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FacebookHow the culture of cost-cutting in Nevada’s capital contributed to the Endoscopy Center scandal
Sun, Mar 9, 2008 (3:01 a.m.)
If the world as we know it were to come to an end, we always knew it would start here.
I have visions of a Crichtonesque warren of underground laboratories, with a team of scientists racing against the clock to find the right strain of hep C, while overhead Dustin Hoffman and Cuba Gooding Jr. are helicoptering for help before the Big One is dropped on Las Vegas, thus saving the world from infection.
So many story lines — some old, some new — have intersected since word first broke nearly two weeks ago of The Great Hepatitis Scare of 2008 that some kind of apocalyptic climax hardly seems unlikely after the frenzied fortnight.
This is a national, nay, international embarrassment for the state and its most famous city, a toxic mixture of questionable medical practices, illogical governmental regulation, opportunistic political posturing and media sensationalism. And the current, horrifying state of affairs, as federal inspectors alight here and every agency imaginable has launched an investigation, finds too many valley residents frightened they have contracted potentially fatal diseases and too many afraid to go for tests (colonoscopies or other procedures) that could save their lives — if they can even find a specialist who can schedule them.
Attorney Will Kemp was the first to invoke the “Third World” analogy to describe the medical practices at the Endoscopy Center of Southern Nevada, and Health District epidemiologist Brian Labus went him one better, saying they would have to be bumped up to make it to Third World status.
Hackneyed it may be, but it is an all too apt metaphor for a state where social services are derided as a luxury, regulation is considered a dirty word and politicians are skilled at ex post facto fulmination but deficient in progressive foresight.
My guess — and fervent hope — is that despite the hyperventilation by too many media folks and too many politicians, very few people will have been infected at local clinics. But based on what already has been discovered — ambulatory surgical centers (50 in the state) are inspected only every three years and regulatory divisions of the state are grossly underfunded and always the first victim of budget cuts — that will be as much luck as anything. (And what of practices at hospitals, doctors’ offices, dialysis centers? We’ll get there eventually.)
Nevada is a Third World country when it comes to most serious funding issues, be it schools, roads or medical clinic oversight. And at some point, as I have been haranguing for years, the infrastructure would begin to buckle — and will break if too many “no new taxes” and “let the market decide” brains populate Carson City. Welcome to that moment.
No new taxes (or fees) have reduced the number of inspectors — the Legislature actually had to reinstate what the governor cut — and the market has decided that if health care facilities need to cut corners, government has no imperative to keep track. Perhaps more inspectors wouldn’t have caught these unsafe procedures at the Endoscopy Center and God knows where else — but it certainly would have dramatically increased the likelihood that they would have been detected earlier.
All of this is par for this Third World course.
“We are already one of the worst states in the nation in terms of access to health care,” Health and Human Services Director Mike Willden lamented in a conference call with reporters Friday as he announced other clinics would be cited.
Doctors, nurses, other trained professionals who knowingly put patients at risk — that’s the easy part of the story. If that can be proved, they will lose their licenses, their livelihoods and, maybe, their freedom.
But let’s assume for the sake of argument —and sanity — that kind of attitude does not pervade the state’s medical system, ridiculed for so long but enhanced in recent years by new facilities such as the Nevada Cancer Institute and the Lou Ruvo Brain Institute. As state epidemiologist Dr. Ihsan Azzam told me, as puzzled as he is by these discoveries, he doesn’t believe any of it was intentional.
“It is about what you know and what you do,” he said of practices such as reusing syringes. “How many of us know we need to wash our hands? And how many do?”
Maybe if the state devoted more resources to ensuring antiseptic procedures in health care facilities — and this is a microcosm in our Third World — we wouldn’t see so many Pontius Pilates now, from the politicians to the regulators to the medical community, trying to claim clean hands.
Discussion: 15 comments so far…
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For those who are worried and scared about contracting a disease, the risk is small. I have not seen reports of additional cases. Be sure to get tested; chances very good for each one of you that the tests will be O K.
For those who are infected, my heart goes out to you.
For those who are outraged,"Amen".
No Jon, it is not lack of funds, it is lack of priority on the part of the Clark County Health District. They've been giving their priorities
to throwing expensive no smoking parties for teenagers monthly at local casinos and giving tickets to smokers. It's about lazy union employees who prefer to spend their time doing other things. It's time to call for the firing of each and every Health District employee for
an obvious failure to give priority to REAL
health issues and replace all of them with NON
union employees. There are plenty of people who
would love to have a chance to prove their competence instead of allowing these lazy slack offs to simply get more money. This has been going on for 7 years! Kenny Guinn's billion
dollar tax increase didn't seem to make any difference in their failure to prioritize.
JUST FIRE THEM ALL AND START OVER!
Yes, the republicans want everything for free and without taxes: School,roads,meat inspectors and health inspectors and of course the republicans want no regulations. It is time they and all of us grow up. There is no free lunch and most regulations serve to protect the public.. What can we expect from republicans when they want to go to(and continue) a very expensive war and pay less taxes. Credit card payments for a war and IOUs to China have put US into a long and hard recession
I agree with you John. I congratulate you in having the conviction to say how the media (and then to cover their asses politicians )hyperventilated and have created a mess like this. Sick patients will suffer and dangerous disease that can be prevented will raise their ugly head.
John's tone in today's column, as well as his last one, suspiciously sounds like he's going to fall into the apologists' camp. If John does that, he will lose all credibility with the masses.
The apologists are pushing three key points to make it seem like the activities at the clinics were not so bad: (1) A claim that the number of people actually infected is going to be small, (2) doctors as a group are well intentioned and (3) the insurance companies are going to punish all of Las Vegas by raising insurance rates.
My view is that there are lots of reprehensible actors here, and that all of them will get what they deserve, bad publicity for the medical community included.
