Las Vegas Sun

May 12, 2008

Jon Ralston laments the most tragic consequence of the hepatitis scare — the loss of trust between doctor and patient

By Jon Ralston

Sun, Mar 16, 2008 (2:01 a.m.)

I had a colonoscopy on Friday.

I am no method reporter. I did not do this to get firsthand knowledge of the public health scare that has caused fear and anxiety among at least 40,000 patients. I had tried to schedule the exam, ironically and scarily, with Dr. Dipak Desai right around the time the Health District discovered the potential contamination at the Endoscopy Center of Southern Nevada. But when I couldn’t get an appointment, I decided to go to Dr. Frank Nemec, whose impeccable reputation was reinforced by my experience at his clinic.

My exam was, thankfully, clean. But my experience there and my conversations with Nemec and his fine team brought the crisis home in ways I could not have imagined.

To a person, the dedicated people there were pained by the crisis, which, they lamented, reflected on the entire medical community. But I also heard about the consequences of shutting down Desai’s clinics, where as many as 70 percent of the procedures in town were being conducted in a valley already short on gastroenterologists. And with so many patients so frightened by the potential for infection, they told me that people were canceling appointments — appointments that could save their lives — even though authorities, after a surprise inspection, gave the clinic a clean bill of health.

Colon cancer is a killer, second only to lung cancer in deaths from the diseases. The National Cancer Institute says that about 56,000 Americans died in 2004 from colon cancer. From 2000-2004, there was an average of 408 deaths a year in Nevada. I shudder to think that number may spike in coming years because of this crisis.

Even though it is so deadly, colon cancer is very treatable if caught early. But because it can take a long time for serious symptoms to arise, regular colonoscopies after 50 are essential. (I’m not quite 50 but I don’t take chances, either, after having had a kidney transplant nearly 25 years ago. That sound you hear is me knocking on wood.)

The plight of the 40,000 falls somewhere between tragic and unfortunate — some will discover they have serious infections, some will have had to suffer with days of uncertainty, as I did. But what I find equally frightening is the number of patients — scores, hundreds, thousands? — who will not get tested now for a variety of reasons — and some of those will allow serious conditions to go undetected.

Some are just scared. Others will have difficulty getting in to see a gastroenterologist — Desai had more than a dozen other doctors at that practice, which dominated the market and was able to use that power to acquire patients and that now-infamous million-dollar contract with UMC.

The folks at Nemec’s clinic nodded ruefully when I asked if patients who did come for procedures were quizzing them about reusing syringes and anesthesia vials. On the one hand, those questions should never have to be asked; on the other, it can’t be all bad that patients are more aware now.

Long after this story became the story, people at Nemec’s office and many other places continue to shake their heads at the two most unfathomable aspects:

• Why would Desai — or any doctor who definitely knew the dangers of such unsafe practices — risk infecting patients, creating a health crisis and thus dwarfing any economic benefit with financial ruin? We still don’t know the extent of the transmission of hepatitis or HIV — 2,000 or so patients, by statistics in the general population, may have been infected before or after their procedures. But why — how? — could anyone gamble with patients’ lives? There was just no percentage in it — and that kind of greed, if it is proven, is simply unfathomable.

• I have seen the speculation about how so many employees who must have witnessed these unsafe practices at the Endoscopy Center and elsewhere kept silent. But ultimately that all melts into psychobabble. Nurses at Nemec’s clinic, I was told, would have stormed over to the Health District had they been ordered to reuse syringes.

And I believed it.

Alas, many will not. I have received e-mails or phone calls every day since the story broke, brimming with outrage or despair. There are so many stories that will come out of this, from allegations of gross negligence to doctors protecting doctors to lawyers seizing the scandal and conflating victims with opportunists.

But in the long run, the shattered trust between patients and their doctors and the consequential failure of too many to get necessary treatments will be the most tragic legacy of The Great Hepatitis Scare of 2008.

Discussion: 3 comments so far…

  1. By nvkorruption
    3/16/08 at 2:32 p.m.
    Suggest removal

    Its isnt the doctors that are the real problem folks...

    Although the local media has resisted truly laying things out on the table, Nevada regulatory agencies such as the Clark County Building whatever and the Medical Board is a cookie cutter version of the Committee on Judicial Discipline.

    The general public needs to understand the significance of what that means as I am sure you do (whether the media has grasped it or not); but if things are wrong in the justice system itself, they are definately going to be wrong in a case like this.

    The courts are the backbone that enables corruption to perpetuate all they way up to the supremes.

    The attorney general runs interference for the supremes, the 'boards and committees run interference for the lower levels; and hopefully the general public will be frustrated enough to throw in the towel before someone figures out that this type of public corruption may be of interest to the feds long before something like this medical problem blows up.

    Corruption in the justice system (the head of the snake) makes it all possible; not just the judges, but the attorney general and state regulatory agencies are all on the same page.

    The medicare connection may be the best thing that has come out of this shuffle because it opens the door for the feds to peek into everything that up until now was sovereign.

  2. By catjackson
    3/17/08 at 6:03 p.m.
    Suggest removal

    John. missed not seeing you tonite I take back calling you an icecube.as I see you also were a victim of the Endoscopy Center ! It.s so surreal that when I moved to Vegas I truly could,nt find the meaning of trust! One thing that you did,nt know about me was that I was in nursing for 30 years befor I found my calling as a Military Mom! Thank you for showing me the human side in you and I do so hope that I am able to find a Doctor that I can trust! Thanks for sharing .

  3. By gfhutchi
    3/19/08 at 10:42 a.m.
    Suggest removal

    Mr. Ralston,

    I would like to commend you on an excellent article highlighting not only the deficiences in practice (to say the least) at the Endoscopy Center of Southern Nevada but the need to continue with screening for colorectal cancer. As a practicing Gastroenterologist myself in a large Midwest city I observe on an almost weekly basis the devastating physical and emotional effects left on patients diagnosed with this largely preventable disease.

    In my mind three tragic events, all of which are intimately intertwined with one another, have occured. The first is a blatant lack of respect for the value of human life and for a patient's safety. Once upon a time in medical school you are asked, not ordered, but asked to take the Hippocratic Oath. The first rule of medicine is to "do no harm". Clearly, a refresher is needed for the physicians in question if not more aggressive action.

    Secondly, an unknown number of patients have been infected with a largely chronic form of infectious hepatitis. The numbers of people infected will grow more than likely, but will pale in comparison to each individual who each day must live with the fact that they have a disease that they contracted while trying to "improve" their health and overall life situation.

    Thirdly, and closely related to the Hepatitis C outbreak, is the fact that perhaps thousands of patients will go unscreened from a colorectal cancer standpoint because of lack of trust in a given physician. This is a particular tragedy as in a best case scenario without outbreaks and outlaw physicians we only screen apprroximately 30-40% of the screenable population in the best of circumstances. The "fear of screening" will continue to plague Las Vegas and likely Nevada in general for years to come and comes on the heels of a health system in Nevada still recovering from high insurance premiums and a mass exodus of quality physicians in the 1990's. What is needed clearly is action. Perhaps a public service announcement is needed. (Where are you Katie Couric?) Perhaps better regulatory control in the health department is needed? Clearly recent events regarding personal and business relationships make the waters very murky. Perhaps an outside "arbitor" is needed to clean the situation up? Many questions remain and many more will be asked but what is certain is that colorectal cancer will continue to contribute unnecessarily to morbidity and mortality in our country, now more than ever. Sincerely,
    A physician with a personal interest in Las Vegas times three.

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