Latest case undercuts Gibbons’ clinic defense

By David McGrath Schwartz, Cy Ryan

Wednesday, March 19, 2008 | 2 a.m.

Gov. Jim Gibbons over the weekend dismissed the crisis stemming from the Endoscopy Center of Southern Nevada, saying if there had been “gross negligence” at the clinic, there would be more cases of hepatitis C linked to unsafe treatment practices than the six reported.

But on Tuesday, the day the Southern Nevada Health District reported another acute hepatitis C case linked to a Las Vegas clinic, officials said they wouldn’t immediately have a clear idea of how many people were infected because of dangerous procedures at the first clinic.

“To get a final number, it’s going to be months,” said Brian Labus, the Health District’s senior epidemiologist.

The contradiction of Gibbons’ statement comes as three members of the Board of Medical Examiners and its executive director continue to defy Gibbons’ call for them to resign.

As soon as the story broke about the six infected individuals and the 40,000 patients of the clinic who were being notified they should seek testing, Tony Clark, executive director of the Board of Medical Examiners, said he assigned an investigator.

Clark said Gibbons, in calling for his resignation and that of three members of the nine-person board, was trying to minimize the fact that Dr. Dipak Desai, the majority owner of the Endoscopy Center, was an election supporter, a campaign contributor and an adviser to the governor when he took office.

“Maybe the governor ought to resign,” Clark said.

Desai voluntarily agreed to stop practicing. But Clark said he could not get the other doctors who worked at the clinic to limit their practices.

Local government, not Gibbons and his administration, closed the clinic.

“We have done everything we could to protect the public,” Clark said. “He is making us the scapegoat for his ineptitude.”

Gibbons said if the board members, who have ties to Desai and have recused themselves from presiding over any disciplinary proceedings stemming from the hepatitis scare, fail to resign, he will look for ways to fire them.

The governor said he wants Clark’s resignation because he did not act promptly in taking disciplinary action against those involved in the clinic.

Gibbons himself, however, seemed to downplay the controversy before he called for the resignations. He told the Reno Gazette-Journal Saturday: “There was no single vial of medication reused. There were no reused needles. Gross negligence when you have far below the number of average (hepatitis C) cases listed? That’s trial lawyer-speak to me. I think if you’d had gross negligence, you’d have a higher number.”

On Sunday, he apologized for blaming public hysteria on media “buffoonery.” And on Monday, he said he’d been incorrectly informed that single-dose vials were not being reused, saying that assertion “may have been a little bit premature.”

He has not, however, backed off his contention that there was no gross negligence at the clinic, using the number of positive tests as evidence.

It was only late last week when the Southern Nevada Health District began seeing test results from those tested after health officials on Feb. 27 announced the unsafe practices at the Endoscopy Center. Health officials notified 40,000 patients that they should get tested for hepatitis C, hepatitis B and HIV, but acknowledged that their list of patients was incomplete.

Investigators will interview those who test positive for hepatitis C to try to determine when they were infected and whether their infections can be traced to any medical procedures, said Jennifer Sizemore, spokeswoman for the Health District. About 4 percent of the clinic’s patient population, officials estimate, would normally carry the hepatitis C virus.

But the acute case of hepatitis C that officials announced Tuesday shows that the system depends on doctors’ and labs’ reporting positive test results to the Health District.

The case was traced to 2006, when an unidentified man underwent a procedure at the Desert Shadow Endoscopy Center of Nevada.

Blood work done before his procedure showed he was not previously infected with hepatitis C, Sizemore said.

When he tested positive in 2006, his hepatitis C case was not reported to the Heath District by his doctors or the laboratory that performed his blood work, Sizemore said.

“That case was never reported to us,” Sizemore said. “It’s something we’re looking into.”

She said the infected man called the Health District himself after the news broke last month about the Endoscopy Center.

The Health District relies on doctors and labs to report cases of certain diseases, such as hepatitis C.

On average, the agency gets 20 to 30 reports of positive hepatitis C cases daily. Most are “chronic” hepatitis C cases, meaning there are no immediate symptoms.

The number of positive hepatitis C tests has been “at the high end of the normal range” so far, Labus said, though he would not release specific numbers on the results of the tests stemming from the notices to the 40,000 Endoscopy Center patients.

Six cases of acute hepatitis C — which may come with symptoms such as loss of appetite, nausea and jaundice — have been linked to the Endoscopy Center of Southern Nevada. Normally, Southern Nevada has only one or two cases of acute hepatitis C annually.