Tests may find existing cases, not clinic victims

Many have hepatitis C, don’t know it

Steve Marcus

Dr. Dipak Desai is majority owner of the endoscopy clinic where at least six people contracted hepatitis C.

Thu, Mar 6, 2008 (2 a.m.)

Hepatitis scare

We may never know how many patients contracted infectious diseases at a clinic where unsafe injections were the cause of the largest hepatitis C scare in the nation.

The reason: About 2 percent of the U.S. population and an estimated 4 percent of patients at the clinic — whether they know it or not — already carry the hepatitis C virus, according to health officials. The estimate is higher for patients at the clinic because it serves an older clientele.

Thus, if 40,000 people were put at risk of hepatitis B and C and HIV by unsafe injection practices at the Endoscopy Center of Southern Nevada, as the Southern Nevada Health District estimates, and all of them get tested, the math suggests 1,600 of them might test positive for hepatitis C.

Most of them would not have known they were carrying hepatitis C until being tested, because in four of five cases symptoms — such as loss of appetite, nausea and jaundice — don’t appear.

And upon learning now that they have the virus, they won’t know whether they contracted it during the procedure at the Endoscopy Center of Southern Nevada or through some other way — before or after their procedure.

Hepatitis C typically is contracted by intravenous drug users, dialysis patients or people who received blood transfusions or organ transplants before 1992, when blood and organs were not screened carefully for the disease.

(It’s highly unlikely that hepatitis B or HIV was passed on at the clinic, health officials say, but they are encouraging the testing to make certain.)

As a result, any litigation by hepatitis C carriers against the endoscopy clinic will be muddied because of the difficulty in proving they contracted the disease there.

Assumptions can’t be made that the Health District will undertake the expensive and specialized genetic testing to show hepatitis C links to the clinic, said Brian Labus, the district’s senior epidemiologist.

The genetic testing that linked six patients with hepatitis C to the clinic was conducted by the Centers for Disease Control and Prevention. “They will do it for investigations,” Labus said. “They won’t do it for lawsuits.”

The Health District’s mission is to identify public health threats, take action to see they’re stopped and communicate to the public, Labus said. In this case, the mission was to find out what happened on July 25 and Sept. 21, the days six people were infected with hepatitis C at the endoscopy center. The district has accomplished that.

Further investigation will be undertaken only if other clusters of hepatitis C cases pop up, he said, or if something else noteworthy comes from the community testing.

The Health District announced the public health crisis after the CDC concluded genetic tests in five of the six known acute hepatitis C cases — the cases in which the patients were showing symptoms. This involved isolating the genetic material — in this case RNA — in each strain of the virus to determine its exact sequence. It’s like identifying a bar code for each virus, an identifier that can be used for the sake of comparison with other viruses, Labus said.

The genetic breakdowns have been completed on the virus from the patient who went to the endoscopy clinic on July 25 and on four of the five who visited the clinic Sept. 21. Hepatitis C viruses are known to mutate and their genetic sequences vary greatly, Labus said. But the four viruses from the Sept. 21 cases match up. Two of them were “100 percent identical and the other two were similar enough, based on what we know about hepatitis C, to say they all came from the same source,” Labus said.

Some attorneys who are suing the Endoscopy Center of Southern Nevada have said that patients, before they join a class action lawsuit, will have to be tested to identify the genetic sequence of their hepatitis C virus. Labus said patients can always look into getting the genetic breakdowns done, but that it’s not the type of testing that’s available to the public in any place he knows.

“I don’t know that it’s ever been done outside the investigative work for public health,” Labus said.

Sun reporter Mary Manning contributed to this story.

Discussion: 10 comments so far…

By morpheus

3/6/08 at 2:16 p.m.

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AANA condemns the reuse of medical supplies. Read the full statement and learn that this has happened in other states recently.

http://www.aana.com/news.aspx?ucNavMenu_...
By AngryPostman

3/6/08 at 3:14 p.m.

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This article is bullshyt propaganda. I see the bad Dr. Desai's lawyers are already churning out nonsense to cover up this criminal's actions. I would argue that the burden of proof is on that chump Desai to prove that the pateint contracted the disease elsewhere, because the assumption should definately be that the cause was his clinic's obscene practices.

You Vegas ambulance chaser's crack me up. You're going to have to do better than this distraction crap to save this quack.
By MikeB

3/6/08 at 4:53 p.m.

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No, this is solid, factual reporting on the nature of the disease in question.
While there are several different genotypes of the Hep C virus, the vast majority of patients in the US have genotype 1, which is also the most resistant to treatment. One medical marker for Hep C is elevated liver
enzymes. (ALT and AST) A patient whose enzymes tested normal prior to
a procedure at the clinic and was found to have Hep C plus elevated enzymes after the procedure would have a better case against the clinic.

The doctors and staff deserve all the punishment they receive, but the reporters are correct in their assessment of the medical/legal situation in
my opinion, and I have 15 years of experience with the disease.
By PeachStatePam

3/6/08 at 11:05 p.m.

