Ex-governor second-guesses Gibbons’ call

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

Saturday, March 22, 2008 | 2 a.m.

Sun Topics: Hepatitis Scare
Board chief: We did all we could (3-20-2008)

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.”

Discussion: 10 comments so far…

By CynicalObserver

3/22/08 at 2:35 a.m.

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Talk about bread and circus, to keep the citizenry entertained. There's something new and outrageous every day concerning the Gastro Disaster.

Who really cares about Kenny Guinn's opinion anyway?
By Dranonymous

3/22/08 at 8:43 a.m.

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Shame on you Kenny. You asked me to step down from the board when you were Gov. I am glad I refused. Now you condemn Gibbons for doing the same thing. In fact your reasons for asking me were baseless, at least Gibbons has real public policy issues at stake.
By susanekg

3/22/08 at 9:03 a.m.

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The problem here is not just that so many board members have ties to Desai, it is that they have failed to recognize more glaring conflicts of interest. McBride should not have been working for a medical malpractice provider while he was reviewing malpractice cases, and Anwar should not have been running a medical consulting business while serving as med board president. Just last year, Anwar's firm, Quality Care Consulting, which he runs with former Gibbons advisor and former med board member, Ikram Khan, apprently gave Desai's clinic a clean bill of health! For info on the med board's long-term history of self-serving incompetence, visit http://faculty.uml.edu/sgallagher/NSBME.... or google "Snake Oil Salesmen Hit Jackpot in Nevada."
By indethink

3/22/08 at 12:38 p.m.

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How about another conflict of interest? Anwar and Khan get paid by hospitals to decrease utilization (translation: crappy care) and then they sell that skewed physician-practice information back to insurance companies that then decide which doctors to contract with.

Nice for-profit medical care system we got here in this country, huh?
By AngryPostman

3/22/08 at 3:17 p.m.

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Wow nice article Susan. Glad somebody is pointing out the failings of the Nevada medical oversight system.

Mecca for third world medicine apparently, given the state of the assembly line endoscopy machine we apparently have in Las Vegas.

What's Goldsmith's wacky idea? Does that have even the slightest possibility of being worth anything? Sounds like a lot of non-sense designed to make money. I guess Ivan didn't get rich enough off his stop smoking plan commercials.

We need some federal oversight to step in here.
By Beezie

3/22/08 at 6:54 p.m.

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To AngryPostman...right on.

Nobody friggin' cares about Guinn's Monday morning quarterbacking. If Dr.McDonald has to form a committee to see what should be done and whether members should resign,he's a little slow in the ethics department. Is there any action the public can take to ask the feds for their help in overseeing this cluster muck because this whole thing is beyond pitiful. Reactions and responses thus far don't bode well for the public in Nevada in the event of any future outbrakes iatrogenic,nosocomial or otherwise.
By jfnance32

3/22/08 at 7:55 p.m.

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Gov Guinn is the man who went out of state to get medical care when he was governor.

Also, Gov. Guinn appointed all these guys who can not oversee the worse medical crisis the state has ever since because of their conflict of interest. Yep, that is right. They want to be on the board and yet they can not vote or discuss anyting about this important crisis.

Guinn knows best. We should listen to his every word.
By localcitizen

3/22/08 at 8:06 p.m.

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I couldn't care less about what the former Governer thinks or what some self-serving feminist at a university in Massachusetts has to say. I agree that our system needs fixing and there needs to be an overhaul, but I certainly don't want the feds in here either, given their stellar track record. Wake up people, this is the future of medicine. This is not just a Nevada problem - it is nationwide and we all helped contribute to it. We shop for the best priced medical care and not the best doctors (look at the Lasik ads on TV), we line the lawyer's pockets because we're unhappy over everything and they're more than happy to take the money (look at the fraud and conspiracy trial that ended in a mistrial), and we fail to take responsibility because it's easier to blame someone else. May not be the most popular opinion, but the truth is, medicine is a for-profit business and if you believe that doctors, or for that matter, lawyers, or university professors are any more ethical or moral than the common person on the street, you will be sorely disappointed.
By Beezie

3/23/08 at 1:14 a.m.

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To localcitizen, I agree with you there are unethical doctors,hairstylists,PhDs,mechanics etc. across America. However,naivete or caveat emptor is not the issue here.This IS the largest public health scare to date in the nation's history. If we cannot rely on our state entities to do the right thing where public safety is concerned then perhaps someone with greater political power can twist the screws or light a fire under somebody's a$$ and help move out the incompetents-especially if all everyone is going to do is say "I'm not stepping down and shouldn't have to". What recourse does the citizenry have other than at election time? Perhaps we could look at other states and rework our processes to fit the needs of Nevadans. Obtaining a best practices guide in terms of public health,reporting,board suspensions etc.would not be difficult. But what am I thinking? This is Nevada and I'm not holding my breath. I could go out if state for care if need be however, not everyone can afford to fly to the Cleveland or Mayo clinics or get to medical schools run by the Ivys or Jr. Ivys.

There used to be a publication or list called "Best Doctors in America" and in the past I've found terrific physicians through this publication (especially if the procedure was difficult,invasive or required surgery). This publication was broken down by national ranking then regional ranking, specialty,sub-specialty and took many factors into account.I'm not sure if this information is still being published but it was tremendously helpful as the top
3 to 5 % of the nations best docs made it into the publication.
By majik

3/24/08 at 6:40 a.m.

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Any body who listens to K.Guinn has to have there head examined, he has screwed the people of Nevada over and over again, he's a nobody now and he should remain that way.
There's plenty of corruption within the medical community and they try there hardest to cover each others a$$, Gibbons is correct, there is the appearance of conflict of interest by these 3 doctors and they should resign.

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