- A Duluth physician who exposed as many as 100 patients
to contagious tuberculosis should not have been seeing patients because
of his symptoms and previous health history, according to a public health
official.
-
- Dr. Okechukwu Iwu, who practices at St. Mary's and Miller-Dwan
hospitals, is now a hospital patient with severe pneumonia caused by the
tuberculosis. Iwu said that he was sick when he was seeing patients in
November and a few days in December, but didn't think he had full-blown
tuberculosis.
-
- Larry Sundberg, an epidemiologist with the St. Louis
County Health Department, said Iwu was too sick to be seeing patients at
the time.
-
- "I'm guessing [Iwu] was in real denial and wanted
to believe it was something else," Sundberg said.
-
- Before Iwu became ill in November, he had a dormant form
of tuberculosis, he said. In addition, he had been treated two years ago
for a bacterial infection that is similar to tuberculosis.
-
- Iwu said he felt seriously ill soon after starting his
vacation in mid-November. Despite symptoms that included coughing, fever
and shortness of breath, Iwu said he went back to work in December. He
said he felt it was important to care for his patients.
-
- "I didn't think I had anything that was communicable.
I continued working and I took the normal precautions," he said. "The
problem for me was you have lots of people to see, lots of patients to
see."
-
- Iwu said he had gotten so weak and short of breath that
he could not climb a flight of stairs.
-
- Sundberg said coworkers urged him to stop seeing patients.
-
- "They were saying, 'You have to get this checked
out. You can't work until this is checked out,' " Sundberg said.
-
- He said public health workers are contacting 50 of the
100 patients who are at the highest risk for contracting tuberculosis.
Those patients either spent a lot of time with Iwu or have medical conditions
that elevate their risk. Hospital workers are also being notified.
-
- Officials at St. Mary's/Duluth Clinic Health System,
which owns both hospitals, knew of Iwu's past medical history when he was
hired in June, a health system spokeswoman said.
-
- "At the time of his hire, he did not have active
tuberculosis," said spokeswoman Beth Johnson. "He did go through
the normal counseling process where he was reminded of what symptoms he
needed to be watching for."
-
- Medical professionals with dormant tuberculosis typically
are allowed to see patients without restrictions because dormant TB can't
be passed to others.
-
- Nearly 90 percent of those with tuberculosis remain in
the latent, or dormant, stage. The bacteria that cause the disease is in
their bodies, but it is not causing symptoms.
-
- A skin test for tuberculosis often is unreliable, and
any positives have to be confirmed through chest X-rays and other tests
whose results takes weeks of lab work.
-
- No screening planned
-
- Because of these difficulties in testing for tuberculosis,
public health officials are not calling for a mass screening of everyone
who might have come into contact with Iwu.
-
- "If you test low-risk individuals, you are putting
them at more risk for anxiety," Sundberg said.
-
- However, those with questions about their exposure risk
are encouraged to call the St. Louis County Health Department.
-
- Despite the fact that Iwu was in close contact with patients
who themselves were ill, public health officials have cautioned against
panic.
-
- "The bottom line here is that tuberculosis is spread
through the air, but it is not very infectious unless you have prolonged
contact," said Dr. Harry Hull, state epidemiologist. "The people
who are at highest risk are people who are in the same household."
-
- Johnson, the health system spokeswoman, said she did
not know whether the hospital had specific policies that prohibited doctors
from working while ill.
-
- "Sometimes we forget that physicians are people
too and are in denial," she said.
-
- Iwu said he is concerned that he exposed his patients
to tuberculosis, but defended his decision to keep working.
-
- "There was nothing TB-like about it. There was no
way I would have known" it was tuberculosis, Iwu said.
-
- At first, Iwu said his symptoms persisted despite antibiotics
he was taking. When asked if he had prescribed the drug to himself, Iwu
replied, "Yes, I had taken a course of antibiotics on my own."
-
- Iwu also said he didn't seek treatment from another physician
for his symptoms.
-
- Later, after Johnson talked to Iwu about the medications,
she said he denied prescribing them to himself and asserted that he got
them through a colleague.
-
- It is not illegal for doctors to prescribe medications
to themselves, said Minnesota Board of Medical Practice director Rob Leech.
But doctors should not be practicing if their health impairs their judgment
or affects patients.
-
- "It would depend on the circumstances, as long as
he was doing everything responsibly," Leech said. "But generally,
as soon as he was symptomatic, it was time not to be practicing medicine."
-
- Self-report expected
-
- Health officials dealing with the TB investigation are
not looking into Iwu's professional judgment. However, Leech said, the
medical board will investigate the doctor's actions if it receives a complaint
from the public, if the hospital takes action against him or if the doctor
reports the matter himself, as he is expected to do.
-
- "I would imagine we would be getting a self-report
from the physician," he said.
-
- State and county public health officials said the health
system promptly reported the case once it came to light.
-
- Iwu became a licensed Minnesota doctor in September.
He also has licenses in Indiana and Maine. No disciplinary action has been
taken against him, according to agencies in each state.
-
- Iwu said he does not know how he contracted tuberculosis
or a bacterial cousin of tuberculosis that made him ill in 2000 while he
was in medical training at the State University of New York Health Science
Center at Brooklyn.
-
- "I spent time in Nigeria, I spent time in New York,
I spent time in Maine. I could have picked it up anywhere," said Iwu,
who received his medical degree in 1994 from the University of Lagos in
Nigeria.
-
- Glenn Howatt is at howatt@startribune.com.
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