Report shows how Dipak Desai put profits ahead of safe practices

By Marshall Allen

Tuesday, Dec. 22, 2009 | 2 a.m.

The Southern Nevada Health District’s final report on the colonoscopy clinic at the center of the country’s largest hepatitis C outbreak details ways in which the greed of its owner, Dr. Dipak Desai, got in the way of sound and ethical medical practice.

Staff at the Endoscopy Center of Southern Nevada were ordered to falsify billing records, reuse syringes and other equipment, and doctors rushed procedures to detect cancer, health officials wrote.

The long-awaited report, released Monday, may also provide the outline for pending criminal prosecution.

Nine cases of hepatitis C were genetically linked to the center, and 106 more were possibly linked to the clinic, which passed along infection by reusing syringes and single-use medicine vials. The outbreak forced health officials in February 2008 to urge about 50,000 patients to be tested for hepatitis B, hepatitis C and HIV.

Metro Police recently turned over its investigation to the Clark County district attorney’s office, recommending prosecution of Desai and the nurses who engaged in unsafe injection practices, the Sun has reported. The district attorney’s office is still considering the case.

Meanwhile, the FBI and Nevada attorney general’s office are investigating whether Desai and his staff falsified records for the purpose of ripping off insurance companies.

The Health District’s report touches on both investigations, and exposes other practices that call into question the cancer screening performed at the clinic. What follows is a summary of the findings:

Unsafe injection practices

Certified nurse anesthetists could have prevented exposing patients to hepatitis C if they had adhered to “well-established, safe and common sense injection practices,” the report said.

• Nurse 1 said he was instructed by “staff” to reuse a syringe and propofol, the drug used to put patients to sleep. Nurse 2 reported being instructed to reuse syringes, but did not do so.

• Nurses admitted using unsafe injection practices and were observed doing so, but said they were instructed to use such practices.

• The estimated cost of the outbreak, including testing and treatment of victims, is between $16.3 million to $21.9 million.

Possible insurance fraud

The FBI and Nevada attorney general’s office are investigating whether Desai ripped off insurance companies and Medicare.

• “Staff members reported that anesthesia times were intentionally recorded incorrectly for the purposes of obtaining additional reimbursement ... Times for procedures shorter than 30 minutes in length were typically reported as 31 or more minutes.”

• A former employee said she was trained to record certain events, such as the time a physician was at a patient’s bedside, in advance of the event.

• According to patient charts, Nurse 1 began administering anesthesia to a patient in Room B while still completing a procedure in Room A.

Problematic procedures

The investigations have not focused on other problems at the clinic, but health officials say patients who were screened for colon cancer have reason to question the test results.

• Total time for procedures — insertion and withdrawal of the endoscope — were as short as three minutes. Medical standards require at least six minutes for withdrawal alone to ensure a proper exam. The short procedures “raise public health concerns that some procedures may have been insufficient to identify colon cancer in patients.”

• Purchasing records showed the clinic had bought about 2,000 bite blocks — used to prop open a patient’s mouth — in 2007, but records showed the clinic performed 5,800 procedures that required bite blocks.

• Clinic staff purchased 6,200 single-use biopsy forceps and polyp removal wires, while logs indicated they performed more than 7,800 of the procedures.