Hepatitis scare:

OK, now I’ll ask the questions

State urges us not to take safe medical procedures for granted

Wednesday, March 5, 2008 | 2 a.m.

Chris Morris

Patients and current or former employees of Endoscopy Center of Southern Nevada who wish to share their experiences at the clinic are invited to e-mail Las Vegas Sun health reporter Marshall Allen.

Hepatitis scare

Knowledge is power: Filling in the gaps (3-4-2008)
Another endoscopy center closed, this one in Henderson (3-4-2008)
Questions on everyone’s mind (3-4-2008)

Nevada health care had a terrible reputation even before last week. But public trust in doctors and nurses may now be at an all-time low.

Already, the state ranks among the worst in the nation for numbers of doctors and nurses per capita, the number of uninsured patients, and the number of unvaccinated children.

Nevada now has the indignity of having the nation’s largest patient notification of a potential hepatitis C outbreak.

And it’s come to this: State health officials urged patients Wednesday to ask the most basic questions of their doctors before undergoing medical procedures, to make sure fundamental safety measures are taken by the physicians and nurses who treat them.

Among the questions specifically suggested by the Nevada State Health Division:

“Can you assure me that I am safe in your facility from the transmission of communicable diseases?”
“How does the staff at this facility conduct sterilization of diagnostic equipment after each patient use?”
And this one, which is analogous to asking a car mechanic if the air filter he put in your car is new or used: “Are syringes and needles disposed of after each use?”

What does it say about the state’s own confidence in health care delivery in Nevada when it issues such an advisory?

It was prompted by an outbreak of cases of hepatitis and subsequent advisories by the Southern Nevada Health District that 40,000 patients of a downtown endoscopy clinic be tested for hepatitis B, hepatitis C and HIV because of unsafe injection practices.

On Tuesday, as many thousands waited for blood test results, the conflict between Dr. Dipak Desai, the clinic’s majority owner and one of the state’s most powerful physicians, and local officials escalated when Henderson and North Las Vegas officials shut down the doctor’s Gastroenterology Center of Nevada clinics in those cities.

Desai’s clinics’ Las Vegas and Clark County business licenses had already been suspended.

At doctors’ offices throughout the city, patients are questioning their doctors and nurses about basic injection practices for fear they’ll contract an infectious disease.

“I had a brand-new patient this morning who asked: ‘Doctor, you don’t reuse needles, do you?’ ” said Dr. Bill Pierce, a Henderson physician who is president of the Nevada Academy of Family Physicians. And that patient, apparently, hadn’t heard the state’s advisory to ask the question.

Pierce assured the patient that no, he does not reuse needles.

According to health officials, the hepatitis cases came from Desai’s Endoscopy Center of Southern Nevada, where patients were administered anesthetics for colonoscopies and other procedures. If the patient stirred during the procedure and needed a second dose, nurses used the same syringe — which might have contained the patient’s blood due to back-flow — to draw from a vial of medicine. That vial was then used to draw medicine for other patients, and if the first patient’s blood was infected, it would have contaminated the anesthetic that was then administered to other patients through the shared vial.

Pierce worries that even though the standard of care at the Endoscopy Center was far outside the bounds of basic medical practices, patients lump all doctors together.

“We’re just one big group to a lot of people,” Pierce said.

For example, Betty Bufis, who had procedures performed at the Endoscopy Center, said her confidence in Nevada medicine is at an all-time low. She told her husband that she might not have any more surgeries performed in the state.

“I’ll go to UCLA to do it,” she said.

Even as the crisis unfolds and anger grows, some experts suggest this is an opportunity to build trust in Nevada health care. Patients can become more informed, doctors and nurses can engage in self-examination to determine how this isolated breach of public trust took place. And agencies charged with enforcing standards and laws — the Nevada State Medical Examiners Board and the Nevada State Nursing Board, Metro Police and the district attorney’s office, which are all investigating what happened at Desai’s endoscopy center — can fulfill their responsibilities to hold violators accountable.

Sally Hardwick, interim director of the Nevada Center for Ethics & Health Policy at the University of Nevada, Reno, compared the public outcry over the hepatitis outbreak to how a neighborhood responds to crime in its midst. After the initial outrage, people take stock and look at the larger picture. In this case, not all doctors are violating basic tenets of patient care.

