Questions about the hepatitis scare

Wed, Mar 5, 2008 (2:01 a.m.)

Less than one hour after I discovered that my tests for hepatitis and HIV were negative, I sat across from the man I had feared for three days might have infected me with a deadly disease.

It was a surreal moment after the fear and loathing of a lost weekend. Dr. Dipak Desai, who performed a colonoscopy on me in 2004, wouldn’t talk to me for the record during a brief meeting this week. But until he hired the client-muzzling Rick Wright, I had high hopes the meeting was a prelude to interviewing him on “Face to Face.” I doubt that will happen now, but the physician I and tens of thousands of others once trusted has a story to tell, one that clearly will not jibe with the portrait of a callous, avaricious doctor sketched by the Health District and colored in by the media.

The crisis trajectory here was perfectly predictable: announcement of public health scare. Media frenzy begins. Public gets scared. Patients get outraged, hire lawyers. Attorneys see opportunity, advertise for clients. Media frenzy continues. Elected officials react and overreact, demonize doctors, shut business, perform for cameras and scribes. Law enforcement gets involved. Media frenzy continues.

So what do we know? We know the cork cannot be put back into this bottle Desai & Co. likely will lose everything and might face criminal charges, some patients will have legitimate claims and others might not (but might still pursue them) and politicians will continue to battle for headlines.

But what don’t we know? Now that my own “what if” question has been answered what if I had been infected? I am struck by how many more global ones remain and how confounding this story really is:

• What if Desai and the clinic administrators actually either mandated or ignored systemic medical practices that attorney Will Kemp called Third World and Health District epidemiologist Brian Labus said would have to be upgraded to be Third World? No matter what the pressures of the modern medical business system, with diminishing reimbursements for doctors and what Kemp called a “fast-food medicine” culture, the diabolical nature of such behavior is unfathomable in this country or many other nations. These people would not only be demonstrably evil endangering people whose lives had been entrusted to them but recklessly stupid knowing, as even laymen might, that the risk of an infectious outbreak would be great.

• What if this really was isolated to that cluster last year and the Health District created an unnecessary near-panic by its massive notification? As devastating as it was to learn I might have been infected, my intellectual side never could reconcile how these doctors, knowing the risk to their livelihoods and reputations, would have countenanced such practices as reusing syringes and anesthesia vials. And it never made much sense to me that if this has been going on for years, all of these trained staff, including nurses, would simply have gone along out of fear for their employment and not reported the center. Could there be another explanation, and what could it possibly be?

• What if the politicians now striking a balance between responding to their constituents and grandstanding for the media and some of them actually do care about responsibility are discovered to have been partially responsible for this scare because of their actions? The state health division inspects prisons more often (twice a year) than it does ambulatory surgical facilities such as the Endoscopy Center of Southern Nevada (once every three years). And the cascading suspensions of various licenses by local governments hey, Henderson and North Las Vegas did it too! show elected officials are very good at being reactive but fall down when it comes to proactive, farsighted policies, especially ones that cost money.

It will be hard to answer any of these questions right away, as we are swept up in a community paroxysm of anger and fear. I understand those emotions all too well. But this is too important for us to succumb to gut responses, no matter how we are tugged by opportunists and demagogues, elected and otherwise.

It’s been a long time since I was suffused with the kind of relief I felt Monday morning when I heard that my tests were negative. But for those unlucky enough to have an infectious disease, the politicians and regulators owe them the truth, whatever that turns out to be, and a punishment that fits the crime, whatever that turns out to be.

By all means, let’s haul out the gallows. Let’s just make sure we hang the right people.

Discussion: 16 comments so far…

By VijayMehta

3/5/08 at 8 a.m.

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Dear Jon,

First of all congratulation for writing a balanced article on this subject.

I am sure you really did not expect Dr. Desai to sit in front of you and say anything on record, your having a procedure by him not withstanding. I am sure there is a long line of media outlet who would like to grab piece of this pie to make a name and fame. I hope you do not imply guilt or innocence based on his denial to talk to you. Any person with commonsense would do the same.

