Former patient sues clinic, doctor, says rushed exam missed colon cancer

Wednesday, March 12, 2008 | 2 a.m.

Rexford lawsuit

Pricey Desai dumped by hospital

Assembly-line colonoscopies at clinic described (3-9-2008)
Sun Editorial: Restoring public trust (3-6-2008)
Sun Topic: Hepatitis scare

Indian doctor in US syringe scandal (3-7-2008)
Colon cancer on WebMd

Kevin Rexford’s main concern isn’t whether he left the Endoscopy Center of Southern Nevada with hepatitis. Rexford says he left the center with cancer.

The 46-year-old Las Vegas pharmacist filed a lawsuit in January 2007 against the center and Dr. Clifford Carrol, one of its owners. Rexford claims Carrol failed to recognize clear signs of colon cancer three years ago because he rushed through a colonoscopy in half the minimum recommended time.

The alleged failure allowed the cancer to metastasize to his liver and abdominal wall, medical experts claim on his behalf in court filings.

If the cancer had been caught at the time, Rexford would have had better than an 80 percent chance of survival, his experts argue. Now, doctors give him less than a one in 10 chance of living five years.

The lawsuit raises the possibility that problems at the clinic reached deeper than dangerous injection practices by clinic employees that might have exposed 40,000 patients to hepatitis B or C, or to HIV. The lawsuit questions the quality of medical care by the doctors themselves.

Medical experts say failure to find the cancer resulted from one of many flawed practices at the clinic, which is majority-owned by Dr. Dipak Desai, one of the state’s most powerful and politically connected physicians.

The clinic committed three fundamental errors in the case, said Dr. Russell D. Yang, a gastroenterologist and associate professor at the Keck School of Medicine at the University of Southern California who is working on Rexford’s behalf: failure to identify the signs of colon cancer, technical failure in performing the endoscopy, and institutional failures in quality assurance.

Documents in the case include a report by an anesthesiologist who said the clinic was grossly overbilling insurance companies and Medicare and Medicaid, the government’s insurance programs. This information might be interesting to the federal and state authorities who are now investigating possible fraud at the clinic.

Neither Carrol nor his attorney, Sherman Mayor, returned the Sun’s calls for comment. But Mayor wrote in court documents that there is no evidence of negligence on Carrol’s part. The cancer was caused by factors outside Carrol’s control, and the doctor used reasonable care and diligence in treating Rexford, the defense attorney said.

Rexford has a wife and two children, ages 11 and 12. Las Vegas cancer specialist Dr. Arnold Wax, who is now Rexford’s doctor and was hired by the plaintiff to examine his medical records, says Rexford showed signs of colon cancer when, on Dec. 6, 2004, he went to the Gastroenterology Center of Nevada, which was founded by Desai.

Wax said Rexford had constipation, abdominal pain, fatigue and hidden blood in his stool, all signs of possible colon cancer.

Wax wrote that the physician assistant who saw Rexford that day did not determine how long he had suffered the abdominal pain. His records said he had no family history of colon cancer, although his grandfather had actually died of the disease, Wax wrote. The physician assistant did not do a rectal exam or test to determine whether Rexford had been bleeding, Wax said.

Two months later, on Jan. 28, 2005, Carrol performed the colonoscopy at the Endoscopy Center of Southern Nevada.

Yang, the university gastroenterologist, noted that Carrol said in his deposition that he could perform 30 to 33 procedures a day, and once set a record at 50.

“With the undue pressure to perform these many procedures by an individual physician in a single day, patients are unnecessarily exposed to procedural risks including missed diagnosis,” Yang wrote.

Medical records show that the Rexford colonoscopy lasted eight minutes. Given that the anesthetic took two to three minutes to take effect and that Carrol testified he needed three minutes to advance the scope into the body, he had only three minutes at most to examine 6 to 8 feet of colon, which is done as the scope is withdrawn, Yang said.

Published research shows it takes six to eight minutes to perform an adequate exam, Yang said. Thus, a three-minute exam is half the minimum standard and means the “risk of missing a lesion is unacceptably high and falls below the standard of care,” Yang wrote.

Yang said the “pattern of carelessness” continued in Rexford’s four follow-up visits, when he was seen by three different individuals. Rexford “fell through the cracks in a practice geared toward seeing a large volume of patients without continuity of care.” Rexford was given no plan of action, so he did not have a repeated blood count or stool test for blood, which could have provided other indications of cancer, Yang said. And there appears to be “no coordination or discussion concerning a young male with classic symptoms of colon cancer,” Yang wrote.

