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

By Jon Ralston

Sunday, March 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.