I think you hit the nail on the head when you ask, “Could there be another explanation, and what could it possibly be?”

There are simply too many holes in blaming this outbreak on Dr. Desai mandating all his employees to re use the needles and syringes to save the money. 1. It costs pennies to change a new needle and syringes probably will cost more to autoclave them. 2. No professional will obey an order that was unsafe for the patient. 3. This is a very high volume clinic with nearly 40,000 patients over four years that is like 50 endoscopies every working day! 4. We have not heard of large number of people coming forward with newly acquired Hepatitis B or C or HIV. 4. So far we know of 6 patients with Hepatitis C that genetically point to the same source and five of them had colonoscopy on the very same day. To me that points to the colonoscope that was used. Could it be the same scope on all five patients? Could there be a system or human failure on that particular day where the person in charge of sterilizing the scope did not do as meticulously as required? But that would not be as a sensational headline as Dipak Desai mandated his employees to cut corners to save few pennies. Do not forget he has generously donated to political and other causes.

I think Health District got swept away with the massive number at the risk (40,000) and created international headlines. Once it became a breaking news it has life of its own. All they simply needed to do is to let the patients know that, “due to an outbreak of blood borne disease in group of patients treated by endoscopy clinic we recommend you to report to us and get set of blood test.”

Once the headline was released next some one Alleged that Dr Desai mandated them to re use the syringes and needles! And they released to general public!

Now with attorneys, politicians, previous workers at the clinic, media and other gastro-enterology centers in the area – all having vested interested in spinning the story the patients of endoscopy clinic are victimized again.

I agree with you, “By all means, let’s haul out the gallows. Let’s just make sure we hang the right people.”

Thanks

Check out my blog at
http://vmehta.conforums3.com/index.cgi?b...
By bajajan

3/5/08 at 9:11 a.m.

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My question is how did they arive at the date of 2004? I went to the same clinic in 2003, same building, same office. Dr. Desai was in charge then too. Did they suddenly get dirty? I don't feel any better because my procedure was done a year earlier than the date announced. I had the test done anyway. If my insurance doesn't pay, I will pay for the peace of mind. And why is he only offering to pay for the indigent? My insurance shouldn't have to pay a dime. This cuts into the money they will have available to pay legitimate claims. With this many people getting tested the costs to insurance companies is going to be substantial. Dr. Desai is living in a 9,000 sq. ft. house, he can afford to pay for them all. I don't care if he has to sell his house. Some people will be sick for the rest of their lives because he wanted to save pennies. How could they do this? He didn't do it without others in the office complying. The demand for this test is so high it took three months to get an appointment. The workers at that clinic were willing to put people at risk for pennies. Now I am concerned about everything he did. I don't trust him at all. Glad your tests came back fine. I don't have my results back yet. Hopoefully they will be ready today.
By Volker

3/5/08 at 9:52 a.m.

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Mr. Ralston. I suspect that when the political posturing settles down into a careful examination of the facts, we will find that the answers you seek are close to those in the thoughtful Sun article today by Marshall Allen. Perhaps the reuse of needles was only limited to the same patient and that the reuse of the vials presented only a minute risk of contamination. That only 6 patients have been found as of this time to be infected is fortunate for the larger population. That they happened on the same day is probably indicative that either, on a percentage basis, the reuse of the vials did pose a small risk or there was some other malfunction in the clinic. However, for those 6 patients, any risk was clearly unacceptable. While it is the role of our government, and in this case, those within that government who are charged with protecting the public by vigorous inspection of processes that surround our health care...we cannot expect any of those agencies to perform that role with the inadequate resources we provide our state and county agencies for this task. It is those necessary services that are usually among the first to get cut in a shrinking budget. Let's all keep that in mind as Nevada wrestles with our funding challenges through this next legislative session.
By Volker

3/5/08 at 9:54 a.m.

