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October 22, 2014

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Ex-governor second-guesses Gibbons’ call

Three medical board members he asked to resign should stay, Kenny Guinn says

Former Gov. Kenny Guinn said Friday he did not believe three members of the state’s medical board should step down because of their associations with the owner of a clinic at the heart of the nation’s largest hepatitis C scare.

The Nevada State Medical Examiners Board is investigating Dr. Dipak Desai, majority owner, and other physicians at the Endoscopy Center of Southern Nevada over allegations that unsafe use of syringes and vials of anesthesia at the clinic led to at least six cases of hepatitis C.

Three of the nine board members recused themselves March 14 from any matters related to the investigation of the situation, which led to a call for 40,000 patients of the clinic to be tested for hepatitis B, hepatitis C and HIV.

The three had had personal and business relationships with Desai, creating potential conflicts of interest. Gov. Jim Gibbons has called for the three to resign, saying recusing themselves isn’t enough.

Guinn, however, said he thinks the members’ recusals from the board’s Endoscopy Center investigation are sufficient.

If potential conflicts become barriers to serving on the state’s numerous boards and commissions, Guinn said, it could lead to two equally undesirable consequences: a constant turnover in membership or appointees who are not well-acquainted with the areas they are supervising.

By the standard Gibbons is calling for in the medical board case, even state and local lawmakers could face calls to resign, Guinn said.

“You’re opening up a very serious concern when you ask people to resign and there’s no overt cause for doing that, especially when they have already recused themselves,” Guinn said. “If you do it for one group (of appointees), you’d do it for every group.”

The board members who recused themselves are board President Dr. Javaid Anwar, Dr. S. Daniel McBride and Dr. Sohail U. Anjum.

Gibbons also called for the resignation of the board’s executive director, Tony Clark, because of the governor’s belief that the board has not acted swiftly enough.

Gibbons spokesman Ben Kieckhefer said the governor was not implying that other appointees or lawmakers who have conflicts should automatically step down. The current health care crisis is exceptional, he said, and the typical process in which a board member discloses conflicts and recuses himself is not sufficient to restore the public’s faith in the board.

“With such a critical issue to the public faith in the health care system, disclose and recuse are simply unacceptable,” Kieckhefer said. “As it relates to other boards, if there’s a minor conflict, we’ve not set precedent for that. We’re talking about the most pressing issue the state is facing right now.”

Under state law, members of the Medical Examiners Board recuse themselves when they have a conflict, and the governor appoints temporary members to hear those specific cases. Clark submitted the names of 14 Northern Nevada doctors for Gibbons to consider before the governor called on the three board members to resign.

Anwar has stressed that he and the two other members of the medical board recused themselves from the process early on to give Gibbons time to appoint qualified temporary board members.

In Nevada, politicians dealing with conflicts are the norm. With part-time state legislators and part-time city council members and county commissioners, disclosures of conflicts and recusals are seen at most meetings.

Politicians and doctors on both sides have weighed in on whether the board members should stay or go.

U.S. Sen. Harry Reid has said the doctors should not quit.

State Sen. Bob Beers, a Las Vegas Republican, supports Gibbons’ call for the board members to step down.

Dr. John McDonald, dean of the University of Nevada School of Medicine, called for a committee to be formed to look at the board and whether the members should resign.

“It’s a difficult situation,” McDonald said. “I would probably resolve this with an independent panel to look at this dispassionately and render an opinion. Right now, this calls for a bit of a cooling-off period.”

Dr. Andrew M. Eisen, associate dean of clinical education at Touro University Nevada, said he supports the governor’s call for the doctors to resign. The fact that a third of the board has to recuse itself on this issue, Eisen said, demonstrates that the board needs to come from a broader section of the medical community.

“You’re not going to be able to find physicians who are going to assure you there are no conflicts in any cases, whenever,” said Eisen, a pediatrician. “But the board should be diverse enough with representatives of the community that the times when multiple people have conflicts are small.”

Assemblywoman Sheila Leslie, D-Reno, head of an interim legislative health care committee, said she did not know whether Anwar or Anjum should resign. She thinks McBride should resign, not because of the Endoscopy Center case, but rather because he had been chairman of a medical insurance liability company while serving on the medical board and hearing malpractice cases.

“Right now, I think this whole stalemate between the governor’s office and the board is a huge diversion to real issues,” Leslie said.

“I do think there are instances when you can recuse yourself and remain on the board. But has the public lost confidence in the board? It’s hard to judge that from Reno. But from the comments I have heard, it’s a valid question.”

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