Leila Navidi

Theresa Morrow comments Monday during a special hearing of the Legislative Committee on Health Care at the Sawyer State Office Building.

By Marshall Allen

Tue, Mar 25, 2008 (2 a.m.)

Leila Navidi

Audience members pay rapt attention to Gov. Jim Gibbons on video during a hearing on the hepatitis C scare in Las Vegas.

When nurses at a Las Vegas clinic failed to follow basic disease prevention methods they did more than cause the largest hepatitis C scare in the nation.

The nurses at the Endoscopy Center of Southern Nevada — and the doctor who allegedly told them to cut corners to save money — shattered the already tenuous trust patients have in Nevada’s health care system.

The violation of public trust was exacerbated by the failures of state oversight agencies that could have — should have, many argue — caught it.

The crisis has gained steam since it was announced Feb. 27, metastasizing like a community cancer. Now the state faces a defining moment that will determine many future aspects of health care oversight and regulation.

The public, reeling from the revelations, showed up in force at a meeting Monday before the state’s Legislative Committee on Health Care. About 200 people attended.

The public anger was palpable when Reuel Williams, who had undergone a colonoscopy at the Endoscopy Center of Southern Nevada, called on the doctors to be “criminally prosecuted and their assets seized.”

The crowd broke out in applause.

And when Loretta Conner, a retired nurse, called for the doctors’ deportation, there were cries of “Yes” and “Amen.”

While the credibility of the health care system is at stake, the crisis also creates opportunities for long-needed reforms.

“This is a defining moment in the sense it has captured the attention of the people,” said Dr. Maurizio Trevisan, executive vice chancellor and chief executive of the University of Nevada Health Sciences System. “Our state is in need of strong leadership in establishing a strong health care system.”

He pointed to the lack of inspections by the state as an area that needs to be addressed, although he cautioned against overregulation. He also said strengthening academic medical resources would help.

“Strong academic enterprises tend to serve as an impetus to raise the bar for the whole medical community,” he said. “It has been very challenging in Nevada, because of the way we are traditionally underfunded.”

Trevisan acknowledged that with the state facing huge financial shortfalls, it was not the best time to be seeking more money. But he said the health crisis has offered the chance for substantive debate.

“I hope with the attention placed on this issue, we can actually broaden the scope of the conversation,” he said. “I hope we can ask ourselves what we want to be as a state 15 or 20 years from now.”

Assembly Speaker Barbara Buckley said she has never seen a comparable health care crisis in Nevada. The scope and magnitude of 40,000 people being told to be tested for hepatitis B and C and HIV, combined with the disregard for standard medical practices, mean “everybody’s talking about it,” she said.

Buckley said the first message is to the medical community: “You can’t cut corners and put patients’ lives at risk.”

Second, Buckley said state legislators need to do what is necessary to ensure an aggressive response when there’s a similar breach of trust. When an agency such as the Nevada State Board of Medical Examiners fails to use its discretion in the public’s favor, legislators will tighten the statutes, she said.

For example, in 2005 the medical board decided to stop posting doctors’ malpractice settlements on its Web site. Two weeks ago Buckley sent the medical board a letter asking it to post the information. If it doesn’t, future legislation will require it, she said.

Dr. Jim Christensen, a Las Vegas allergist who sits on the board of the Southern Nevada Health District, said legislators need to give broader power to the medical board. It is currently hamstrung when it comes to meting out discipline by laws that make taking action a matter of interpretation of whether the public is in immediate danger, he said. When a doctor’s livelihood and reputation are at stake, it’s difficult to summarily suspend his license, he said.

In contrast, whenever a police officer is involved in a shooting he is immediately placed on paid administrative leave while investigators gather evidence, he said. A similar legislative mandate would help the medical board in situations like the one with the Endoscopy Center.

“It’s a timeout, it’s a pause, and it allows people the time to gather facts so they can make an objective and informed decision,” Christensen said.

Holly Sweetin, a registered nurse who works at University Medical Center and also operates a patient advocacy business, said the crisis can bring reform on many levels. Legislators could add more laymen to the medical board, which would help avoid doctors’ conflicts of interest when policing their peers, she said. And they could create oversight boards for local hospitals that would investigate sentinel events — deaths directly caused by failure to follow hospital procedures.

Doctors, she said, can be reminded that they need to be more concerned with patient care, and nurses, whom she called the “ultimate patient advocates,” must stand up for what’s right. When something unethical is taking place, nurses must realize their “license is on the line, and the patient’s life is on the line and you have to stop.”

And patients must realize they need to ask doctors questions, she said.

“It’s their body,” Sweetin said. “They have the right to ask questions of any doctor and any medical personnel who may be performing a procedure or giving them medication.”

Bobbette Bond, government and community affairs coordinator of the Culinary Health Fund, said this may be a crucial moment for Nevada health care, but many Las Vegas insiders were not surprised by what happened. People have long known that health care in Nevada is at the “bottom of the heap” nationally, she said.

Health care is suffering throughout the country, Bond said, but Nevada is much worse comparatively in terms of transparency, public reporting, oversight and sunshine on the regulatory and licensing boards, she said.

People know reform is necessary, “but you can’t get good legislation passed without a fight, or good strong regulations passed that are effective, and you can’t get the financial resources devoted to move our health care indices,” she said.

The public will play an integral role in moving forward, she said.

“People have to push back more and expect more,” she said.

Sun reporter David McGrath Schwartz contributed to this story.