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Mr. Ralston. I suspect that when the political posturing settles down into a careful examination of the facts, we will find that the answers you seek are close to those in the thoughtful Sun article today by Marshall Allen. Perhaps the reuse of needles was only limited to the same patient and that the reuse of the vials presented only a minute risk of contamination. That only 6 patients have been found as of this time to be infected is fortunate for the larger population. That they happened on the same day is probably indicative that either, on a percentage basis, the reuse of the vials did pose a small risk or there was some other malfunction in the clinic. However, for those 6 patients, any risk was clearly unacceptable. While it is the role of our government, and in this case, those within that government who are charged with protecting the public by vigorous inspection of processes that surround our health care...we cannot expect any of those agencies to perform that role with the inadequate resources we provide our state and county agencies for this task. It is those necessary services that are usually among the first to get cut in a shriking budget. Let's all keep that in mind as Nevada wrestles with our funding challenges through this next legislative session.
By JohnF

3/5/08 at 11:14 a.m.

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To expand on what previous posters said, one has to wonder: why four years? Is the 2004 date perhaps the last time the state inspected this particular facility and could therefore vouch for safe practices? If so, we certainly see what the cost is of not having more frequent inspections. Restaurants are inspected twice yearly, why not medical facilities?

To change the subject, we are fortunate to have a Governor who understands that growth pays for itself, so there will be plenty of money to cover the cost of more frequent inspections during the next legislative session. Right?
By Brian61

3/5/08 at 2:15 p.m.

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I am one of the 40,000 patients that may be infected.

Each of these Joseph Mengala, Adolf Hitler, Saddam Hussein, Osama Ben Laden doctors and typhoid Mary nurses should each be injected with both the hepatitus and HIV virus. They should also have to be strapped down to a medical table and at the same time, have to have an EGD (the test where they put a tube down your throat) and a colonoscopy, without anestisia.

Many years agao there was the "Keep doctors in Nevada" campaign. Dr. Desai donoted $25,000. to it. He blamed rising medical malprcatice insurance rates on why doctors were leaving. I guess Dr. Desai just stuck it to the insurance companies, what with the insurance companies now having to pay for these approximately 40,000 blood tests and medications and hospitalizations (for those infected).

When is the Nevada State Medical Board going to revoke these doctors and nurses medical licenses?
By CynicalObserver

3/5/08 at 8:40 p.m.

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John:

I read your column, and forgave you your skepticism by thinking to myself "No one wants to think his doctor is a scoundrel". I understood your very human desire to be fair to your own doctor.

I then thought "Thank God I had my colonoscopy and endoscopy in the hospital". I also thought "Thank God I had an American gastroenterologist, Mickey Weisz."

Then, just today, I realized that Mickey Weisz is affiliated with the infamous Gastroenterology Center of Nevada, but apparently not one of the four owners, per the newspaper stories.

So now, what am I to think? Sadness for a decent guy who had the misfortune of working for the wrong medical group at the wrong time. Skepticism that an American doctor with a great resume would willingly continue working with a medical group using contaminated vials of drugs.

Yet at the same time, I realize that when the good doctor saw me for my third visit, he couldn't even remember me, or that he had done my colonoscopy and endoscopy. I also remember the absolute frenetic pace in the office, affecting receptionist, appointment bookers and the doctor himself. I also remember never seeing a nurse.

High volume, frenetic pace. Maybe the doctors didn't know what the nurse anesthetists were doing before the doctors entered the room. Then again, aren't they supposed to be supervising the nurse anesthetists?
By PeachStatePam

3/5/08 at 10:13 p.m.

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Part 2 - You should be tested for Hepatitis C if you:
* received a blood transfusion or solid organ transplant before July 1992
* were notified that you received blood from a donor who later tested positive for hepatitis C.
* have ever injected illegal drugs, even if you experimented only one time many years ago (or snorted any drugs)
* were a recipient of clotting factor(s) made before 1987
* have ever been on long-term kidney dialysis
* have had tattoos or body piercings
* had sexual activity that involved contact with blood
* have had vaccinations administered with pneumatic jet injectors
* are a veteran (especially Viet Nam)
* have shared razors, toothbrushes, nail clippers, tweezers, etc. with an infected person
* are a health care worker exposed to needle sticks or first responders
* have ever been incarcerated
* also 5% of babies born to infected mothers will get Hepatitis C

Doctors do NOT test for Hepatitis C on annual physicals or routine exams. You have to ASK TO BE TESTED!