“There are some bad apples, and we need to make sure that we have clear ways of making sure that these physicians are no longer practicing,” Hardwick said.

If the enforcement is swift and public, people will realize the system works, she said.

“It has to be done in a timely manner,” she added.

Larry Matheis, executive director of the Nevada State Medical Association, which represents doctors, said “people’s trust has been put to the test,” and that doctors now face a unique challenge.

Doctors will have to spend additional time with patients and understand the nature of the hepatitis C problem and the treatment options.

“We restore trust by showing that there never was a breach of trust by most health professionals,” Matheis said.

In the long term, the profession needs to take a close look at the ethics that are at its core, Matheis said.

Discussion: 10 comments so far…

By HCVet

3/5/08 at 2:03 p.m.

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The question is, why did it take so long for public health to notify and shut down clinics with major breaches in universal/standard procedures? Why did it take 40,000 people to wake up this country to just how wide spread Hepatitis C is?

In 2002 through 2006, HCVets.com lobbied congress, specifically the FDA, to bring to their attention the following info... Sept 1999, Sterilants and Disinfectants Applied and Environmental Microbiology, p. 4255-4260, Vol. 65, Hepatitis C Survives Treatment with Commercial Sterilants and Disinfectants. We informed the FDA that the CDC was not warning public health or anyone to new procedures needed to kill, specifically the Hepatitis C virus. But, processing plants for "reused" not "reusable," single use medical device, still sprang up VOID any regulation.

The FDA finally got the message when the Veterans Affairs (VA) - June 2, 2006 MILWAUKEE - More than 22,000 veterans who underwent prostate biopsies at veterans' hospitals across the country are being warned that improperly sterilized equipment may have exposed them to deadly viruses...inadequacies with the biopsy cleaning procedure at 21 medical centers in 18 states, plus Puerto Rico.

FDA Public Health Notification filed June 19, 2006 Prostate biopsy between 1989 and 2003 : Reprocessing of Reusable Ultrasound Transducer Assemblies Used for Biopsy Procedures

But it took 8 months, February 7, 2007 Prostate biopsy between 1989 and 2003 FDA News FOR IMMEDIATE RELEASE P07-14 Media Inquiries: FDA Press Office, 301-827-6242 Consumer Inquiries: 888-INFO-FDA- Custom Ultrasonics Signs Consent Decree- Company agrees to stop manufacturing devices that wash and disinfect endoscopes until it corrects problems...

So, Congress knew, the CDC knew, the FDA knew... and you thought FEMA was bad:(
Are you upset about this, as should be?, Then tell your congressman we need a "general awarness" campaign, TODAY! Not the bill they're working on now that only addresses HIV transmission. Hepatitis C is 100 times more infectious and harder to kill, but these fact are drowned out by CDC speical interest, that want the funding:( other tragady!

Hearts and prayers go out to all worried over this totally avoidable ice berg.

For more info on Hep C transmission http://www.hcvets.com/data/transmission_...
By NW_Dweller

3/5/08 at 2:15 p.m.

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Who expects a layperson to ask questions regarding sterilization, or other like questions, and get an answer other than a positive one? "Why no Mr. Patient, we do not employ proper sterilization of our equipment and we do re-use our syringes." Come on, get real!

And, what happens if you ask too many questions? I'll tell you and probably others will too. You are asked to no longer come back. Yes, I've had doctors, and even dentists, "break up with me" because I asked too many questions.

When the medical board seriously starts pulling licenses where a doctor/dentist can no longer go to another state and start a new practice, we will never rid stories like this.
By Cactus

3/5/08 at 5:38 p.m.

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The photos and names of the doctors are given on their website
http://www.gastrocenternv.com/physicians...
By cy

3/5/08 at 8:13 p.m.

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The risk of getting HIV or heapatitis C is very low under these circumstances. But anybody who had a procedure done at these clinics should have the tests done. They should not think that the chance of getting infected is high.But the risk is there.

If the doctors did practice the unsafe techniques for many years there should have been more cases of acute hepatitis C reported.

