Board chief: We did all we could

By Marshall Allen, David McGrath Schwartz

Thursday, March 20, 2008 | 2 a.m.

The president of the Nevada Board of Medical Examiners said Wednesday that his agency took the strongest action it legally could against a doctor whose clinic caused the nation’s largest hepatitis C scare, and that he would refuse the governor’s demand that he resign because he did nothing wrong.

“I think there has been a cloud on my good name if you read the newspapers, and I do not think I should leave with this cloud on my good name,” said Dr. Javaid Anwar. “I don’t intend to resign at this time.”

Gov. Jim Gibbons has called for the resignation of Anwar, two other medical board members and its executive director, Tony Clark, for not taking stronger action. Gibbons also said that past interactions between the three board members and Desai created the appearance of a conflict of interest.

In an interview with the Sun, Anwar addressed the claims of both apparent conflict and that the board had not acted forcefully.

In his first public comments since Gibbons called for his resignation, Anwar said that every step taken — and not taken — by the medical board was at the advice of Christine Guerci, chief deputy attorney general.

Thus, while some criticized Anwar and the board for not summarily suspending the license of Dr. Dipak Desai, whose clinic was the source of the hepatitis C outbreak, Anwar said accepting Desai’s voluntary offer not to practice during the investigation was the most Guerci said the board could do.

“There was no brokered deal,” Anwar said of accusations that the board treated Desai gently. “We followed her advice as to what we could do.”

The board not only took the most serious action it could at this early stage of the investigation, Anwar stressed, but the three members last Friday also recused themselves from presiding over any future decisions in the case to avoid any appearance of bias because of their personal and business ties to Desai.

Guerci could not be reached for comment Wednesday, but Clark confirmed Anwar’s account.

Clark said the idea to ask Desai to voluntarily stop practicing medicine came after the board was advised by Guerci that suspending his license before the board’s investigation was completed was not legal. Desai and others at the clinic would not have agreed to voluntarily surrender their licenses — as five nurses at the clinic did — because, unlike in the case of the nurses, it would mar their permanent record, Clark said.

Because of procedural differences in how license matters involving doctors and nurses are handled, if the nurses are later cleared, the fact that they surrendered their licenses would not appear on their permanent records.

“It would be a black mark against the doctors’ records for the rest of their entire practice,” Clark said. “We could have asked them to do that, but they would have been foolish to accept that.”

With the board’s investigation still ongoing, Clark said it did not have enough evidence for a summary suspension of Desai’s license. The board has been stymied by not being notified of the investigation until after it was publicly disclosed, Clark said.

Under state statute, in order for the board to take emergency action, including summarily suspending a license, it must find that the risk to the “public health, safety or welfare” requires an immediate move. Furthermore, the law says that the medical board should interpret the law liberally for the “protection and benefit of the public.”

While some of Gibbons’ staffers and others contend the circumstances merited immediate action, Anwar said the threshold specified in the law has not yet been met.

Under the process the board follows, board members do not learn anything about what the investigation turns up until the probe is completed. So in this case the three members whose resignations Gibbons is seeking not only have not been involved in the investigation, but will not have a voice in the board’s ultimate decision because they have recused themselves.

On Feb. 27 it was announced that nurses at the Endoscopy Center had passed on infectious disease by reusing syringes and single-dose medicine vials. They allegedly told health inspectors that they were ordered to engage in the dangerous practices by Desai and other clinic managers.

For more than two weeks, the news that 40,000 people needed to be tested for hepatitis B, hepatitis C and HIV caused panic almost everywhere in Nevada except the office of Gibbons, who downplayed the crisis and blamed the media for public hysteria.

Then on Sunday Gibbons did an about-face, abruptly calling for the resignations of Anwar and board members Dr. S. Daniel McBride and Dr. Sohail U. Anjum, who have connections to Desai. The governor also called for the resignation of Clark, who has no ties to Desai.

All four refuse to resign.

Anjum was Desai’s doctor when he had a heart condition. McBride, managing partner in General Surgery Associates, has offices in the same building with one of Desai’s practices and is chairman of the Nevada Mutual Insurance Co., which provides liability coverage to doctors. Desai resigned recently from the company’s board.

Anjum and McBride did not return calls from the Sun for comment.

The three board members’ voluntary recusal from any part of the medical board’s investigation, Anwar said, eliminates any concerns about potential conflicts of interest.

After the three recused themselves, Clark gave two senior members of Gibbons’ staff names of 14 Northern Nevada doctors who could temporarily replace them.

Anwar believes the governor’s unfamiliarity with the medical board’s procedures has been exacerbated by reports in another newspaper, which alleged that Anwar brokered a soft deal for Desai because of personal or business interests.

Those ties were casual, Anwar stressed. He noted, for example, that he attended the wedding of Desai’s daughter, but pointed out that hundreds of other prominent people also did so. And Anwar said he does not recall referring any patients to Desai in at least the past 15 years.

The company that Anwar co-owns, Quality Care Consultants, performed a peer review job for Desai last summer — an evaluation of the processes being used at the Endoscopy Center to measure it against industry standards, not, Anwar noted, a judgment of its physicians. Anwar was paid in full by November, he said, adding that he has no ongoing business dealings with Desai.

Anwar said he has not spoken to Desai or any of his representatives since the hepatitis C outbreak was announced. And he never defended Desai regarding the crisis, he said.

From the start, Anwar said his position has been that the investigation will show who is responsible for the flawed injection practices and then “let the chips fall where they may.”

Anwar said when he finally talked to Gibbons Tuesday on the phone, it seemed the governor did not know that the attorney general’s office had been involved in the process and that the board did not have the authority to immediately suspend Desai’s license.

Gibbons never asked him to resign in that conversation, nor has anyone in the governor’s office, he said.

The controversy has spawned a surging political battle, with power players pointing fingers from both sides of the dispute.

In an interview Wednesday with NewsONE’s Jeff Gillan, U.S. Senate Majority Leader Harry Reid said the doctors should not quit.

“Their quitting is an admission they’ve done something wrong,” Reid said.

But state Sen. Bob Beers, R-Las Vegas, joined Gibbons in calling for the three medical board members’ resignation, calling their failure to step aside “both puzzling and improper.”