You do not have any symptoms that damage is being done until the latter stages of the disease and that can be from 10 to 40 years! That is why it is called the *silent killer* There are treatments for Hepatitis C that are 45-80% successful depending on your genotype.

There are an estimated 4 million of you walking around with it that don't know you have it and can be inadvertently spreading it. Whether at the beauty salon where an HCV+ person was nicked and then you were nicked with the same instrument (Hep C does not die when it hits the air unlike HIV) and can live on surfaces for up to 4 days plus. Ignorance is not bliss.

Know your Hepatitis C status!
GET TESTED!

There are vaccines for Hepatitis A and B. There is NOT a vaccine for Hepatitis C!

Would you feel guilty if you found out you were in fact positive and might have put other people at risk over the years because you didn't know to be careful with your blood?

Please GET TESTED for HEPATITIS C! It is a simple blood test and can be added to your routine tests the next time you see your doctor. Just ask him/her to add it! Take care and be your OWN advocates.

To learn more you can visit my My Space at:
www.myspace.com/figmento
By PeachStatePam

3/5/08 at 10:14 p.m.

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Part 1 - I wish I had been told I was negative (back in 1997) but alas I do have Hepatitis C and already had cirrhosis by the time it was found. It is the main reason I continue trying to educate and advocate where I can. I have been posting this comment whenever another story has been written n hopes that it might help at least one other person.
~~~~~~~~~~~~~~~
While I am so sorry to read that so many people are getting diagnosed with Hep C due to *medical negligence* I am glad that the word is finally getting OUT about hepatitis C because for YEARS no one has wanted to talk about much less learn anything about it. For the person who is worried about giving it to her boyfriend - it is only transmitted BLOOD to BLOOD! There have been many *scares* over the past few years that make the newspaper for a day and then disappear. I hope these last few outbreaks keep it IN the news for awhile. Here is a comment I made on the Long Island site:
~~~~~~~~~~~~~~~
Well now that so many of you have expressed your outrage at the doctor (we might never know the *real* story) I would like to challenge you to learn a little bit about Hepatitis C! Don't misunderstand as I am also appalled that this could have happened in this supposedly enlightened day and age of universal precautions. Perhaps all this happened (sadly) so that more of you might get educated about Hepatitis C! It is reaching epidemic proportions in our country and most people don't know the differences between Hep A, B, C, D, E and G.

Hepatitis C requires a blood to blood transmission. It is the most common chronic blood borne virus in the U.S. today. There are an estimated 5 million Americans with Hepatitis C (FIVE times more than HIV) Bet you didn't know that! Only about 1 million know they have it. It is the leading cause of liver transplants in the U.S. 2/3 of patients will die waiting for a liver transplant because there are not enough organs to go around (please sign your donor cards!) There are an estimated 200 million people with Hepatitis C worldwide. Please read Part 2.
By joe

3/6/08 at 3:51 a.m.

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Dr.Dipak Desai or whatever his name may be, typically represents the greed of a gang of Indian doctors who enter the medical profession in their own country paying huge bribes and donations. Most of them enter the U.S. driven by sheer avarice to make big bucks. Dr.Desai's story is just the tip of an iceberg and there may be many more of these scoundrels out there not caught yet. What about American patients rushing to India for cheap medical treatment? They have no way of legal protection against medical crimes in that country where some doctors were recently caught for stealing kidneys for transplanting on medical tourists. The federal government should seriously legislate against the risk of outsourcing medical care to Asian countries where medical ethics is far below human trust.
By cy

3/6/08 at 4:49 a.m.

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Joe is full of love!! He is full of "information"!!
By John116

3/6/08 at 9:41 a.m.

