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Covenant’s chief medical officer, Dr. Owen Heisler, defended the lengthy timeline as necessary to complete a complex investigation into the degree of risk patients faced.

“It took some time to determine if the risk approached the level where patients should be notified,” he said.

Hepatitis B and C infections often have no obvious symptoms initially. Hepatitis B can lead to liver failure for a small number of people, while those with hepatitis C may develop a chronic infection that can be fatal.

Patients who should be tested include 952 people who received insulin pen training at the Grey Nuns Diabetes Education Centre between March 2013 and February 2016, and 355 patients who were trained at the Misericordia between May 2014 and February 2016.

As part of the insulin pen instruction, staff at the hospitals used demonstration pens filled with saline that attach to a disposable needle. Patients learn the proper technique by injecting saline into a practice pillow.

The pen is meant to be used only with the pillow, but in some cases patients were invited to also use the device on themselves “mostly to give them some feel of what (the needle) felt like to go into the skin,” Heisler said.

Needles were always changed after each use and never shared between patients. However, the saline reservoir in the pens was sometimes used repeatedly until it ran out.

Heisler said there is a small risk that someone with hepatitis B or C who injected themselves with the pen may have transferred a microscopic amount of virus into the saline.