State failed to inspect clinic for seven years

Thursday, March 6, 2008 | 2 a.m.

Hepatitis scare

Bureau of Licensure and Certification

The Nevada agency in charge of inspecting medical facilities issued a memo in 2001 promising complete inspections of medical facilities every three years.

Since 2001, however, the state had not conducted a single full inspection of the Endoscopy Center of Southern Nevada before investigators traced a hepatitis C outbreak to facility in January, leading to the largest public health crisis of its kind.

There is no guarantee that an inspection would have uncovered the practices that led to 40,000 former patients being notified last week that they need to be tested for hepatitis B, hepatitis C and HIV. But it was the best chance the state had to spot the deliberarly risky procedures that created the outbreak.

If the state Licensure and Certification Bureau had followed its announced schedule, the center would have been inspected in 2007 and in 2004 — the year health officials believe supervisors there adopted the careless procedures.

Asked Wednesday whether inspections would have uncovered the problem earlier, the bureau's chief, Lisa Jones, said: “Maybe. We just don’t know the answer to that.”

She ascribed the failure to inspect to a lack of resources and difficulty in recruiting inspectors.

If the agency had followed its schedule, two inspectors would have spent two days at the clinic in 2004--the same year health officials believe the clinic adopted the flawed procedures. The inspectors would have observed medical protocols and discussed them with staff, Jones said. Those discussions could have offered employees a chance to quietly reveal that they were being asked to follow the medically risky procedures. One of the many questions surrounding the outbreak is why none of those employees blew the whistle.

“We have to count on education,” Jones said, “and we have to rely on health care practitioners taking responsibility for standards of practice.” Jones stressed that even the full inspections are “only snapshots in time.”

Such a snapshot did take place in January after a cluster of hepatitis C cases pointed to the Endoscopy Center of Southern Nevada as a source.

Health investigators watched nurses reuse syringes to draw anesthesia from vials. If the reused syringes had been in contact with a diseased patient, the vials became contaminated. That alone would not have spread the disease if the nurses had thrown away each vial after it was used on a single patient, as intended. Instead, anesthetic was withdrawn from the vials and used on other patients, spreading the disease.

Assemblywoman Sheila Leslie, D-Reno, is chairing a meeting today to review the state’s oversight and response to the Endoscopy Center crisis. Told of the seven-year lapse in inspections, Leslie said Wednesday that it “is completely unacceptable. The state needs to do better than that.”

Jones said the state is focused on inspecting all facilities. “Going forward now, we’re retooling all our resources and working to get on-site at all these centers,” she said.

The state has been at the Endoscopy Center of Southern Nevada other times since 2001. But those visits by state surveyors have been in response to complaints. And during those inspections, state surveyors more narrowly focus on addressing the subject of the complaints, Jones said. None of the complaints was based on syringe or single-dose medicine use.

In explaining the shortage of resources, Jones said her agency’s 25 inspectors are responsible for routine inspections and for responding to complaints at 1,100 facilities statewide.

The volume of complaints forced the agency to cut back on routine, thorough inspections, she said.

The Licensure and Certification Bureau is supported by fees paid by facilities. Earlier this decade, Jones said, fees weren’t keeping up, so vacant positions were frozen and eventually eliminated. In this past session, in 2007, the Legislature allocated seven more positions to the agency, though it has been difficult recruiting people, Jones said.

Leslie said, “I guess the moral of the story is that you get what you pay for.”

State legislators today will look at the state’s role in the public health crisis.

Among questions Leslie said she intends to ask:

• Are the fines sufficient?

• Are inspections of medical facilities by the state sufficient?

• Was the state’s response to the crisis sufficient?

The Endoscopy Center of Southern Nevada has so far been given a $3,000 penalty. If that seems mild, consider that if this had happened in Colorado, Oregon or California, the clinic would have faced no fines. In New Mexico, the maximum fine would have been $15,000.

In Nevada, the fines were capped by a 1989 state law at a maximum of $1,000 per violation. The level of fines was intended to encourage compliance, not as a punishment for bad operators who corrected their ways, Jones said.

