LITTLE ROCK — Dozens of patients seen at a half-dozen dental clinics around the state during a three-month period in late 2011 and early 2012 may have been treated with tainted medication, the state Department of Health said Tuesday.
The department said it has begun contacting about 100 patients ranging in age from 14 to 22 who received intravenous injections of Demerol administered by Dr. William Jarrod Stewart at Ocean Dental clinics in Fayetteville, Fort Smith, Hot Springs, Jonesboro and Little Rock, and Bevans Pediatric Dentistry in Little Rock, between Nov. 20, 2011, and Feb. 20, 2012.
The agency said it had concluded, based on information from the U.S. Drug Enforcement Administration, that some of the drugs used by Stewart may have been contaminated with infectious material.
Dr. Dirk Haselow, the state epidemiologist, said that after Stewart’s death on Feb. 29, 2012, DEA officials found vials of the drug that had been under Stewart’s control at clinics where he practiced had been tampered with. Demerol is a narcotic pain killer also used for mild sedation.
The vials appeared to have been stored appropriately, under lock and key, he said.
"The lid of a single dose vial had been removed and put back on the vial, on several vials. That is highly unusual. We can’t predict what was done with that vile. It raises the suspicion that the vial could no longer be sterile," Haselow said. "We have no reason to believe we need to be concerned, but this is so out of the ordinary for competent medical practice, so different than what we expect, we just needed to notify people and give them the opportunity to be screened for infection."
Haselow said patients would be tested for the same infections as would someone who sustained a needle stick in a clinical setting: HIV, hepatitis B and C, and syphilis. It was unclear whether any patient was given medication from any vial that was tampered with.
"There are so many ifs involved in this scenario we are unable to classify the extent of the risk. We believe the risk is low because so many things would have to go wrong," he said, "(but) there is a potential with all of these (infections) that symptoms may not have appeared."
At the time of his death, Stewart was screened for all of the diseases and the results were negative, which Haselow said substantially reduced that risk that his patients were exposed to any of them.
The department said it had started contacting patients potentially at risk by telephone and letter and recommending that they be screened. Screening will involve a questionnaire and a blood draw and will be coordinated at local health department locations free of charge, officials said.
Health Department spokeswoman Ann Russell said only patients who received intravenous medicine from Stewart during the specified time period may be at risk. No risk is related to medicines injected into the mouth — local anesthetics used for numbing purposes — or anesthetic gasses, or to treatment received prior to Nov. 20, 2011.
No other providers at the clinics listed had access to the medications and no patients seen by other providers at those locations are thought to be at risk, she said.
"We’re really trying to let the public know that its a very narrow window of people here and we know exactly who they are," Russell said.
The department said no patients treated at the Fort Smith clinic have been identified as being at risk.
William Bryant, assistant special agent in charge of DEA in Arkansas, said the agency received information from two sources that controlled substances in Stewart’s possession may have been compromised.
Bryant would not confirm or deny that the information was obtained as part of a DEA drug investigation or that an investigation is ongoing, but did say "I have no idea" if the medication had been tested.
Arkansas State Police spokesman Bill Sadler said state police, at the Health Department’s request, took possession of 78 vials of medicine between Friday and Tuesday and turned them over to the state Crime Lab for testing.
"The ASP, at this particular juncture, does not have any active criminal investigation," Sadler said. "There is no information nor is there any evidence at this hour that these vials were anything other than just compromised. We have no information to substantiate that the vials might have some infectious disease within the vials."
In separate statements, Ocean Dental and Bevans Pediatric Dentistry said they were contacted by the Health Department last week and were cooperating fully with the agency. The companies said they had volunteered to cover the cost of the testing, which Haselow put at about $70 per person.
The companies said they had not received any reports about any of the affected patients contracting any infectious disease.
Bevans Pediatric said 16 of the affected patients were seen by Stewart at its Little Rock clinic for IV sedation during the period. It said Stewart was a contract dentist who provided root canal therapy and tooth extraction with the option of IV sedation at the clinic.
"We follow the highest standards for infection and hazardous material control. Dr. Bevans is devoted to children’s oral health and nutrition. He is deeply saddened by this situation, and is committed to continuing to assist the investigating authorities in any way he can," the Bevans Pediatric statement said.