Media Library

Officials Uncover Hepatitis Case Link

Though Southern Nevada Health District disease investigators think they have "clear-cut" evidence a patient contracted hepatitis C at a Las Vegas endoscopy center in 2006, they just can't say how.

As a result of the findings, the district is not going forward with a full-blown notification of patients at the now closed Desert Shadow Endoscopy Center at 4275 Burnham Ave.

In a report released Thursday, investigators said they do not have enough information to determine the source of hepatitis C transmission at the facility, which was affiliated with the Endoscopy Center of Southern Nevada on Shadow Lane.

Seven hepatitis C cases were linked to the reuse of syringes and anesthesia vials at that clinic, prompting a massive public health investigation.

No other patients who have tested positive for hepatitis C have been linked to the Burnham facility, and health officials have not been able to document any other unsafe practices that could have led to transmission there, said Brian Labus, the health district's senior epidemiologist.

"We have one case there," Labus said. "The person tested negative (for hepatitis C) two days prior to undergoing a procedure at the facility. That patient then developed acute hepatitis C. It's likely the patient acquired it at the clinic, but how, we can't speculate on because we can't make the same assumptions as were made at the Shadow Lane facility.''

As for 13,000 former patients of the Burnham clinic, Labus said, "it's an unfortunate frustrating situation, but we can't give them a firm recommendation.'' They need to discuss whether to get tested for hepatitis and HIV with their physicians, he said.

"We're not discouraging patients from getting tested. We're just suggesting that they speak with their physicians about their risk,'' Labus said. "We will be sending those patients a letter (saying) here is what we've found and here's what we know."

Unlike observations made at the Shadow Lane facility, state Bureau of Licensure and Certification inspectors did not observe staff reusing syringes at the Burnham facility, which was closed shortly after news of the health crisis broke. But they did find staff there reusing single-dose vials of propofol, according to inspection reports.

The Centers for Disease Control and Prevention and health district officials think the cluster of hepatitis C cases at the Shadow Lane facility resulted from nurse anesthetists contaminating single-dose propofol vials with syringes that had been reused.

Regardless of the health district's announcement, attorneys representing patients in hepatitis C litigation said people should get tested.

"It is extremely important that they make sure they are free from disease,'' Lewis Gazda said.

His firm represents 50 clients who have tested positive for a blood-borne disease and were treated at a facility owned by Dr. Dipak Desai, majority owner of the Shadow Lane and Burnham clinics.

The law firm also represents more than 50 patients who have tested negative.

Dr. Vishvinder Sharma, a gastroenterologist who resigned as a member of the state's Board of Health, managed the Burnham facility.

The health district also announced Thursday that it has started a Hepatitis C exposure registry.

The registry was developed to help in identifying patients who had procedures at the clinics, including those infected by hepatitis C. The registry will include a way for patients to report on possible hepatitis B or HIV infections.

The health district will be mailing enrollment forms to patients of the Burnham and Shadow Lane facilities, including the 40,000 who were initially warned to be tested. The forms are available online at www.southern nevadahealthdistrict.org.

Dr. Lawrence Sands, the health district's chief health officer, said there are many former patients the agency has been unable to locate because clinic records were incomplete. The registry is another way to identify such patients.

Labus said the previous system of calling patients based on positive lab results received by the health district was not working.

"This approach eliminates us trying to make contact with someone who may have moved or changed their telephone number,'' he said.

Officials think 50,000 patients visited the Shadow Lane facility between March 2004 and Jan. 11, the time frame that they said unsafe injection practices took place.

With the seven hepatitis C cases linked to that clinic, a possibility exists that an additional 77 people who have chronic hepatitis C might have contracted the disease there. About 400 people who underwent procedures at the clinic have tested positive for hepatitis C.

Lawyers Want to Postpone Hepatitis Class Action Lawsuit

There are new developments in the hepatitis crisis involving the Endoscopy Center of Southern Nevada. A portion of the pending class action lawsuit against four of the doctors at the clinic has been postponed.

Defense attorneys are trying everything they can to postpone the pending class action lawsuit against Dr. Dipak Desai and other doctors who worked at the Endoscopy Center.

