By Steve Kanigher (contact)

Tue, Mar 4, 2008 (2 a.m.)

Here are the answers to other frequently asked questions about the hepatitis C outbreak connected to flawed medical practices at the Endoscopy Center of Southern Nevada.

The city of Las Vegas closed the clinic Friday. But why didn’t the Southern Nevada Health District immediately close the clinic after discovering the problems there in January?

Under state law, the Health District can shut down restaurants that pose public health hazards, but it has no regulatory authority over medical facilities beyond the ability to conduct disease investigations.

Besides the city, what other entity could have shut it down?

The Nevada State Health Division, which regulates the facilities through its Licensure and Certification Bureau.

Why didn’t it?

The state decided instead to place investigators at the clinic from Jan. 9 through Jan. 17 to learn how the diseases were being transmitted among patients — a mystery that would not have been solved had the clinic been immediately shut down. Investigators were to make a surprise visit later to make sure the rules were being followed. If not, the facility’s license could have been yanked. The city didn’t wait. On the basis of the state investigators’ findings, the city on Friday closed the clinic by suspending its business license.

Short of revoking the facility’s license, what other powers does the health division have?

The division can fine the clinic, and it has. Those fines, which are limited to $1,000 per day per violation, haven’t yet been announced. The state can also take over temporary management of the facility.

Can the owners protest any state actions?

Yes. Administrative rulings can be appealed in court.

Can the owners open other facilities?

Yes, if they can obtain both a health facility license from the state health division and a business license from either Clark County or one of its municipalities, depending on the location. But on Monday, Clark County officials suspended the business licenses of three other Desai clinics: the Desert Shadow Endoscopy Center, the Gastroenterology Center of Nevada and the Spanish Hills Surgical Center.

Might there be criminal offenses?

Clark County District Attorney David Roger’s staff is looking into it.

If nurses have knowledge of shoddy health care practices at a medical facility, are they under any ethical or legal obligation to report that information?

Yes. Under state law nurses and nurse assistants must report that information to the nursing board or risk losing their licenses and certifications. The Nevada State Board of Nursing has launched an investigation.

What about the clinic’s doctors?

The Nevada State Board of Medical Examiners, which also has launched an investigation, has the power to revoke or suspend the licenses of medical professionals under its authority. Other penalties can include probation, reprimands and fines, as well as mandatory medical education and drug testing.

The Health District is recommending that 40,000 clinic patients over the past four years be tested to see if they’ve been infected by hepatitis B, hepatitis C or HIV. How much will that cost?

LabCorp., a major testing laboratory in the Las Vegas Valley, is offering free tests for those individuals. Quest Diagnostics Inc., another major testing laboratory, has said it will offer reduced testing rates for these patients: $35 for hepatitis B (normally at least $88.50), $45 for hepatitis C (normally at least $104) and $85.10 for HIV (the standard price). For an uninsured person taking all three tests, the tab would be $165.10. Insured individuals should talk to their doctors and insurance companies. The nonprofit Nevada Health Centers Inc. also offers tests as low as $15 each on a sliding fee scale based on income. Major Nevada insurers Sierra Health Services, Cigna HealthCare, UnitedHealth Group and Anthem Blue Cross and Blue Shield have announced that their health plans will cover the cost of the tests, if any, for their customers.