Three dental clients lost a medical malpractice lawsuit in which they alleged “that a government dental provider failed to properly sterilize its equipment and infected them with hepatitis C,” in the words of the lawsuit, Ledermann et al. v. U.S. Here’s what happened in the Texas case and why the judge ruled against them.

But first, hepatitis is inflammation of the liver. When untreated, it can lead to scarring of the liver (cirrhosis), liver cancer, the need for a transplant and death. The virus that causes hepatitis C is most commonly transmitted through sharing needles and other equipment used to inject drugs. However, unsterilized medical equipment and tattoo needles are possible transmission routes as are blood transfusion and organ transplants before 1992 as well as sexual contact with someone who has hep C. For more details, see “Hepatitis C Transmission and Risks” in Hep’s Basics of Hepatitis. 

The origins of the hepatitis C lawsuit date to February 2018, when two federally funded dental clinics in Texas City and Galveston were cited by health officials for failing to properly sterilize equipment and administer spore testing on dental instruments, among other violations. The clinics warned clients that they might have been exposed to HIV and hepatitis B and C and advised them to get tested for the illnesses as a precaution. Subsequently, three people discovered they had hepatitis C virus (HCV)—and they sued the U.S. government for medical malpractice.

On July 19, 2021, Judge Jeffrey Vincent Brown of the U.S. District Court for the Southern District of Texas ruled against the three plaintiffs—Steven Ledermann, Curtis Green and Daniel Saldana—on the grounds that they failed to prove that the clinics were the cause of their hepatitis C.

The judge pointed out that all three clients had risk factors for the virus and could have contracted it outside of the dental clinics, reports Bloomberg Law. In addition, medical evidence showed that their hepatitis C infections were in advanced stages, meaning they had been positive for 10 to 15 years and were unlikely to have contracted hep C during their visits to the clinic. What’s more, they had visited the clinic between October 2015 and August 2016.

“Given their risk factors, the time at which they visited the clinics, and the evidence of their later-staged infections, the plaintiffs have shown at best a temporal association,” the judge wrote, adding that all three plaintiffs presented only “a mere suspicion of causation, and that is not enough.”

According to Bloomberg, in response to the filing, the plaintiffs’ counsel, Scott Greenlee, countered that the court’s “finding of facts are not consistent with the evidence that was admitted at trial. There was evidence of violations of the standard of care for sterilization of dental instruments going back for many years.”

As a result, they plan to appeal the ruling.

As the Hep Basics section titled “What is Hepatitis C?’ explains, it’s estimated that about 3.5 million people in the United States are chronically infected with hepatitis C. But this number is steadily increasing, driven largely by the opioid epidemic. The Centers for Disease Control and Prevention estimates that there were 41,200 new hep C cases in 2016 and that chronic hep C infection accounted for more than 18,000 deaths that year in the United States.

You may be at risk for hepatitis C and should contact your health care provider for a blood test if you:

  • Were born between 1945 and 1965, regardless of any other HCV-related risk factors

  • Were notified that you received blood or an organ from a donor who later tested positive for hepatitis C

  • Have ever injected illegal drugs, even if you experimented only a few times many years ago

  • Received a blood transfusion or solid-organ transplant before 1992

  • Received a blood product for clotting problems before 1987

  • Have HIV

  • Have ever been on long-term kidney dialysis

  • Have evidence of liver disease (e.g., persistently abnormal liver function tests)

  • Have an HCV-positive mother (Women with hepatitis C have a 6% chance of passing the virus along to their babies during pregnancy or delivery.)

  • Have been exposed to HCV through your occupation (Note: The risk to health workers of acquiring HCV following a needlestick is quite low, averaging 1.%.)

Although the risk is uncertain, you may also be at risk if you:

  • Have ever gotten a tattoo or piercing in a nonprofessional setting where equipment such as ink, inkwells or needles were used and potentially unsterilized

  • Have had multiple sexual partners or sexually transmitted diseases

  • Have ever inhaled cocaine or shared other non-injection drugs.

Hepatitis C is not transmitted by casual contact such as coughing, kissing, sneezing or sharing food, beverages or utensils.

For a collection of Hep articles about hep C, click the hashtag #Hepatitis C.