Las Vegas Endoscopy center closed by the city today
By Las Vegas Sun Staff · February 29, 2008 · 5:05 PM
The Endoscopy Center of Southern Nevada, where sloppy medical practices have sickened six patients with Hepatitis C and exposed about 40,000 others to that, hepatitis B and HIV, was closed down Friday by an emergency action of the city.
The city's business services division manager, noting that practices at the clinic were likened to "driving the wrong way down the freeway," said such behavior could not be tolerated.
State and federal investigators told the city that members of the clinic's nursing staff knew of the poor techniques, which included reusing syringes when drawing medicine from vials, and sharing vials among patients, resulting in cross contamination.
The nurses said they were told to cut those corners by their bosses, even though they knew they "risked contaminating patients with life communicable diseases."
One investigator told Jim DiFiore, the business services manager, "It's very hard to believe that they won't do it again."
The city offered a post-suspension hearing on Monday at City Hall.
City shuts clinic, with harsh words for owners
Official: Staff told to reuse vials, syringes to save money
By Marshall Allen
Las Vegas Sun
Sat, Mar 1, 2008 (2 a.m.)
Dr. Dipak Desai, one of the state's most prominent physicians, willfully chose to "mortally hazard his patients for profit" by operating an endoscopy clinic fraught with cost-cutting sloppiness, a Las Vegas city official said Friday.
Desai, who was a member of Gov. Jim Gibbons' transition team in 2006, is the majority owner of the Endoscopy Center of Southern Nevada, the source of a disease outbreak that's caused the largest hepatitis C scare in the country, according to health officials, who said 40,000 people who received anesthesia while undergoing endoscopic procedures there, including colonoscopies, must be tested immediately for hepatitis B, hepatitis C and HIV. The clinic was one of the busiest of its kind in Nevada.
When Jim DiFiore, manager of the city's business services decision, suspended the facility's license Friday, he cited previously undisclosed findings by health investigators who inspected the clinic in January.
DiFiore said in a letter to the clinic's owners that Desai ordered his nurses to reuse syringes and reuse single-dose vials of medication when administering anesthesia to patients who received endoscopic procedures. The practice, which allowed cross contamination of patients' blood, caused six people to become infected with hepatitis C.
Desai did it to save money, DiFiore said.
The state Licensure and Certification Bureau, which oversees the ambulatory surgical center, allowed it to stay open because the dangerous procedures were corrected.
But DiFiore quoted a health investigator who said, "It's very hard to believe that they won't do it again," when explaining why he was shuttering the clinic.
"The fact that, once caught, you have agreed not to engage in a technique well known to the medical community to subject patients to death or serious illness again does not persuade me that you won't do it again," DiFiore wrote.
Desai and the other Endoscopy Center owners would not comment for this story, on the advice of their attorneys, Abran Vigil and Alan Sklar.
DiFiore, who referred to the investigators from the Southern Nevada Health District, the Licensure and Certification Bureau and the Centers for Disease Control and Prevention as a "tiger team," said he was told by a CDC officer that the Endoscopy Center practices were so obviously dangerous it was like "driving the wrong way down the freeway."
"I do not believe that there is any department of motor vehicles in this country that would not immediately revoke the driving license of a driver when given credible evidence that the driver had driven the wrong way down the freeway every day for the past four years," he wrote.
Citing more information provided by the health investigators, DiFiore said many nurses knew the technique was dangerous to patients, but they were ordered by administrators, mainly Desai, "to engage in the practice in order to save money."
Some followed Desai's orders and risked contaminating patients with life-threatening diseases, while others disobeyed him, DiFiore wrote.
Desai used to sit on the Nevada State Board of Medical Examiners, which has now launched an investigation into the clinic, which is also owned by Dr. Vishvinder Sharma, Dr. Eladio Carrera and Dr. Clifford Carrol.
Dr. Jim Christensen, an allergist who is on the board of the Health District, said the allegations in DiFiore's letter elevate the situation from malpractice to criminal behavior.
District Attorney David Roger promised "a massive investigation" into what occurred at the clinic.
Clinic cut corners for profit, critics say
'It was just a poorly run operation,' says doctor who practiced at Endoscopy Center
By Marshall Allen
Las Vegas Sun
Fri, Feb 29, 2008 (2 a.m.)
The largest hepatitis C scare in the country likely started with the seed of many problems in medicine.
Greed, some doctors say.
In fact, it's unknown why basic medical practices were apparently so abandoned that at least six patients of the Endoscopy Center of Southern Nevada have contracted hepatitis C. Because the faulty practices that likely led to the outbreak were so entrenched at the endoscopy and colonoscopy clinic, health authorities fear as many as 40,000 patients over the past four years may have been exposed to hepatitis B, hepatitis C or HIV.
Several doctors said the clinic apparently put profits ahead of patient care. The staff cut corners in order to accommodate the high volume of patients, doctors unaffiliated with the clinic surmised.
Dr. Dipak Desai, the gastroenterologist who is the majority owner in the practice, is not talking and neither are his partners.
