn pointed out the irony of the situation. Here we are, sitting in BD's Columbus plant that makes safe syringes it sells all over the world, she said. And we are only 50 miles from the spot where the use of dirty syringes caused the largest outbreak of hepatitis C in American history. The technology spread across this conference table, if used by every hospital and clinic in the country, could make a hep C outbreak like the one in Fremont a virtual impossibility.
“It shouldn't have happened to us,” she told the men in suits. “It shouldn't happen now. It shouldn't happen ever. But it does.”
When medical professionals do infect dozens of people with hepatitis C, they often end up behind bars.
A former Las Vegas doctor was recently charged with second-degree murder and sentenced to life in prison after unsafe practices at his clinic infected nearly 100 people with hepatitis C in 2007 and 2008. A technician is serving between 30 and 40 years in a New Hampshire prison after he infected 46 patients in four states.
Steve Langan, director of HONOReform, thinks Javed should face a similar fate.
“Think about the Norfolk bank murders, and ask yourself what the difference is,” said Langan, referring to the deadly 2002 armed robbery that claimed five lives. “What is the difference, really?”
The Nebraska Attorney General's Office will face serious hurdles if it does pursue criminal charges.
The statute of limitations on most felonies is three years, according to Nebraska law, though there is no statute of limitations on the most serious offenses or on “any person fleeing from justice.”
There is also this: Javed lives in Pakistan, not Paxton. The oncologist has made at least one trip to New York City since he fled Nebraska. He is not believed to have returned to the Fremont area since July 2002.
In those dozen years, Javed, his former head nurse and other employees in that office haven't faced any criminal charges. Because of malpractice insurance and because most victims accepted settlements from the state fund, he has also avoided much of the civil liability.
I recently asked Evelyn McKnight if she could live with the reality that America's deadliest medical care hepatitis C outbreak may well result in no criminal punishment.
“If nothing ever comes from this, if our suffering was for naught ... ,” she said, her voice trailing off. She fell silent for 30 seconds, maybe a minute.
“Myself and the 98 others, our voices need to be heard,” she said finally. “We need to be heard.”