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Jon,
Your call for moderation and a non-emotional investigation is a true credit to your profession. This will be difficult to do for the reasons you have enumerated, but critical, nonetheless. As a nurse anesthetist in private practice, I am outraged at the prospect of other practitioners engaging in the criminal activities mentioned in some of the reports.

This is such a radical departure from accepted practice, however, that the investigators need to be very sure before anyone is implicated. There are many details that must be adhered to in order to comfortably and successfully get the information you need from a colonoscopic exam. Departure from practice standards at any of dozens of points will possibly injure the patient, or at the very least, negate the effectiveness of the exam.

I have to think, though, that if anyone giving intravenous medication, be it anesthesiologist, nurse anesthetist, or registered nurse, were reusing contaminated medication vials, syringes, or needles in a facility that averages 50 colonoscopes a day, we would be looking at 600 to 1000 cases of Hep C, not 6.

Perhaps, it is a clerical lapse in technique? By this I mean taking 1 vial of medicine labeled for "single patient use" and drawing it into 5 different clean syringes. This decreases the cost to each patient by utilizing drug that would otherwise be thrown away and is absolutely clean and sterile from an infection control standpoint but is technically "wrong" according to labeled usage.

I am going to reserve judgement until more information is made available but I know there are those that will not. This is an unfortunate but predictable response. As a health care practitioner with 20 years experience, I will hope for the best, but if anyone knowingly used contaminated instruments on a patient (i.e. the anesthesiologist from New York in November 2007)...."let’s haul out the gallows" or at the very least, end their health care career.

The "good" nurse anesthetists, nurses, and anesthesiologists that I have worked with now and in the past feel the same way about the "bad" practitioners.
By pokerface56

3/6/08 at 2:08 p.m.

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A similar incident occurred in an oncology clinic in Fremont Ne. It created the largest single outbreak of HEPC in history. 101 people were infected. In that case the provider left the country. Patients must learn to ask the right questions and never assume anything about anyone regardless of his/her title.
By KC

3/6/08 at 2:32 p.m.

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I fully agree with moscati re: bio-terrorists!
My husband went for a colonoscopy to the Burnham clinic in Nov 2007. Thank God all came back clear on the test. UNTIL this week.
Now we sit in "terror" waiting for his blood results to come back, which he took yesterday at our local drs office.
My heart and prayers are going out to everyone that is a part of this living nightmare.
I blame not only the drs that own these clinics, but even more so I blame the nurses, drs and anyone that "knowingly" used dirty syringes etc,,
Let's face it,,,they are the ones that fired the fatal shot, the owners gave the word and they re: those who intentionally did this due to their own lack of morals, ethics, common sense, etc,,are even more guilty then the one that said lets save some money.
There is NO EXCUSE whatsoever and I believe that anyone who did this should be fully prosecuted to the full extent of the law.
What makes "them" any different then the terrorists we are fighting in Iraq? At least we can see them and are trained to fight our enemies and do it well.
All it took was for 1 person that knew of this disgrace in the clinic to make a call, without giving their name and this could of been prevented.
I know that God will be the final judge on these people.
With hope and prayers to all who have or are suffering now with these diseases, and are waiting for the "results" may God Bless you with HIS PEACE during this time of bio-war in our valley.
By cy

3/6/08 at 6:55 p.m.

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KC is justifiably worried.But be reassured that the chance your husband is actually infected is extremely small.Unfortunately I cannot say it is zero, but it is close to it.
By joia

3/6/08 at 9:08 p.m.

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I also was a patient of Dr. Desai, and had a procedure performed at one of his clinics in July 2007.

Yes, the news is terrifying, but using this tragic situation as a cover for racism and prejudice is sickening. Dr. Desai's ethnicity has nothing to do with this. Greed and avarice rear their ugly heads in all ethnic groups.

Let's wait for all the information to come out about how this situation came to pass - and try to keep a realistic perspective on infection rates. Yes, it's scary - but odds are I don't have anything to worry about, and neither do most of the people who got those fateful letters.