Other physicians, patients and elected officials become frustrated and enraged when trying to explain the failure to practice basic infection prevention at the clinic.
Certified nurse anesthetists at the business, at 700 Shadow Lane, were reusing syringes and single-dose vials of medicine for multiple patients, health officials said.
Anesthesiologist Dr. Rodney Borden, who said he did procedures at the practice in 2001, said using a certified nurse anesthetist to administer the drugs is permitted and is known as a cost-saving measure. In past years, he said, the clinic used anesthesiologists - medical doctors - for the procedures.
"I'm really not trying to indict nurse anesthetists as a concept," he said. "It was just a poorly run operation there. Someone was trying to save on drugs and supplies."
Some drugs could cost $20 a bottle, he said, so rather than throw away a partially used vial, there would be some motive to keep it for use on another patient. The clinic, he said, was penny-wise and pound-foolish.
An investigation - conducted jointly by the Southern Nevada Health District, Nevada State Bureau of Licensure and Certification, and Centers for Disease Control and Prevention - found the nurses were doing what they were told in administering anesthesia for procedures, and that it was standard practice.
Six patients who received anesthesia injections at Endoscopy Center have been diagnosed with acute hepatitis C. One picked it up July 25 and five were infected Sept. 21, health officials said.
Health officials announced on Wednesday that they were sending letters to every patient who had received anesthesia between March 2004 and Jan. 11 for a colonoscopy or endoscopy at the Endoscopy Center.
Disbelief and anger over the crisis spilled over Thursday during the regular meeting of the Health District. Las Vegas City Councilman Gary Reese said it's a "clear case of cutting corners" to save dollars, and "we can't let this happen anymore."
Said a frustrated Dr. Jim Christensen, an allergy specialist who sits on the Health District board: "Everything I do is on a personal trust and this just gives patients another reason not to trust their doctor."
Elected officials demanded that the clinic be stripped of its business license, which would effectively close the facility. Mayor Oscar Goodman asked city staff to begin the process of forcing the clinic to demonstrate why it should not lose its city business license. Clark County Commissioner Chris Giunchigliani, who also sits on the Health District board, agreed that the licenses should be yanked.
And Bobbette Bond, government and community affairs coordinator for the 120,000-member Culinary Health Fund, said the self-insured union will likely terminate its contract with the Endoscopy Center. For now, Culinary is making arrangements for 3,500 patients to get their blood tested and urging others to use a different gastroenterologist.
Greed is the most likely root of the problem, local doctors said, because there's just no other credible reason the staff at the Endoscopy Center could have been so careless.
"The amount of money you save on those syringes is pennies," said one local gastroenterologist. "This was a volume issue."
If 40,000 people are being notified for work performed in less than four years, that represents a lot of patients for a two-bed facility, said the specialist, who did not want to be identified.
The specialist said he can't imagine the infections were passed intentionally, but in pursuit of money there "is less time to stop and apply the appropriate safeguards."
In March 2004, the Endoscopy Center was licensed by the state as an ambulatory surgical center, allowing multiple doctors to perform procedures there. It is one of the highest-volume endoscopic clinics in Nevada.
The controversy at the Endoscopy Center comes as the practice was growing. The center is affiliated with Gastroenterology Center of Nevada, a 14-physician practice started by Desai. One of them, Dr. Vishvinder Sharma, is also an owner of Desert Shadow Endoscopy Center, at 4275 Burnham Ave., Las Vegas. And Desai and Sharma just licensed Spanish Hills Surgical Center last month at 5915 S. Rainbow Blvd., records show.
The Bureau of Licensure and Certification investigation found five other violations on Feb. 1 at the Desert Shadow site, but those will not be made public until the clinic finishes its plan of corrective action. Health officials said the violations are not related to the problems at Endoscopy Center that caused the infectious disease crisis.
In Feb. 2004 the Bureau of Licensure and Certification found failures with the Endoscopy Center's patient discharge practices.
It's unknown whether nurses, doctors or both are responsible for the various failures that led to the hepatitis C emergency. Health officials did not make that question a subject of their probe, but the answers may be forthcoming as other agencies get involved. The Health District is filing complaints with the Nevada State Board of Medical Examiners and Nevada State Board of Nursing.
Doug Cooper, chief of investigations for the medical board, said he has launched his investigation. The board has never received more calls on a single subject from doctors, patients and state legislators, he said. To Cooper's chagrin, the board did not know about the hepatitis C outbreak until Cooper heard it on the news. But the investigation has been given the highest level of urgency, he said.
Cooper would not speculate on possible disciplinary action because the allegations are unproven. Punishment for a physician could range from probation to losing his license, depending on the offense. The same severe punishment could be meted out on offending nurses, said an official from the nursing board.
It's also possible the investigation could lead to criminal prosecution.
"I've asked our major fraud deputies to get together with Health District investigators to see if criminal charges are warranted," Clark County District Attorney David Roger said Thursday. "This is a pretty unusual case and I'm not familiar with any cases like it that have occurred in Clark County."