“Kevin represents a series of failures by Dr. Carrol which resulted in a colon cancer which has progressed to an incurable stage,” Yang said.

Finally, Yang said clinics he is familiar with have quality assurance programs that include peer review to ensure doctors follow guidelines for performing procedures. But both Carrol and Desai, who was medical director of the clinic, said in their depositions that no peer review program existed at the clinic, Yang said.

The court record also includes a report by Las Vegas anesthesiologist Dr. Joseph Schifini, who reviewed the Endoscopy Center’s anesthesia records. They showed that certified nurse anesthetist Ronald Lakeman documented 31 minutes of anesthesia time. Schifini said that was highly unlikely for an eight-minute exam, noting that the record shows Lakeman was monitoring Rexford 25 minutes after the intravenous catheter was removed by a recovery nurse.

The 31 minutes is significant because anesthesia is billed to insurance companies in 15-minute increments, Schifini said, allowing the Endoscopy Center to bill for three 15-minute time frames because of the extra minute. This also meshes with what a nurse who worked at the clinic told the Sun. She said every procedure was billed for at least 30 minutes of anesthetic.

Discussion: 9 comments so far…

By indethink

3/12/08 at 9:44 a.m.

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Wow, 50 endoscopies in one day. At a safe rate of 30 minutes per endoscopy, Carrol and all the staff worked at least 25 hours that day!
By confusedvegan

3/12/08 at 11:38 a.m.

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Wow.. so these guys are bigger idiots than we were first told? How come this story has not come out before if this lawsuit was filed over a year ago? Who is the attorney suing these guys? You would think the public might want to know so they can get an attorney who already knows how horrible these doctors are!! Unless it is one of these advertising idiots who is foaming at the mouth to get a piece of the action. Question then? If all these patients possibly got sick from going to a sloppy mill type clinic where there is no individualized attention given to the patient, why would so many of them go to an attorney who practices in essentially the same way (volume over individuality)?
By CynicalObserver

3/12/08 at 2:38 p.m.

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I had a colonoscopy performed at local hospital by Dr. Nicolae Weisz, who is one of the doctors practicing at the Gastroenterology Center owned by Dr. Desai & partners. I do not yet know whether Dr. Weisz was a partner or a mere employee.

At the time Dr. Weisz seemed like a conscientious person. However, since I was asleep during the procedure, I don't know how long it took. Did Dr. Weisz follow his medical group's custom of "taking a fast look"? I have no way of knowing, except to go and look at my medical records at the hospital.

I appreciate the technical information disclosed in Marshall Allen's article, because it will allow me to review my hospital records and determine whether I need to have another colonoscopy.

Sad as it seems, everyone who had a colonoscopy performed by a doctor from this medical group should be checking their medical records.
By jsquared01

3/13/08 at 4:37 p.m.

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I met with my primary care doctor earlier this week to discuss this very issue, as a small polyp was discovered and removed during my colonoscopy 6 months ago at the location on Shadow Lane. My doctor said that my concerns were not unfounded, as there was an article that had come out on Sunday about the clinic rushing procedures and went on to tell me how she has had patients who had colonoscopies at that facility where it was learned later that the doctors there had missed polyps/cancer (note, she did not refer me there, I had gone there once before back in 2004 before she was my doctor). In any case, she felt that I should have another colonscopy, especially in light of my family history (both my mother and grandmother died from this disease, my mom was 42 when she died). I am in a high risk category and I am almost assured a death sentence if they in fact missed something. I'm hoping the word gets out there that it may be a wise decision to undergo another test if you are one of those that fall in a high risk category. I have spent 17 years educating myself on this disease and having regular preventative screenings so not to suffer the horrible death my mom and grandma did, only to find out that no matter how on top of your care you think you are, that there are doctors out there who care more about money, power and bragging that they can do a 15 minute procedure in 5 mins. All I can say is... What goes around comes around!!!!
By pmcgregor

3/13/08 at 5:31 p.m.

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Dr. Wang is right on the mark. They could not have done an adequate exam on the pull out, no matter how fast they got to the end point, the ileum. I feel really sorry for these patients, and disgusted with the 'gastroenterologists' who sacrificed speed for accuracy, with death standing at the door, for many. As an endoscopy nurse, I am really grateful for the integrity of the physicians with whom I worked. They received a 'stipend' to direct the medical affairs of the department; I doubt if it went above $30,000 annually. But the hospital also had a nurse director (me), on salary, and most of the day to day details were handled this way, leaving only purely medical decisions to the medical director. Very efficient, and kept self interest at a standstill.
By JoPlezia

3/24/08 at 3:21 p.m.

