Las Vegas Sun

September 6, 2008

Nevada health crisis:

Decoding their silence

How ‘social facilitation’ can erode the ability to distinguish between right and wrong

By Brian Eckhouse

Thu, Mar 13, 2008 (2 a.m.)

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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.

Discussion: 5 comments so far…

  1. By nkls3713
    3/13/08 at 8:04 p.m.
    Suggest removal

    Stop making bloody excuses.

    "Social Facilitation" sounds like a lot of nonsensical psychology garbage to me.

    There is no excuse for these so called health care "professionals".

    They violated there Hippocratic Oath.

    There is not a single solitary decent human being among the lot.

    Let these spineless souls live with the consequences of their actions.

  2. By Beezie
    3/13/08 at 9:52 p.m.
    Suggest removal

    Can be destructive? Ya think? I'd say Desai and company suffer from a deep seated,pathological sense of deprivation causing them to behave in a greedy,reckless and unethical manner endangering public health and bringing shame upon the medical profession.It was never enough money for him and just like any hoarder,they become engulfed and trapped into a hell of their own making-only in this case-his pathology has endangered others. Watch defense teams twist all the psycho-babble into a defense strategy.

  3. By William
    3/14/08 at 3:16 p.m.
    Suggest removal

    What do you expect from a country whose leaders advocate torture?

    I'm talking about Bush's America.

    Nuremburg defense;"I was just following orders."

    Bush quote; "We don't torture."

    Except-
    May 22, 2004* FBI internal e-mail, suggests that Bush issued a secret Executive Order authorizing the use of extreme coercive measures in interrogation, including sleep deprivation, stress positions, attack dogs, and use of hoods to intimidate prisoners. The Geneva Convention Against Torture bans all of these practices.

    “These documents raise grave questions about where the blame for widespread detainee abuse ultimately rests,” Romero said. “Top government officials can no longer hide from public scrutiny by pointing the finger at a few low-ranking soldiers.”

    The human rights groups’ statement called on the Senate to scrutinize Gonzales, the White House Legal Counsel, on a Jan. 25, 2002, memo he wrote to Bush arguing that the Geneva Conventions outlawing torture did not apply to the war in Afghanistan. Gonzales described the conventions as “quaint” and “obsolete.”

    In August 2002, Gonzales, “without consulting military and State Department experts in the laws of torture and war,” according to the Washington Post, approved a memo from the Justice Department claiming that “unlawful enemy combatants” could be detained indefinitely without criminal charges or the right of due process. The memo, the Post said, “gave CIA interrogators the legal blessings they sought.”
    Gonzales asserted Bush’s “right to order the torture of detainees, a position that violates U.S. treaty obligations under the Convention Against Torture and other international agreements,” PHR said.

    Wilson “Woody” Powell, executive director of St. Louis-based Veterans For Peace, another group in the lawsuit, told the World in a telephone interview that they are now examining the documents, which they recently received.

    “Since Gonzales was Bush’s legal adviser at the time, it would make sense to ask him about that memo,” Powell said. “It would be a good question: what was Bush’s role in the torture?”

    “If our nation’s highest law enforcement officer is known for abrogating international law in the treatment of detainees, we are just confirming to the world that we don’t care about human rights. We would be confirming a criminal, a scofflaw, to be the nation’s chief prosecutor.”

  4. By cherrybim1961
    3/14/08 at 4:19 p.m.
    Suggest removal

    As one of the 40,000 plus (no one is bothering to think about spouses, boyfriends, girlfriends etc. who have been affected) I am appaled at the fact that people could even begin to make excuses for why these people did what they did. You can blame Gibbons, you can blame the Bureau of Licensure and Certification, you can blame anyone you want. You can try to figure out why these people made the decisions they made to practice the way they did. You see the fact is this: for money Desai and his merry men decided that they were more important than God himself. Desai is so materialistic that he practiced by playing a game of Russian Roulette with people's lives. One of the earlier articles I read indicated that Dr. Desai was instrumental in getting the cap on malpractice suits passed. While some people sue health care providers and facilities for honest mistakes, they rarely find that people intentionally harmed someone. In this case it is so much different. Desai instructed his employees to expose thousands of people to disease. It doesn't matter if the number of people who test positive is low. One positive case is too many! What about the nurses and other physicians that went along with his practices? They want you (us) to believe that they went along with these practices becuase they had to make a living! I believe the exact phrase was "to put food on the table". What a joke. There is a nursing shortage out there. It is not like Desai's practice is the only place there is to work. I have to wonder if the nurses too were reaping some monetary benefits as well. I am a nurse and myself as well as other nurses I work with and in the community are embarrassed to say that we are nurses. These people, simply for greed, have made the community afraid to seek medical attention. If the nursing board and medical boards feel that a simple slap on the hand is all these people deserve, I truely hope that the justice system prevails. These people should not only have their licenses to practice taken away from them they should serve jail time. A lifetime sentence isn't even enough for them.

  5. By William
    3/14/08 at 5:47 p.m.
    Suggest removal

    To nkls3713 and cherrybim1961.
    Who is making excuses?

    Aren't you interested in preventing this from happening again?

    There are REASONS why people chose to do these things.
    Reasons to do with brain function, instinct, psychology, societal pressure, cultural upbringing and other sciences.

    Only when these reasons are discovered, can we begin to change human behavior into something more humane.

    To give simplistic answers like "these doctors and nurses are greedy" and "Hitler was a monster" is to be doomed to endlessly repeat these tragic occurrances.

    It is laughable when politicians and populace can be lulled into believing that tragedies like suicide bombing and school shootings can be averted by stiffer laws and harsher punishments.

    This has nothing to do with excusing the perpetrators and everything to do with making sure it doesn't happen again.

    When people say "Never again" about the Holocaust, we have conveniently forgotten that Stalin, Mao Ze-Dong,Pol Pot, Idi Amin, Milosevic, Papa Doc Duvalier, Mugabe, Saddam Hussein, Rwanda, Somalia, Sierra Leone have proven that that kind of insanity has happened over and over since then.

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