I agree - sounds like Mr. Ralston is trying to tone down the rage felt by most of our community. Doctors are doing things intentionally, motivated by greed...knowing that by cutting corners allows them to see more patients is a great motivator. Health care in Nevada is abominable; however, it is true that there are some good doctors. I believe that if these good doctors have any sense at all, they will be leaving the state. Malpractice premiums are sure to rise, the Board will become more disciplined-inclined, and Medicare cuts are looming, decreasing reimbursement rates. It isn't about what you know and what you do; it's about what you know you should do to uphold your Hippocratic oath.
But, gee, how is it malpractice rates will rise? Weren't we promised if we passed the limits on doctor's liability that would keep rates from going up?
Didn't you mean the doctor's insurance rates will go up? Medical malpractice insurance may go up if the hoards of government officials undo what should have never been done and turn that medical malpractice cap around. And I still say, the doctors who screw up and commit negligent medical malpractice, especially because of greed, should have their medical malpractice rates raised. To bad it is usually only raised years after a medical malpractice suit and the insurance finally had to pay up to the injured. I believe the doctor who is good, kind and attends to his/her patients needs should only have to pay the rates of their good record, but the abusers should see that money go the same way it came.
We were promised a lot of things, weren't we? I agree, real medical malpractice should not be tolerated. However, there are too many greedy attorneys and patients out there who don't know the difference between a known risk or complication of surgery and true negligence. What these doctors did was true negligence and they should be punished, but surgeries do carry risk. Someone wrote recently that if the lawyers truly felt their clients deserved $1 million, why do they take up to 40%? Plus, rising malpractice rates for doctors don't help patients...the good ones who treat patients with difficult conditions can't afford to stay, leaving us with mediocre docs or docs who won't touch a difficult case. We're in deep trouble with a bunch of empty promises.
This doctor should be charged criminally under the RICO statutes as an ongoing criminal enterprise.
Short of that, deport him and his accomplice wife back to the "3rd world" that bred this greed into them.
While State regulators should have been on the ball, it is just as shocking that the insurance carrier covering the malpractice - liability was not auditing this practice. After all, it is the insurance carrier who ultimately assumes the risk.
Does anybody know who the carrier is for Endoscopy Center of Southern Nevada?
MORE POLITICAL RHETORIC, NAME CALLING, AND FINGER POINTING INSTEAD OF ACTION, JAIL, CONVICTIONS, AND PRISON!
Pathological greed and political power combined with incompetent political appointments,impotent local and state agencies coalesce into 3rd world medicine in Nevada. No wonder we get all the medical practioner rejects from the other 49 states practicing here. Just lovely.
Dear hfcooke: Why would an insurance company be inclined to watch over this clinic. Think about that, not only do I think that may be against the law, but most importantly... how much would watching over the clinic cost them. Taking into account that these doctors liability is about $50,000 and not more, why would the insurance company add additional expense to that. You know if their liability is only $50,000, the insurance companies do not make a profit if they spend it watching over the doctors and the clinic. It really is not their place either. What do they know, they are glorified accountants. Looks like we are back to making money 101 in Las Vegas again. Money really makes the world go around huh. There has got to be a better way to balance it than this $50,000 cap for all our sakes.
Patient2008: I agree, people file the silliest, most stupid and very greedy lawsuits. Some people will say they do it because it is a free country and they can. The Courts sometimes need to think more about the Defendants rights as well, but in reality, they do that. When was the last time anyone heard of the Court ordering costs to be paid from a Plaintiff in a bogus case which they just simply were laughed out of Court after wasting everyone's precious time. The Court's sometimes really do make the Plaintiffs pay the Defendants costs fighting that case, but if the person who sues doesn't have the money it is useless. Why don't we just look into other ways to make them pay.... like restitution - make them work it off while the payment/paycheck goes to the Defendant. But that is just a fleeting thought. There does have to be a way, I just don't think it was looked at by the able minded law makers. I'll tell you this much though... there are lawyers learning lessons on those types of cases. If it is a contingency fee agreement... they put work into it and if they lose, they make nothing for all their work. That helps slow the flimsy lawsuits down when noone is willing to take them anymore. The other side of that coin is that when there is a viable case, like medical malpractice and someone is injured or ripped off by not getting the treatment they go to these doctors for, There are not many attorneys at all that would take that case because all they can sue for is $50,000 and that is not enough for the time and energy they put into a case. Here we go with money makes the world go around again. Hard to balance that in a "free country"... unless you have money... you can buy it, not matter what IT is. Round and Round it goes.
Is everyone missing the boat here?
Six patients were found to have contracted Hepatitis C, whereas the average number of acute cases in Nevada is only two a year. Because of this anomaly an investigation was launched, and the common factor was that all six had endocrine procedures done at this clinic, five in one day.
Because the anesthesiologists had been found to have been using single dose vials of medicine on more than one patient, it was assumed that was the cause. That led to many more inspections at medical clinics, and the practice was found to be routine at many of them for a number of years.
But if this is so, and the practice is so inherently dangerous, why have there not been many more such incidents to now? Why have there only been an average of two per year up to now?
Doesn't it seem likely that something else might have caused those cases?
Given that these procedures involve inserting probes and other instruments into the rectum and colon of patients, one would expect those instruments to be scrupulously cleaned and sterilized before use on another patient.
But the doctor/owner of this clinic has bragged about doing fifty procedures a day. Even at a ten-hour working day that's only twelve minutes each for a procedure that normally takes fifteen minutes. Where is the time to properly check on the cleanliness of the equipment.
And I recall reading something about this or another clinic cited for not properly cleaning and sterilizing equipment.
By the way, how many different performed the procedures on those six patients? One? Two? Between two and six?