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This was a very good and very accurate article. I am sorry AngryPostman that you might be one of the people who were exposed there and are thus *angry* but as MikeB stated this is *solid, factual reporting on the nature of this disease* I have probably had it since the 60's (before universal precautions) but had no symptoms, no elevated ALT or AST over the years, but was already cirrhotic by biopsy in 1997. I keep trying to post information to educate the public about Hepatitis C but most are just seeing the $$ signs of an impending lawsuit rather than learning what the truths are (the reverse of an ambulance chaser - a lawsuit chaser which has become far too easy in this country). One woman who came back positive has already been quoted in the paper as saying she can no longer have sex with her husband or allow her many children to eat or drink after her or share her bathroom. POPPYCOCK! She is causing her own *mental anguish* (which I am sure she hopes to turn into $$) by not learning THE FACTS about her own disease. And if she is already experiencing symptoms (and she wasn't in the acute phase) then she has had this disease for much longer than a few years. As this article stated most people never have any symptoms and it takes anywhere from 10 to 40 years to get symptoms. I am very sad that this happened and I truly feel very sorry for those that did pick this up at the clinic but it is true that the majority of people who will be found positive have had the disease since long before they ever walked into that or any other clinic. For more info on Hepatitis C please see my comments at:
http://www.lasvegassun.com/news/2008/feb...

This is one of the best articles done out about this horrible *outbreak* thus far. Everyone should be tested for Hepatitis C. There are far more ways than just an endoscopy clinic to *pick it up at* Beauty parlors, barber shops, tattoo parlors, any place that might have a blood to blood transfer. KNOW YOUR HEPATITIS C STATUS! GET TESTED!
By KC

3/7/08 at 2:15 p.m.

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How come everyone is just talking about the HepC?
What about HIV?

There was a woman on the local news that is devestated,,,she had HIV,,went to the clinic and now has Hep C. Does her blood with HIV make this situation any easier? I am sure there are many that go to these clinics for tests,,and are HIV+
they may not be aware of it just like others may not be aware they have the Hep virus I don't blame these people,,,bottom line is "they,,clinic nurses etc" infected more people!

I have a friend that has HepC which she did catch from these clinics, and I also have a relative that has had HIV for years. These people in my life take every precaution NOT TO INFECT others.

HIV is spread through the blood also,,,but everyone seems to be concentrating on Hep C.
Thanks to the stupidity and greed of these clinics and the some of the people that work there,,,we now await to see the outcome and the damage done to our lives and those of others in this valley and others who have come to Vegas for medical treatment at these greedy, immoral places. All for what?????

May God protect all of us innocent victims from this hellish act!
By moscati

3/7/08 at 4:51 p.m.

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I have contracted hepatitis C due to one or more of these clinics. I have had 6 or 7 colonoscopies due to colonrectal cancer. I was due again just 3 months ago and was enraged to hear that what the doctor prescribed for cleansing would not work and I'd only have to come back in two weeks to do it again. I was also told that I should have the colonoscopy and endoscopy anyway!!! I was extremely vocal about this and many other people heard it. I left with some pretty harsh words, vowing to never go back. Now I see that he and many others that put people at risk are listed and work at these clinics. If any of you can remember the screaming patient, please speak out. I know that there was a lady at the front desk with a very young child who heard the nurse say that the medication I took would not work. Please, you know what happened for a fact and heard what the nurse said. I found out about the infection when I had applied for a life inurance policy a couple of years ago. I had tested negative prior to that. It was recommended to take the test again to ensure that it was not a false positive. This diagnosis almost destroyed me and almost cost me my marriage. My wonderful internist has stood by me and agrees that prosecution is necessary. These doctors and nurses that committed these heinous and vicious crimes are BIO-TERRORISTS and should be treated as such. I wouldn't mind giving each and everyone of them a colonoscopy with a dirty scope, without the benefit of anesthesia so they can feel the pain of knowing that one way or another they'll be infected with something. Okay, I'm done. Have a nice day. I have just one more thing to say. You must also have a Quantitative PCR test. It is a very expensive test, but will catch very minute amounts of virus in the blood. Let the Health Department pay for that. You will likely only get the routine hepatits c panel required if you do not specifically ask for this test.(there will be a lot of false negatives if you don't do the more sensitve testing). Now I'm done.
By Snippy

3/7/08 at 9:49 p.m.

