Take a grain of salt and read this

By Marshall Allen

Tuesday, March 4, 2008 | 2 a.m.

Dr. Dipak Desai has finally spoken out, buying a full-page advertisement to offer his first words about the unprecedented hepatitis C crisis blamed on faulty practices at one of his clinics. How forthcoming was he?

Six patients at the Endoscopy Center of Southern Nevada have been stricken by hepatitis C, and 40,000 other people treated there in the past four years are being advised to be tested for hepatitis B and C and HIV because of flawed injection practices at his clinic.

Health authorities found that nurses used syringes more than once for individual patients, allowing their blood to taint vials of anesthetics that were then used for other patients, contaminating their blood — a violation of basic disease prevention methods.

Nurses told investigators that Desai and other managers ordered these shortcuts to save money.

On Sunday, his “open letter to patients and the people of Southern Nevada” appeared as an ad in the Las Vegas Review-Journal. What follow are excerpts from the ad, and a few facts that Desai — or more likely his consultants, who probably wrote this letter — left unsaid.

“The trust we have spent years building in this community has been challenged by the discovery that some of our patients may have been exposed to blood-borne diseases at our facility.”

By saying that some of his patients “may have been” exposed, Desai seems to question the findings of health inspectors. But in fact, he did not contest the conclusions of health inspectors — supported by genetic evidence — that his clinic was the source of the outbreak. Also, he seemed to minimize the problem by referring to “some” patients. “Some” could be as few as the six patients already known, but health officials said the blatant disregard for infectious disease prevention put as many as 40,000 at risk.

“... we have carefully reviewed our procedures and implemented the changes they recommended.”

This suggests that it took some effort to correct the problems. The clinic was simply ordered to abide by the most basic of practices — ones that exist even in the Third World — by not sharing among patients vials of medicine that have been contaminated with one patient’s blood. The only change that needed to be implemented was to stop cutting corners to save money.

“I am also grateful to the health district for clarifying news reports about syringe re-use at the Endoscopy Center of Southern Nevada. The evidence does not support that syringes or needles were ever re-used from patient to patient at the center.”

In correcting media errors he muddied the truth, because his clinic staff did commit a similar sin: When a patient needed more anesthetic, the once-used syringe was used again to draw more medicine from the vial, contaminating that vial with the back-flow of the patient’s blood. Medicine from that vial was then drawn for other patients, contaminating them.

“... without making excuses, I think it’s important for the public to know that the chances of contracting an infection at our center from 2004 through June 2007 were extremely low.”

Desai not only avoids excuses — he avoids telling the public how this took place. And his reassurance that the chances of contracting an infection are slight is cold comfort to the six people health officials say were infected with hepatitis C at his clinic, and the 40,000 others who must be tested to alleviate their fears of being infected with a deadly disease.

“Regardless, if you were a patient at our facility, I encourage you to get tested.”

This would fall under the category of “advice doctors hope to never give patients.”