Tuesday, they partially got their wish. Defense attorneys for Desai and the other doctors in question asked the judge to postpone the possible class action lawsuit, specifically depositions of the four doctors who would be asked to answer certain questions about the practices at the clinic.

Attorneys argue that any comments made at these depositions by the defendants during the class action suit could possibly be used against them in the current criminal investigation.

Desai's attorneys have threatened that Desai may assert his Fifth Amendment rights in the case to avoid possible self-incrimination.

Tuesday, the judge decided to postpone those depositions until the end of July in hopes attorneys would know where the criminal investigation stands. Doctors would also be able to assert their Fifth Amendment rights.

"If they take the Fifth Amendment, we are entitled to adverse inference for any question they refuse to answer. So if we ask a question like, ‘What was the standard procedure at the clinic X?' and they refuse to answer it, then the jury can take the inference that the standard procedure was X," said attorney Will Kemp.

Attorneys for the plaintiffs have also been working to get their hands on an inspection report done on the Endoscopy Clinic on Shadow Lane. The inspection was performed by a third party quality care consultant, but has yet to be turned over to attorneys working in the class action lawsuit.

All of the attorneys will meet again on July 29, 2008 to talk about the current postponement of those depositions. The judge said the court will see if they have any more of an appetite to extend the postponement.

No date has been set for filing criminal charges against the doctors. The DA's office has said in the past they are working on it and should see something in the near future.

PUBLIC HEALTH CRISIS: Medical Board Defends Efforts

By ANNETTE WELLS REVIEW-JOURNAL

Responding to criticism brought last week, the president of the state Board of Medical Examiners told Gov. Jim Gibbons and Nevada lawmakers Monday that the regulatory agency is diligently investigating doctors' culpability in the hepatitis C outbreak.

The medical board's Investigations Division is " vigorously, urgently and professionally pursuing its investigation ... following every lead, interviewing every witness that will talk to them and cooperating fully with law enforcement," said a letter signed by board President Javaid Anwar.

His letter was a response to a missive sent Thursday by Gibbons and four lawmakers who contended there was a lack of communication with new board members regarding the investigation involving unsafe medical practices at the Endoscopy Center of Southern Nevada.

Gibbons and the legislators also said the medical board's executive director, Tony Clark, had been unwilling to "vigorously handle the matter."

He did not write the letter, but Anwar said Monday he checked its content and signed it before it was sent to Gibbons, Sens. Steven Horsford, D-Las Vegas, Randolph Townsend, R-Reno, and Joe Heck, R-Henderson, and Assemblywoman Sheila Leslie, D-Reno.

The letter said that the medical board has scheduled a Wednesday meeting with its five adjudicating members to discuss the replacement of Donald Baepler as chair overseeing the hepatitis C investigation. Baepler died May 25.

Health officials have linked seven cases of hepatitis to the Endoscopy Center's Shadow Lane facility and continue investigating hundreds of other clinic patients who have tested positive for the blood-borne disease. Last month, the Southern Nevada Health District announced that 77 patients with hepatitis C might have contracted their disease at the clinic.

Anwar, who has recused himself from matters concerning the hepatitis C outbreak because of a relationship with the center's majority owner, Dr. Dipak Desai, said in a telephone interview that the medical board is being unfairly targeted because it licenses physicians.

On Monday, Anwar defended Tony Clark, the medical board's executive director, and the board's investigation.

The letter said that Clark "has been actively pushing the board's investigative process since the board was first made aware of this crisis situation on Feb. 28.''

The letter also said that the three board members brought on to replace Anwar and two other board members who resigned because of business relationships with Desai cannot yet receive evidence in the case. "Triers of fact must not be tainted or receive any evidence or information outside the judicial, or in this case, quasi-judicial, hearing process.

"As evidence is obtained and developed, additional formal disciplinary complaints will be filed against other licensees involved with Endoscopy Center," the letter said, noting the process has been "slowed considerably" since law enforcement agencies have confiscated the clinic's records.

Heck said the letter answered most of his concerns about the medical board's investigation. He said the agency needs to do a better public relations campaign.

"The board is progressing, but none of this information is being made public,'' he said. "Everybody needs an update. We understand there is due process and the medical board has to act accordingly, but our constituents, those impacted by this, want answers.''