Leslie said the fines struck her as too low. But she said, “To be fair, I don’t think anyone envisioned malfeasance or behavior this egregious.”

The assemblywoman also said Nevadans have frequently resisted granting government more oversight, arguing that it could squelch business.

“Nevada has a libertarian, ‘regulation is bad’ attitude,” she said. “This tragedy may make people realize regulation is there to protect the people, not harass business.”

Larry Matheis, executive director of the Nevada State Medical Association, said professional organizations and governmental agencies should use this as an opportunity to come together and review regulations.

“You don’t want to make this so difficult that it discourages available services,” Matheis said. “At the same time, the first responsibility of all agencies is protecting the public.”

State Sen. Randolph Townsend, R-Reno, wrote letters to state officials asking them to prepare by early next month a report on how the hepatitis outbreak occurred.

“Do they need more authority, more regulatory authority?” he asked. “We don’t know.”

Discussion: 9 comments so far…

By catalinakel

3/6/08 at 12:54 p.m.

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Leslie said, “I guess the moral of the story is that you get what you pay for.”

And what Dipak Desai paid for is freedom from oversight, apparently. Sadly. Tragically.

This little mistake might just affect home prices more than the lousy sub-prime loans.

Good thing, too. That will probably keep people away; keep people from having to risk their lives when the need for medical care arises.

The horrendous medical care (barely) available in Southern Nevada is frightening. I fear this episode may only be the tip of an iceberg.
By KC

3/7/08 at 10:38 a.m.

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It is only the tip of the iceberg. This city in more ways then one has been "slipping" for a long time not only in the medical field, but in other ways too.

Our gov't officials, our elected county officials etc,,are all being paid by our tax dollars taken from us at the high price of what our homes "use" to be worth, and personally I don't believe that due to lack of funds or positions that the health inspectors did their job properly being they knew of different problems with these clinics years ago. And am sure they know of other health issues in the valley they are not talking about. This city is all about CYA and MONEY!

Believe me there is much more that is going on in the medical fields that is not seen. And probably as most people feel, just like I do, you try to call them, try to report something and you get no response.

If I could move out of his city I would,,,but now I wait to find out if what they have done to thousands of others they have done to my family. With their "Injections"

There is really no comparison in the following,,but it would not surprise me if they work in the same office bldgs.

Try calling the animal control people to capture a loose dog or file a complaint. They want "you" the "victim" to give your name, telephone number, address, and want you to take care of the problem, I have personally been asked well do you have the animal caged. Since when is it my job to capture,,, this is what they get paid for,,,,they are too busy,,there are many who want jobs in this city, take a look at our unemployment status, and we are being told this "garbage" I don't believe it at all. Yeh let them all try to cover their tails. They have a lot to answer for and we have not seen the end of it and won't for several years.

The bottom line is this,,,these places of biz want to say it is all money related,,lack there of etc,,lets just face the facts there are not many if any who are willing to face up to the fact that they don't care, just want a paycheck.

My question to the health district would be,,,did you go to these facilities or did you send any of your loved ones there for treatment, knowing what you did years ago?
By KC

3/7/08 at 1:58 p.m.

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catalinakel

You mentioned in your post:
This little mistake might just affect home prices more than the lousy sub-prime loans.

And:

Leslie said, “I guess the moral of the story is that you get what you pay for.”

I hope that I am "misreading" your comments,,this by all means is no little mistake, and also those that had the tests done at the clinics for their health have been dealt a devestating blow to their own health, their loved ones and those of this valley and all that have lived here before, and moved on.

Maybe I misunderstood you,,,but this is no little matter.

As for the housing dept,,,and the loans,,we are talking about peoples lives here.

No matter what kind of "money" anyone has or doesn't have,,,it can not buy your health.

People bought their homes and signed papers at whatever interest rates they agreed upon. That was their "choice" in this matter with the clinics,,,as I for one await my husbands test results as so many others wait for their loved ones test results,,,did NOT HAVE A CHOICE.
By KC

3/7/08 at 3:28 p.m.