Something terrible happened on those days when the infections were contracted by the unsuspecting patients.
By CynicalObserver

3/5/08 at 8:19 p.m.

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In case anybody missed tonight's CBS Network news, a new medical study just came out which indicates that doctors doing colonoscopies can easily miss indented lesions in colons while still seeking polyps which are easier to see. The study apparently says the indented lesions create a greater cancer danger than the polyps.

So when Dr. Desai and his merry partners were zipping through colonoscopies in 5 minutes, it seems safe to assume they might have missed these indented lesions.

It's as if the medical researchers doing this study, and CBS in reporting it, were just waiting for the Las Vegas gastro scandal to break.
By Nightingale

3/5/08 at 11:52 p.m.

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Dr. Mehta's defense of Dr. Desai contains some inaccuracies that suggest he hasn't read the newspaper stories closely. The CDC investigators mention syringes, not needles, so the nurses apparently used blunt cannulas or another needleless system to withdraw medicine from the vials. The drug Propofol is a short acting anesthetic agent that is not abused. Accusing a nurse of pocketing it for his/her own use based on absolutely no evidence is just ludicrous, if not libelous.
Hepatits C virus transmits blood to blood, almost always injected, so the instruments even if not cleaned properly between patients are not likely sources. It's true that six cases out of 40,000 people exposed to someone else's blood is low, but Dr. Mehta should educate himself on HCV. Many people may not have symptoms for years.
By AngryPostman

3/6/08 at 3:09 p.m.

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I think it's semi-official now that all doctor's in this valley must suck. Otherwise they would be living somewhere nice like San Diego. So basically, Las Vegas doc's are degenerate gamblers, drunks, drug addicts, or fleeing prosecution from some other jurisdiction.

They decide prescriptions, treatments, and therapies all based on how much money they can net, not on what is in the patients' best interests.

They practice medicine to get rich, not to treat patients. If you can afford it, go out of state for your health care needs because you are probably more likely to get sick than get cured from these clowns.
By KC

3/6/08 at 4:44 p.m.

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I fully agree with moscati re: bio-terrorists!
My husband went for a colonoscopy to the Burnham clinic in Nov 2007. Thank God all came back clear on the test. UNTIL this week.
Now we sit in "terror" waiting for his blood results to come back, which he took yesterday at our local drs office.
My heart and prayers are going out to everyone that is a part of this living nightmare.
I blame not only the drs that own these clinics, but even more so I blame the nurses, drs and anyone that "knowingly" used dirty syringes etc,,
Let's face it,,,they are the ones that fired the fatal shot, the owners gave the word and they re: those who intentionally did this due to their own lack of morals, ethics, common sense, etc,,are even more guilty then the one that said lets save some money.
There is NO EXCUSE whatsoever and I believe that anyone who did this should be fully prosecuted to the full extent of the law.
What makes "them" any different then the terrorists we are fighting in Iraq? At least we can see them and are trained to fight our enemies and do it well.
All it took was for 1 person that knew of this disgrace in the clinic to make a call, without giving their name and this could of been prevented.
I know that God will be the final judge on these people.
With hope and prayers to all who have or are suffering now with these diseases, and are waiting for the "results" may God Bless you with HIS PEACE during this time of bio-war in our valley.
By cy

3/6/08 at 7:49 p.m.

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I am glad that the AngryPostman thinks out of state doctors are good. Do they become bad once they cross the stateline? Does this change happen to anybody else? Just curious.
By LVresident

4/30/08 at 6:01 p.m.

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April 30th - I JUST HEARD ON THE NEWS THAT ONE OF THE DOCTORS IS SHIPPING HIS CAR TO DUBAI???

When are we going to get a prosecutor that will file charges on these doctors and put them in jail. They have knowingly exposed people to deadly diseases. If this is not attempted murder or terrorist attack, what is? Before our prosecutors do anything, these doctors will all leave the country and the city and county will be left with hundreds of thousands of victims and no way to get any restitution from any of them.

How can we get our elected officials to understand this is a crisis of criminal activity? These centers not only reused needles, but plastic tubes and mouthpieces that could not be resterilized. What harm do they plan to do? This is more than cost effectiveness.

ARE THE ELECTED OFFICIALS LISTENING???

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