Decoding their silence

By Brian Eckhouse

Thursday, March 13, 2008 | 2 a.m.

Community reaction to the revelation that a group of Las Vegas health clinics reused syringes and single-use vials has been one of universal revulsion.

Owners knowingly put more than 40,000 patients at risk of hepatitis and HIV infection in a quest to run as many patients as possible through the Endoscopy Center of Southern Nevada and other clinics.

The motive was simple greed, which, perversely, made sense. Owners had put profit ahead of medicine.

But what of the salaried nurses and technicians who worked at the clinics? How could they have gone along with the dangerous procedures, violating common moral standards, not to mention basic medical training to first do no harm? As instructed, they were reusing syringes and bottles of anesthesia meant strictly for individual patients.

The staff members had to have known at some point that their practice was reckless, said Frank Farley, former president of the American Psychological Association and a psychology professor at Temple University in Philadelphia.

Yet those employees didn’t blow the whistle — a step they could have taken anonymously if they feared for their jobs.

The reason they did not remains a mystery because the nurses haven’t returned phone calls from reporters or responded to knocks on their doors.

Psychologists, however, have a theory. They call it “social facilitation.” It consists of a series of behaviors that can erode the distinction between right and wrong.

If social facilitation occurred at the Endoscopy Center, it could have happened like this: A respected or feared employee took the lead. He or she began reusing syringes and dipping them into the single-dose vials. When other staff members saw no evidence of spreading infection, they followed the first employee’s lead. Each month that passed without infection would have served only to reinforce the behavior as acceptable.

“In some way, they lulled themselves into thinking it was not dangerous — something minor,” said psychologist Elliot Aronson, a professor emeritus at UC Santa Cruz.

The nurses and technicians could have begun to regard the reuse of syringes and vials as akin to the patient who takes pills past the recommended expiration date, Aronson said. “It’s a bit of a leap, but not a huge one,” he said.

Another factor that cannot be dismissed is the role of pressure from the bosses, who sought to make more money. Employees hoping to keep their jobs often have a tendency to discount reality, said Bruce Spring, a professor of psychiatry at the University of Southern California. “We can be blind in the service of our own interests,” Spring said.

Endoscopy Center majority owner Dr. Dipak Desai was well-connected to Nevada’s medical and political communities. His long reach could threaten the career of any employee who blew the whistle.

“It’s not just about being a good boy,” Spring said. “It’s about putting food on the table for the family.”

The most inflammatory psychological explanation heard in Nevada recently likens Desai’s staff to Nazi minions — the “good Germans” who gassed Jews because, they later claimed, they were simply following orders.

But that analogy is flawed, Aronson argued. Anti-Semitic fervor was rampant in Germany after World War I. “The Jews were viewed as vermin and blamed for the economic depression,” he said. “The Germans could (gas them) without conscience.”

That wasn’t the case in Nevada. Nurses and technicians had no reason to dislike a patient, no way to dodge moral responsibility for their behavior by cloaking it in hate.

As for Desai, Farley has a few thoughts. The Temple University professor said Desai, who was involved in a number of clinics and other medical endeavors, probably had a strong entrepreneurial streak — an uncommon characteristic for a doctor.

Entrepreneurs often ooze self-confidence and are risk-takers. “They look at Mount Everest and say: ‘I can climb that,’ ” Farley said.

Many entrepreneurs tend to cut corners, if not bend the rules — a behavior, Farley said, that “created the modern world” but also can be destructive.