Leslie disagreed with the medical board's response that it has acted diligently.

Leslie is still calling for an independent investigator.

"This pace has absolutely produced nothing,'' she said Monday. "I don't think we're going to get anywhere with them. ... The medical board has made it quite clear that it is going to conduct its investigation the way it wants to and at its own pace.''

Gibbons' office said it had yet to see Anwar's response.

"We believe there is a clear need for action on this issue by the board, and we hope the letter ... outlines the steps the board plans to take to protect public health and restore public faith in the healthcare system of Nevada," Gibbons' press secretary, Ben Kieckhefer, said in an e-mail.

An investigation by health authorities that began in early January led to the largest patient notification of its kind in U.S. history. About 50,000 former patients of the Shadow Lane facility are being urged to get tested for hepatitis and HIV. About 400 people have tested positive for hepatitis.

Investigators have blamed the infections on unsafe injection practices by the nurse anesthetists, including reusing syringes and single-use vials of anesthesia.

Lawyers Argue Over Whether Desai Waived Right to Silence

By Jeff German

Tue, Jun 3, 2008 (2 a.m.) Click here to find out more!

The effort to pry crucial information out of Dr. Dipak Desai for the massive lawsuit over the hepatitis outbreak takes center stage this afternoon in District Court.

Desai and other physicians associated with the Endoscopy Center of Southern Nevada have threatened to assert their Fifth Amendment rights against self-incrimination if forced to submit to early fact-finding depositions in the case. Desai and the others don’t want to risk making statements under oath that could help authorities pursuing criminal investigations against them.

Last month, Will Kemp, one of the lawyers for plaintiffs, filed court papers suggesting Desai waived his Fifth Amendment privilege when he submitted a three-sentence affidavit May 19 in the case. In the affidavit, Desai acknowledged he is the managing member of the Endoscopy Center and part of a committee that hired Quality Care Consultants, a politically connected medical inspection company, to conduct an audit of the clinic.

Getting a copy of the audit is important to the plaintiffs’ efforts to establish a direct link between the Endoscopy Center and the hepatitis outbreak.

So far, Desai and company have stonewalled those efforts.

“We’ve had to fight for every bit of information,” complained Ed Bernstein, another attorney for plaintiffs.

Desai’s lawyers contend the doctor did not waive his Fifth Amendment right in the affidavit.

District Judge Allan Earl is to have the last word.

• • •

In the federal government’s sale of the Crazy Horse Too, expecting the unexpected has become the norm.

Worried that yet another deal to buy the strip club might fall through, an attorney for Rick Rizzolo, its former owner, has asked U.S. District Judge Philip Pro to order federal marshals to obtain a temporary liquor license from the city.

Mark Hafer wants the marshals to reopen the club briefly before it loses its liquor license permanently under a city-imposed June 30 deadline. If the club can’t sell alcohol, the prospects of selling the Crazy Horse Too for a price big enough to cover Rizzolo’s $28 million in debts associated with the property will dim considerably.

There is precedent for the government to get involved in the sex business. It ran the Mustang Ranch brothel in the early 1990s after the IRS seized it.

The marshals, who took control of the Crazy Horse Too under an order from Pro eight months ago, have no interest in running the topless club, however. And Pro doesn’t seem to be in a mood to force them to get a license.

The marshals are still pushing a $32 million sale agreement with LCC Cafe Nevada, a company put together by South Carolina businessmen David Dupont and Mahesh Patel.

LCC Cafe Nevada has had trouble getting all of its financing, which is making everyone tied to the deal nervous as the city’s deadline approaches.

Commercial real estate executive Geoffrey West, who has been marketing the Crazy Horse Too for the Marshals Service, says he expects the deal will come together by Wednesday when the City Council takes up LCC Cafe Nevada’s temporary liquor license.

West, however, hasn’t had much luck with predictions in this deal.

• • •

Sheldon Adelson last week left little doubt about his resolve to kick New York restaurateurs Marc Packer and Richard Wolf out of the Palazzo.

The billionaire casino owner turned a few heads when he showed up in District Court for a hearing asking Judge Mark Denton to reconsider a preliminary injunction that allowed Packer and Wolf to resume construction of their upscale restaurant and nightclub in the main lobby of the Palazzo.

