Clinic reports lapses in disinfection

By Marshall Allen

Wednesday, Dec. 31, 2008 | 2 a.m.

An outpatient surgery center has notified state authorities that it failed to properly disinfect instruments it uses during procedures, state health officials said Tuesday.

Authorities said there was minimal risk to the clinic’s patients.

The staff at Specialty Surgicare of Las Vegas, also known as Specialty Surgery Center, realized during a routine maintenance inspection on Dec. 18 that the disinfection cycle on the machine that cleaned the scopes used in colonoscopies and upper-endoscopy procedures was set at one minute instead of five, as the manufacturer recommends.

The next day, after correcting the problem, the clinic faxed a letter divulging the hygienic lapse to the State Health Division, which licenses the facility. The clinic also notified the Centers for Disease Control and Prevention and the Southern Nevada Health District — the two agencies that investigated the hepatitis C outbreak in early 2008 at a different endoscopy center that triggered widespread alarm and outrage.

Specialty Surgery Center, at 7250 Cathedral Rock in Las Vegas, has 10 procedure rooms and performs 750 to 950 procedures a month, state officials said, including urology, orthopedics, dentistry, radiation oncology, gynecology and plastic surgery. The disinfection problems were with the scopes used for gastroenterology procedures and go back to at least the beginning of 2007.

Dr. Ihsan Azzam, the Nevada state epidemiologist, said he spoke to the manufacturers of the machine and the CDC and both told him that the error caused virtually no risk to patients. Previous outbreaks — including the hepatitis C infections caused at the Endoscopy Center of Southern Nevada — were caused by unsafe anesthesia injection practices, Azzam said. There have been no known infectious disease outbreaks caused by inadequate disinfection of endoscopes, and no infections related to Specialty Surgery Center have been reported, he said.

“There was no clear quantitative answer to how high or low the risk is,” Azzam said. “But based on previous experience the risk is minimal.”

State health officials are not recommending that patients who have been treated at the facility get tested for hepatitis B, hepatitis C and HIV, as 50,000 people were told to do in February, when the outbreak at the Endoscopy Center was announced. But a spokesman for Specialty Surgery Center said the facility will provide counseling and screening for infectious diseases to any patients free of charge.

State officials said that although the risk of infection is low, it’s troubling that the surgical center failed to follow the manufacturer’s instructions.

“The problem is a consistent one we deal with,” said Richard Whitley, administrator for the Nevada State Health Division. “The equipment comes with directions and the facility didn’t follow them.”

What made this situation unusual, Whitley said, is that Specialty Surgery Center officials self-reported the problem, which he commended. The state Bureau of Licensure and Certification, the licensing agency, took the self-report as a complaint and conducted a full inspection Tuesday.

Specialty Surgery Center could be fined heavily for the violations. The state has levied record penalties against facilities in the past two months — in response to the ongoing violations by health care providers. On Nov. 21 a Reno assisted-living facility was fined $121,600 for poor record keeping and failing to give residents medications. On Dec. 10 the state fined Desert Springs Hospital & Medical Center $228,000 and required it to provide a year of donated services to select patients for failures in its mammography program.

Whitley said the Specialty Surgery Center investigation needs to be finished before the state can determine a penalty.

The self-reporting of the mistake stands out in contrast to the behavior of Dr. Dipak Desai, owner of the Endoscopy Center of Southern Nevada, after his facility caused the largest hepatitis C outbreak in the nation. Health officials genetically linked nine hepatitis C cases directly to the clinics and classified an additional 101 cases as possibly associated with the facility, which caused the problems by reusing syringes and single-use medicine vials. Desai, a former member of the Nevada Medical Board, never admitted any wrongdoing and bought a full-page newspaper ad to downplay the situation. He has since been prohibited from practicing medicine by a court order and faces civil lawsuits, criminal investigations and discipline by the medical board.

Specialty Surgery Center is affiliated with Tennessee-based Hospital Corporation of America, one of the largest health care companies in the country, with 166 hospitals and about 100 free-standing surgery centers in 20 states and London, England. HCA also owns the Sunrise Health System, which includes Sunrise Hospital and Medical Center, Southern Hill Hospital and Medical Center, and MountainView Hospital. More than 200 local physicians have credentials at the facility.