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What exactly is a false positive anyway. I hear that a lot. Does it mean that the negative given could possibly be wrong and it could actually be positive? And why bother asking the Health Department to pay, 1st it will come out of our pockets anyway - Taxes. 2nd, they didn't cause this expense - The expenses to everyone or their insurance should come from the owners of the endoscopy centers. For each share owned, that is the % they should pay for each persons test. That is how they divided up their power, chain of command, and profits. When that is not offered, with intent, by the ones who caused this mess, it has to be fought for. Everyone complains about lawsuits. This is really all they are about to most people who sue-to recoup a loss (as well as to punish a person who has been able to avoid meaningful punishment). To speak derogatory about anyone involved who wants to sue in this scenario is beyond me. People who are sick from this are not only losing their health, but they will have lost income from the illness... inability to work some days, doctor appointments other days or some may be disabled from the illnesses they had thrust upon them. They will have medical expenses they didn't deserve to have to worry about how they will get paid, or worse yet - can they even get the procedures required if the money is demanded up front. The list of loss to them goes on, much less the mentally ability to deal with this. The people who were shocked to hear this and forced to get their blood test, left to worry for a week while they wait the results are entitled to demand a punishment for these people. Are you paying attention to how this happened? How the laws were changed to protect medical providers, leaving them with no serious consequence if they did carelessly screw up and cause damages as they did here. These doctors created those laws, they sit on the Medical Boards who are in charge of punishing doctors who screw up. DO YOU THINK THEIR FINDINGS CAN POSSIBLY BE FAIR AND PARTIAL? Find and read up on the history of cases that went before them. It is in the pit of the stomachs of everyone involved. People want to see justice and do not want this swept under the carpet. Lawsuits are the only way to get justice sometimes for monetary loss or just plain justice. To get what is due and owing to them, they will need attorneys who do this work to make a living just like everyone else who goes to work every day. I am not saying the fees are reasonable, but it is a viable career and a livlihood all the same. No I am not an attorney. If you ask me, if you want these types of incidents to stop and keep more of it out of the courts, get the "brothers" off the boards. There has to be a fair and partial board who really does care about the health and well being of mankind, and not to protect their brothers. We need boards who are willing to punish careless and thoughtless doctors and hospitals.
By AngryPostman

3/8/08 at 12:17 a.m.

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I apologize.. this is factual medical reporting used as bullshyt propanda!

Inroducing the argument that "Hey these poor schmucks might have already had a blood borne infectious terminal disease" is medically correct.

But still bullshyt propaganda.

Anyone with any blood borne illness that had the misfortune to have been stabbed with a potentially contaminated needle at any of these clinics or their related clinics.....

The burden of proof is on them! This article makes me angry because it appears to deflect responsibility for this crime.

I see the good Doc Desai 'surrendered' his license.

Every Doc associated with all these clinics should surrender or get reviewed.

The nurses all already surrendered... time for the doc's to put up.

Time for the recipients of the good Doc's campaign donations to do some explaining....

Jon....?
By atriskoutofstate

3/22/08 at 12:47 p.m.

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i am livid and utterly amazed by all of this; all US citizens should be outraged and up in arms about this crime against innocent citizens. i was just contacted today by my lover who was a former patient at this clinic and i am so angry. he had moved out of NV and never received any notification of this tragedy from any official. we just "happened" to receive word from someone living in the state. i agree that there is failure in the news articles i've read to talk about HIV or any other blood borne diseases besides HepC. all of the lovers of the people who received procedures from the clinic are at risk and are victims, too--let's do the math. my mental anguish has been caused by the clinic's negligence because i get to worry whether i'll become symptomatic for HIV or something else in the future as a result of this crime. everyone involved needs to lose their licenses and needs to be prosecuted. does anyone know of a group that has formed of those of us who have been put at risk? what can we do to make sure our voices are heard LOUD and CLEAR--that we are not going to accept what has happened to us quietly!
By Ambrosette

3/27/08 at 6:31 p.m.

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We have been tested for three life insurance policies, who do test for HIV and Hep C in the last ten years as soon as 2003, never have had anything. In 2004 annual physical request for hep and hiv, came back neg, in late 2005, my husband went for his annual physical, came back with acute Hep C!!! he came home devastated. Since his findings, 4 other guys at work have came back positive for Acute Hep C!!! For almost 2 years now, I have thought there has to be someone at the jobsites where they build these casino's, who is purposely spreading this disease... What the heck is going on, something is going on!!! I've thought for 2 years. NOW IT ALL MAKES SENSE! WE ALL HAVE THE SAME INSURANCE AND GO TO THE SAME CLINICS AND DOCTORS AND HOSPITALS!!! I'm sorry, but I think much more carelessness has been going on, and I think there's alot of people right now who have been infected not even realizing or thinking they are, because they didn't go to the clinics in question.... I suggest EVERYONE that has been diagnosed with Acute Hep C go get all your med records and blood tests from the past and also you should see an attorney. THIS IS BULL$#!T!!!, what is going on and been going on, this kind of behavior by doctors, assistants and nurses etc has been going on everywhere. Not just in these 5 endoscopy cases, the more people who get their records investigated, with and by an attorney, the more places are going to start being found neglegent of this same thing... If you've been told by your doctor or life insurance company or any blood testing person or place, that you have Hep C Acute, in the past 3 years, you need to contact an attorney!!! (like my husband and I, there is no possible way he contracted this anywhere else, accept at the dentist!!! who needs to start being held accountable for their careless sterilizations also. These doctors put this law out to be in effect, to save their arses! They knew exactly what they were doing!!! We as citizens of Las Vegas, NV need to contact our governors, senators, mayor, etc, and demand that this negligent law be reversed and voted back for our safety! I really would like to talk to Peach State Pam for more info... I have been researching Hep C for two years now, and I want more info...