The hearing took place just three days after a jury in another case ordered Adelson to pay a $43.8 million judgment to a Hong Kong businessman who helped him land a lucrative gaming license in Macau.

Adelson also recently submitted a five-page affidavit in the Palazzo case in which he again accused Packer and Wolf of moving too slowly to open the nightspot.

The unoccupied space in the heart of the Palazzo, Adelson alleged, has been bad for business and the new resort’s image.

Denton has promised a ruling soon.

Police Expect Lengthy Investigation Into Las Vegas Clinic

June 1, 2008 KOLOtv.com

LAS VEGAS (AP) - Authorities investigating the Las Vegas clinic at the center of a large hepatitis C outbreak say the investigation has been slowed by clinic workers who have refused to talk.

"I'd be very surprised if we don't go into next year," Las Vegas police Capt. Al Salinas said of the investigation of the Endoscopy center of Southern Nevada. "It's going to be a long investigation."

Salinas is leading of a group of detectives who are interviewing witnesses and reviewing patient files to build cases against those believed to be responsible for the transmission of the bloodborne pathogen.

Chief Deputy District Attorney Scott Mitchell said some clinic workers have given statements, but nurse anesthetists and doctors have been reluctant to cooperate with investigators.

"We could stand to have a few people do the right thing and not worry so much about self-preservation," Mitchell said. "The longer you wait, the less we'll need you and the less willing we'll be to offer some sort of deal to you."

Federal and local public health officials have blamed the outbreak on practices of reusing syringes and single-use medication vials. The outbreak led to the biggest public health notification operation in U.S. history. Officials have linked 84 cases of the potentially deadly liver disease to the clinic and have notified 50,000 patients that they may be at risk.

Hepatitis C results in the swelling of the liver and can cause stomach pain, fatigue and jaundice. It may eventually result in liver failure. Even when no symptoms occur, the virus can slowly damage the liver.

Mitchell said that criminal charges including medical neglect could be filed within three or four months if the investigation continues at its current pace.

"Some people are becoming less obvious targets, and some people are becoming more obvious targets," Mitchell said.

Mitchell said the charges would focus on the confirmed infections to keep the case from getting too big.

Salinas said the investigation is a priority for the department but won't be rushed.

"People want closure. They want resolution, but we have to cross our T's and dot our I's," Salinas said.

"Maybe it's going to take the first few prosecutions before the rest realize this is serious," he said.

Endoscopy Clinic Probes Progressing

Every day, Las Vegas police Capt. Al Salinas expects his phone to ring with news of another infectious disease case linked to the Endoscopy Center of Southern Nevada.

"It's not a question of if that call is coming; it's a matter of when that call is coming," he said.

A team of detectives in Salinas' Organized Crime Bureau have been interviewing witnesses and poring over patient files for more than two months, building criminal cases against those they believe are responsible for infecting clinic patients with blood-borne diseases.

Health officials have linked seven cases of hepatitis C to unsafe injection practices at the Las Vegas clinic and continue investigating hundreds of other clinic patients who have tested positive for hepatitis, HIV and other diseases.

Last month, the Southern Nevada Health District announced that 77 patients with hepatitis C might have contracted their disease at the clinic.

Salinas knows each new confirmed case will fall to his already busy detectives, who are immersed in an investigation expected to last many more months.

"I'd be very surprised if we don't go into next year," he said. "It's going to be a long investigation."

The investigation has been slowed by a lack of cooperation by clinic workers who refuse to talk to police, he said.

Chief Deputy District Attorney Scott Mitchell, who will prosecute the case, said some clinic employees have come forward and given statements, but investigators have found nurse anesthetists and doctors the "most reluctant to cooperate."

Public health investigators have blamed the infections on unsafe injection practices by the nurse anesthetists, including reusing syringes and single-use vials of anesthesia.

Some clinic workers have told investigators they were ordered by clinic management to reuse supplies to save money.

"We could stand to have a few people do the right thing and not worry so much about self-preservation," Mitchell said, adding that witnesses who cooperate now are more likely to receive favorable treatment.