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My father went to this clinic in October 2006 and Saturday, 3/22/08 we found out that he has a turmor completely blocking his colon with 3 tumors in his liver. One tumor is 5" long. His doctor that perform the procedure on 03/22/08 says there is no way my father's situation got this out of hand in such a short period. They missed the colon cancer in 2006. Now I am in the process of trying to find a surgeon that specializes in liver operations to give my farther a chance to life.

How do these and others sleep at night? What I would like to do to this owner is get every know horrible disease and inject him with it, put him in a cell and make him suffer the diseases. Torture the good doctor for putting his profit over peoples' health and lives at stake.
By vincent

11/9/08 at 11:22 a.m.

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I have not filed a lawsuit against Doctor Desai, but I should have.

Doctor Desau and his clinic treated my wife. She was schedueled to have a endoscopy of her throat at the clinic.
We keep he appointment that day, she is taken in, only to be returned about ten minutes later.
She has a anti biotic hooked up to her. I ask the nurse why?
"The doctor didn't know she has two mechanical heart valves and needs this before they procede." She tells me.

Didn't anyone at all look at here medical record in all this time from the initial exam two weeks ago?

Didn't they see she is a stroke victim, partially paralixed, confined to a wheel chair, is a diabetic, cannot swllow os speak due to the stroke, and that she has two mechanical valves in her chest? Evidently no one looked or cared.

She is taken back again for the test only to return again a half hour later.

Nurse, "The couldn't go ahead she was to difficult to have the tube inserted, It will have to be done at a hospital so she can be put asleep." I am told.

"Didn't they sedate her." I ask.
"NO." WAS HER REPLY.

It's on her record for that day, (no sedation)

What happened at the hospital is too long a story to include here.

They put the final nail on my wif's coffin.

Vincebt T. Ciano

Henderson
By vincent

11/9/08 at 3:44 p.m.

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My wife's treatment by Doctor Desai. FOR FULL STORY CLICK URL.

http://community-2.webtv.net/bd14me/mess...
By vincent

11/19/08 at 3:50 p.m.

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Sent to me by e mail.

My answer to "Average citizen:"

The doctors pay high insurance rates for the protection, why shouldn't they pay ?

E-mail message

From: REMOVED

Date: Mon, Nov 10, 2008, 8:01am (PST+3)

To: bd14me@webtv.net (a victim)

Subject: Re: THERE OUGHT TO BE A LAW

Sadly, I must agree with the decision against allowing the lawsuit to procede against Nevada Mutual as they, too, were also merely victims of Dr. Desai.

However, not to rule to allow the Class-action Lawsuit to continue is tantamount to a rape victim being screwed over by some legal technicaliy. Obviously, when several people come forward with empiracal evidence of malpractice by the one man who they placed their hopes and trust in, this must show that there is clearly a risk to the health and safety of the general public and the Government is entrusted to provide us, it's citizens. with a CONSTITUTIONAL PROTECTION to matters of Life, Liberty and the Pursuit of Happiness.

Now, the Legal System, usually favors the Criminally Negligent Doctors by placing such huge roadblocks in the path of the 'VICTIMS". They must first find a lawyer willing to fight the System, then they need to pay Tens of Thousands of Dollars to Medical WItnesses of equal stature to the accused doctor. Surely if Dr. Desai has done no harm by his actions, then other medical pesonnel would not come forward for any payment....but if he has, where do victims get the money to pay medical witnesses?

Do you think the Average Joe has that kind of cash ? No, Sacrifices would have had to be made by the Doctor's Victims. I see Mortgages and Credit Cards ( and, perhaps, cashing in the kid's College Funds) coming into the picture.
In the end it will ll be worth it, right? As this case shows, the answer is WRONG.

I think that you should also know that I have no physical connection to this case or any of its participants. I am, however, emotionally connected and appalled, as every normal citizen would be, by what I see. I think its time that the Courts dispence with the technicalities and get back to the business of Justice.

I think Judge Judy has the right idea. Let the Victims prove their case by a preponderence of the evidence then give us a ruling by the SPIRIT of the law, not the letter of the law.

Average Citizen