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Thank you GOD for your comment,,now all we can do is pray to GOD that he has not allowed innocent people to be destroyed by these people that care about no one but their money and jobs,,,

God will prevail HE knows who each and everyone of them are. They can run, they can hide but they are not going to be able to buy their way out of this one with their endless chatter, etc...and I believe in "the golden rule" so they may be standing in line waiting for us to inject them with these diseases!

Wonder if they are able to sleep at night? After playing "mini gods" in their biz life,,,as I mentioned in another post this is just as bad if not worse then the terrorists. At least the suicidal bombers take themselves out too! Instead we see Dr Desai on the tv looking smug.

I know that there are thousands out there right now that are pacing the floors,,,waiting and wondering......
Me being one of them....
By CynicalObserver

3/7/08 at 8:22 p.m.

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I just watched Nevada Week in Review. They discussed the fact that Channel 8 and one newspaper are breaking a story that the state employees responsible for inspecting these outpatient surgery centers asked the Governor to fund 5 more inspectors. Governor Gibbons refused, citing his "no new taxes" pledge. He refused after Drs. Desai and Sharma lobbied him on the issue. Bye, bye Governor Jimbo. Rhymes with dumb bimbo.

I can't wait to see the election ads on this topic! The public won't forget by then, because the Hep C patients may be dying, the HIV patients may be showing symptoms, and the irritating parts of the litigation will be in full swing.
By JES

3/7/08 at 8:46 p.m.

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Still waiting for the results of my test. Wonder how many other cope with thinking and hearing about this non-stop. I just wish they could get my results so that part goes away, and that part is the wondering and worrying. I have four kids a wife and dang good job. I love las vegas and would never leave, regardless of the test results. It's not the city or state, it was one man's greed that effected a lot of people who will in turn truly suffer for many years with worry and termoil.
By Snippy

3/7/08 at 10:35 p.m.

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I get riled up when I think and hear about this mess Jes! I hope you get your results soon. Those last few hours when you know the results are waiting for you at the doctors office are the toughest. That's when it really sinks in. Much worse than the week's wait. Isn't it funny how this all started over Medical Professional's greed, yet, in order to get your results, you are required to go pay a Medical Professional to give them to you. I somewhat agree about this city. I love it here, the weather is nice 9 months out of the year, tolerable those 3 hot months, but I have to say, I have thought of leaving before because of the medical situation which I think is mostly caused by greed.... how many patients can we cram in an hour, don't spend to much time on a patient, let the patient leave without diagnosis, forcing them to continually come back time and time again while they just keep billing for each visit, but the greed kind of bothers me in other places around this city also. The health care greed is most upsetting because it causes disregard for life. They make so much more than the average Joe, why do they want so much more and willing to get it in these ways? It's bad here, and if this mess doesn't turn it around and fast, some of us who are sick will have to leave to get good proper care and diagnosis. Greed is prevelant here in this city, but when it becomes so apparent in our health care and you know it will adversely affect you and your family... its time to go. That reality really stinks, but it is before us all.
By KC

3/9/08 at 6:38 p.m.

Suggest removal

I agree with you Jes,,,and the rest that are awaiting their results.
My husbands should be coming in this week,,,and I have been hardly able to try and stay "normal" acting or functioning,,

I look at my husband, read these articles and the tears start to flow, because I know since his test that he had done in Nov 07 at the burnham hack and whack clinic, that he has had more problems with his colon etc......

As for myself I have been more tired out as he has too, now add this to the mix of dealing with family that has not been to these hack and whack clinics, caught HEP C,,,and other family members that were in the hospital for other reasons, the whole medical mafia here scares me.

If I could I would leave LV in a heartbeat,,,but right now as so many others unable to.

Hopefully some "good" can come out of this for this valley, it is long overdue that the people of Las Vegas band together and do something to change the ways of our city.

We need to pull together,,,and this is one of the few places I have seen this happen. I know there are so many loving and caring people here in this city,,,,,so lets try to band together and get rid of this corruption in this city we call home.

Any suggestions I am open to them~
Just email me privately,,by clicking on my nic.
To me this is out right Greed and it needs to stop,,,and it is going to take all of us to stop it!

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