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August 22, 2014

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Officials: Clinic procedures put thousands at risk

Headed by a prominent Nevada doctor, its flawed care may have spread hepatitis

The medical director and majority owner of the Endoscopy Center of Southern Nevada, where apparent negligence has triggered the largest hepatitis C scare in Nevada history, is one of the state’s most prominent physicians.

He is Dr. Dipak Desai, a former member of the Nevada Board of Medical Examiners who has served as chief of gastroenterology at local hospitals and taught at the University of Nevada School of Medicine.

Desai was not present when the Southern Nevada Health District announced during a news conference Wednesday that his staff members had contaminated patients with the blood of others.

Health officials said the staff commonly used the same syringe more than once on a single patient while administering anesthesia and used single-dose vials of medicine on more than one patient.

This flawed process could allow a virus from the first patient to contaminate the vial and then be transferred to another patient who received medicine from the same vial.

At the news conference to notify patients of the risks, Desai’s business was represented by three doctors and a public relations expert.

More about Hepatitis

Hepatitis is an inflammation of the liver. Several different viruses cause viral hepatitis. Hepatitis C and Hepatitis B viruses are the two concerning Las Vegas and state health officials.

Hepatitis C: This virus is spread through contact with infected blood. Less commonly, it can also be transmitted through sexual contact and childbirth.There is no vaccine for hepatitis C. The only way to prevent the disease is to reduce the risk of exposure through infected needles, or sharing personal items such as toothbrushes, razors and nail clippers with an infected person.

Hepatitis B: This virus is spread through contact with infected blood. There is a vaccine for hepatitis B. Persons infected with acute hepatitis B usually recover on their own. Very severe cases can be treated withlamivudine.

HIV: Stands for human immunodeficiency virus, which weakens the body's immune system. The virus may pass from one person to another when infected blood, semen or vaginal secretions come in contact with an uninfected person's broken skin or mucous membranes, including the mouth, eyes, nose, or other body cavities. An infected pregnant woman can pass HIV to her unborn baby during pregnancy, delivery or through breast-feeding. HIV destroys a certain kind of blood cell (CD4+ T cells), which weakens the human immune system and can lead to AIDS, which stands for acquired immune deficiency syndrome.

Sources: The National Institutes of Health

Southern Nevada Health District

Desai did not respond to the Sun’s request for comment. The question that would have been asked of him: How, in the era of AIDS and extreme concern about contamination of patients through the use of needles and syringes, could his employees have allowed the transgressions that will now require that 40,000 patients be notified that they should be tested for hepatitis C, hepatitis B and HIV, the virus that causes AIDS.

Patients are most at risk of hepatitis C, officials said, a disease that presents symptoms in only about 20 percent of the people infected. The symptoms include nausea, jaundice and vomiting, and may lead to cirrhosis of the liver or liver cancer, even if no symptoms are present.

Patients who have been given anesthetic at the Endoscopy Center from March 2004 are at risk. Hepatitis C can linger in a body for years undetected. The flawed practices have been corrected, officials say.

The outbreak came to light when three cases of acute hepatitis C were reported to the Health District in January, and through an investigation the district found three others. Typically only two cases of the disease are reported to the Health District a year.

Each of the six patients had procedures done at the Endoscopy Center.

The investigation, conducted by the Southern Nevada Health District and the Nevada Licensure and Certification Bureau, did not determine why workers at the Endoscopy Center were reusing the single-dose vials. But the practice was widespread, said Brian Labus, senior epidemiologist of the Health District.

“It was one of those policies where the staff members told us this was what they were told to do — they admitted this is what (they) have been doing,” Labus said. “It wasn’t any one particular staff member. It was something that was basically seen across the clinic as a common procedure.”

The sloppy practice has been reported in other states, officials said, but the patient notification effort that began Wednesday is the largest of its type in the nation.

Desai is board certified in gastroenterology and internal medicine. A medical graduate of Gujarat University in his native India, he has served as chief of gastroenterology for both University Medical Center and Valley Hospital Medical Center in Las Vegas.

In Desai’s absence, another doctor from his practice, which sees about 60 patients a day, read a statement that said, in part: “We are on a mission to maintain the trust our patients have had in us.” Two doctors stood beside him, silent. Their lawyers would not allow them to answer questions, the statement said.

Desai also founded the Gastroenterology Center of Nevada, which has six locations and shares an office at 700 Shadow Lane with the Endoscopy Center of Southern Nevada. In 1996, the state alleged Desai was advertising the practice of medicine in a false, deceptive or misleading manner by falsely stating that members of his medical group were board certified gastroenterologists. He agreed to pay a $2,500 fine.

Lisa Jones, bureau chief of the Licensure and Certification Bureau, said the findings announced Wednesday were severe enough that authorities would have closed the business if they had not been corrected immediately.

The state can fine the Endoscopy Center a maximum of $1,000 for each of three types of violations, Jones said, but licensing agencies such as the Board of Medical Examiners and the Nevada State Board of Nursing could investigate the problems to penalize the various providers.

In a finding unrelated to the hepatitis C outbreak, the Licensure and Certification Bureau found that technicians were not discarding cleaning solution after cleaning each endoscope, nor were they adding the proper amount of detergent.

Sun reporters Steve Kanigher and Mary Manning contributed to this story.

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