Familiar face answers call for help resolving endoscopy center crisis

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Dr. Mary Guinan spent 20 years with the federal Centers for Disease Control and Prevention investigating and tracking deadly infectious diseases such as AIDS and smallpox.

On Thursday, she became Nevada's acting chief public health officer and will be charged with getting to the bottom of the hepatitis C outbreak and keeping Nevadans healthy.

"How is it possible in this day and age, in infection control?'' Guinan asked about the link health officials have made between seven hepatitis C cases and medical practices at two Southern Nevada endoscopy centers. "That's what I am going to try to find out.''

Guinan's comments came hours after Gov. Jim Gibbons announced she would be taking the job. She held the chief public health officer's position from 1998 to 2002; the position had been open since Dr. Bradford Lee retired in June.

The first task for Guinan -- along with the Southern Nevada Health District -- is to ensure the 40,000 patients who were warned to be tested for hepatitis C and HIV are located. Health officials then must identify those who test positive and direct them to the appropriate care.

Review Journal

[Ken Burch]

1. All I can say is...

I'd hate to be the investigative journalist who went undercover to break this story.

Ewwwwww....Owweeeee!!!!.....

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2. "How is it possible in this day and age, in infection control?''

MONEYMAKING MENTALITY: Clinic assembly line described

Patients, others say Endoscopy Center rushed colonoscopies

There was the standing room-only waiting room. There was the ground-in dirt on the floors and the "filthy chairs," Barbara Zufelt said.

...

She went through with the preventive colonoscopy and was surprised by how quickly it was over. But the experience felt more like a "cattle call" than a medical procedure, she said.

Behind the standing room-only waiting room and assembly-line procedures was a moneymaking mentality that frequently trumped patient care, some doctors -- including a witness in a malpractice case -- have said.

The profit motive led administrators to push the limits of the clinic's capacity, the doctors said, scheduling colonoscopies and other procedures as little as 15 minutes apart -- a time frame that can lead to rushed exams and missed diagnoses.

The penny-pinching also led administrators, mainly majority owner Dr. Dipak Desai, to order the reuse of syringes and single-use vials of sedatives on patients.

Both are substandard practices that triggered a hepatitis C outbreak and potentially exposed nearly 40,000 patients to life-threatening blood-borne diseases, health officials told a city of Las Vegas administrator.

Desai "had willfully chosen, until he was caught, to mortally hazard his patients for profit," Las Vegas business services director Jim DiFiore wrote in a letter suspending the clinic's business license.

PARTNERS SPLIT PROFITS

At the time of the announcement, Dr. Dipak Desai ran the Gastroenterology Center of Nevada, Southern Nevada's largest medical group specializing in disorders of the digestive system. The group's 14 doctors worked among six medical offices and two endoscopy centers in the valley and controlled 60 percent of the local business.

The doctors who owned the offices and their associated clinics, the Endoscopy Center of Southern Nevada and the Desert Shadow Endoscopy Center, split the profits based on their ownership stake, according to a deposition given by one of the clinic's owners, Dr. Clifford Carrol, in a medical malpractice case filed last year.
Revuew Journal

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3. Where is Desai?

Desai may be told: ‘Not so fast, Doc’

If he tries to leave the country, he’ll likely face some questions first

Authorities have “flagged” the passport of the majority owner of the Las Vegas medical center responsible for the hepatitis C crisis, meaning that if Dr. Dipak Desai were to try to leave the country, law enforcement officials would be notified, sources close to an investigation said.

The flagging of Desai’s passport, which authorities arranged after serving a search warrant at the Endoscopy Center of Southern Nevada last month, would not prevent him from leaving the country, according to sources who requested anonymity because their investigation into conditions surrounding the hepatitis C scare is ongoing.

It would allow them, however, to attempt to interview Desai before he left the country.

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Authorities believe Desai, a native of India who has been licensed to practice medicine in Nevada since 1980, is still in Las Vegas.

Las Vegas Sun

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4. More Violations Found At Endoscopy Center of Southern Nevada

The unsanitary practices employed by the Endoscopy Center of Southern Nevada have turned out to have been much worse than first reported. In addition to reusing syringes and drawing from single-dose medicine vials for multiple patients, the Endoscopy Center of Southern Nevada regularly performed 2-minute surgeries and reused other disposable devices. These revelations have caused some to speculate that the reused syringes and medicine vials might not be the primary cause of a hepatitis C outbreak linked to the Endoscopy Center of Southern Nevada, but health investigators say that is not likely.

...now it appears that may have just been the beginning of the dangerous methods employed by the Endoscopy Center. According to a report in the Las Vegas Sun, the clinic regularly engaged in other dangerous practices. Several staff members told investigators that biopsy equipment labeled for single use was reused for multiple patients after disinfection. Records seem to confirm this: 7,800 biopsies or polyp removals were performed in 2007, but only 6,200 biopsy forceps or polyp removal wires were purchased.

The clinic’s staff also told investigators they’d reused bite blocks - devices put in patients’ mouths for some procedures - which cost about $2.25 each. According to the Las Vegas Sun, the clinic’s purchasing records show it bought only about 2,000 bite blocks in 2007, when about 5,800 upper endoscopy procedures, which call for use of the blocks, were performed there. One clinic staffer told investigators that they were permitted to use only four bit blocks each day in each of the Endoscopy Center’s procedure rooms.

The Las Vegas Sun also is reporting that on Sept. 21, 2007 — one of the dates on which hepatitis C was passed to patients — one colonoscopy lasted only two minutes and another only three minutes. Several staff members told investigators that anesthesia times had been incorrectly reported to allow for additional billing. This could be insurance fraud and is the subject of an investigation by the Nevada attorney general’s office and the FBI.

News Inferno