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Another violation, many clinics

Anesthesiologist admits risky practice

Updated Tuesday, March 11, 2008 | 7:34 p.m.

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A Las Vegas anesthesiologist told health inspectors he used injection practices similar to ones that have triggered the nation’s largest hepatitis C scare, adding a new wrinkle to a still-developing infectious disease crisis.

The doctor’s admission complicates the investigation because he has worked at hospitals and clinics throughout the valley.

Sources identified the physician as Dr. Scott Young, an independent contractor at the Gastrointestinal Diagnostic Clinic.

Health inspectors in January linked the hepatitis outbreak to the Endoscopy Center of Southern Nevada, where they said certified nurse anesthetists were using syringes multiple times on patients — a practice that could allow vials of anesthetics to be tainted with infected blood from the first patient and then passed on to other patients.

Authorities announced their findings Feb. 27, notifying about 40,000 clinic patients that they should be tested for infectious disease. Six patients contracted hepatitis C at the Endoscopy Center.

Before the announcement, authorities had launched inspections at other medical practices, including at the Gastrointestinal Diagnostic Clinic on Feb. 14, where they observed Young’s risky injection practices.

When reached by the Sun, Young said only that he could not talk about it.

The revelation came Monday as about 45 federal, state and local investigators, including Metro Police’s entire intelligence section, served search warrants on six valley clinics owned by the Endoscopy Center of Southern Nevada and the Gastroenterology Center of Nevada.

The state Health Division’s inspections of the Gastrointestinal Diagnostic Clinic, at 3196 S. Maryland Parkway, were not related to the emerging criminal probe.

Young, who is not named in the state document, told inspectors he changed the needles when administering anesthetics to patients — but thought it was OK to use the same syringes on individual and multiple patients because of where he introduced anesthetics into the IV line, documents show.

Brian Labus, senior epidemiologist for the Southern Nevada Health District, said syringes and vials of single-dose medicine should never be reused under any conditions because they can transfer tainted blood.

The Health District is trying to identify his patients, both at the clinic where he was observed and elsewhere. Because the investigation is ongoing, authorities say they don’t know whether more patients will need to be tested.

At their Feb. 14 surprise visit, inspectors observed Young using a syringe multiple times on the same vial of Propofol, an anesthetic, and then using that vial multiple times on other patients, according to the report.

Contamination warning

Propofol, also known as Diprivan, is made by the pharmaceutical company AstraZeneca and has strict guidelines for use. It’s for individual patient use only because it can “support the growth of microorganisms.” It is not to be used if “contamination is suspected,” the manufacturer’s guidelines say.

Young told inspectors it was OK to use the drug on multiple patients because the procedures were conducted so quickly, one after another, that there was not enough time for bacteria to grow. He initially said that when he switched to new patients he changed the needle, but reused the syringe on multiple patients, which he said was OK because a “high port” was used on the IV line.

In a separate interview a few minutes later, Young said he would discard the needle and syringe after each use, but not the vial of medicine.

Dr. Chris Millson, a Las Vegas-based board member of the American Society of Anesthesiologists, said Monday that while Young was not following the recommended practices, his case appears much different from what occurred at the Endoscopy Center of Southern Nevada, because Young was injecting into a “high-port” IV line, relatively far from the patient’s vein, minimizing the risk of blood backflow. In comparison, the Endoscopy Center patients’ injections were occurring in IV ports at the arm, he said.

Also, Millson said, while it’s not recommended to reuse Propofol, the likelihood of its hosting infection is extremely slim if the vial is consumed swiftly.

Labus said the risk to patients would have been about the same at both clinics. “They’re single use items, plain and simple,” Labus said.

Anesthesiologist dismissed

Young works throughout Las Vegas, including at University Medical Center. Health officials said they don’t know whether Young used the same injection practices at other sites.

Doctors at the gastroenterology clinic, a source said, dismissed Young after learning of the claims against him.

The unrelated criminal probe by federal and state authorities of the Endoscopy Center and the Gastroenterology Center of Nevada was launched Monday morning.

“This has the potential of being one of the largest criminal investigations into the medical field we’ve ever had in Nevada,” Clark County District Attorney David Roger said.

According to a copy of a five-page search warrant, investigators sought a wide range of business and medical records at the clinics from March 2004 through February.

FBI spokesman Joe Dickey described the investigation as a “high priority.”

Among other potential violations, federal and state agencies have the ability to pursue cases of Medicaid and insurance fraud in this investigation.

Attorney Richard Wright, who represents Dr. Dipak Desai, one of the owners of the clinics, declined to comment.

This story has been corrected. In an earlier version, Young was incorrectly associated with Summit Anesthesia.

On Tuesday, Millson said he wanted to clarify the impression he gave that he was condoning or minimizing the threat of using vials of propofol for multiple patients. He said the use of syringes or propofol on multiple patients is completely unacceptable.

Sun reporter Jeff German contributed to this article.

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