"The longer you wait, the less we'll need you and the less willing we'll be to offer some sort of deal to you," he said.

The investigation has given authorities a clearer picture of who was involved, Mitchell said.

"Some people are becoming less obvious targets, and some people are becoming more obvious targets," he said.

New targets could come up when detectives interview two doctors for the federal Centers for Disease Control and Prevention who observed unsafe practices during clinic inspections in January, Mitchell said. The CDC last week agreed to allow police to interview the doctors about what they saw and name who did what, he said.

If the investigation continues at its current pace, the first criminal charges could be filed in three to four months, Mitchell said.

Charges, which could include medical neglect, would center on the confirmed infection cases to keep the case from growing too unwieldy, he said.

"Maybe it's going to take the first few prosecutions before the rest realize this is serious," Salinas said.

Meanwhile, the FBI and Nevada attorney general's office were continuing their investigations into potential Medicare, Medicaid and medical insurance fraud, and administrative investigations by the state medical and nursing boards also were ongoing.

The Nevada State Board of Medical Examiners' investigations unit continues to gather evidence to determine if disciplinary action should be taken against doctors who worked at the endoscopy center and its affiliates between March 2004 and Jan. 11, the time frame health district officials place on the unsafe medical practices.

Executive Director Tony Clark said the board's three investigators and chief of investigations attend weekly meetings with authorities and share information.

The medical board is "particularly interested" in the group of 77 patients who might have contracted hepatitis C at the clinic, Clark said.

"We want to see where those cases lead us, what doctors performed procedures on them. That's what we're pursuing right now.''

The medical board has filed malpractice complaints against two doctors who performed medical procedures on the six patients who contracted hepatitis C on either July 25 or Sept. 21.

Dr. Dipak Desai's hearing is scheduled for September. Dr. Eladio Carrera's hearing is set for October.

Clark couldn't say when the investigation would be completed. Evidence is being given to one of the board's investigative committees, which will determine if formal complaints should be brought against other doctors.

"You've got to have evidence before you proceed,'' he said. "We're gathering more every day.''

Debra Scott, executive director of the Nevada State Board of Nursing, said six nurse anesthetists who worked at the endoscopy center and its affiliates have voluntarily surrendered their licenses pending a hearing.

They are all under investigation by the board, as are roughly 20 nurses who worked at the Endoscopy Center of Southern Nevada between March 2004 and Jan. 11.

No decision has been made on whether to file formal charges against the nurses, Scott said.

The nursing board was reviewing information in a CDC report, and the nurses' personnel records have been seized by Las Vegas police, she said.

Salinas said the criminal investigation is a police department priority, but it won't be rushed.

"People want closure. They want resolution, but we have to cross our T's and dot our I's."

HEALTH CRISIS: Progress of Inquiry Criticized

May 31, 2008 Las Vegas Review-Journal By ANNETTE WELLS REVIEW-JOURNAL

Gov. Jim Gibbons and four lawmakers have expressed frustration with the progress of the Board of Medical Examiners' investigation into the hepatitis C outbreak, saying the board has failed to communicate with new members brought in to determine whether physicians should be disciplined.

But the board's executive director, Tony Clark, says the criticisms aren't valid and Gibbons may be trying to deflect attention from his personal life. Gibbons has made headlines in recent days because of allegations brought by his wife about a relationship with a married Reno woman.

"There are other issues getting in way of his gubernatorial duties and I think this is a diversionary tactic,'' Clark said Friday afternoon.

Gibbons and four lawmakers sent a letter Thursday to the medical board's president, Dr. Javaid Anwar, demanding "an immediate and detailed report of all actions" taken to address the role physicians played in the hepatitis C outbreak. They expect answers by the close of business Monday, said Sen. Randolph Townsend, R-Reno.

Townsend and Gibbons were joined by Assemblywoman Sheila Leslie, D-Reno, and Sens. Joe Heck, R-Henderson, and Steven Horsford, D-Las Vegas in signing the letter.

They asked why three temporary board members appointed by Gibbons to replace Anwar and Drs. Daniel McBride and Sohail Anjum have not been contacted by the board regarding the investigation. They also criticized Clark, saying he "has demonstrated an unwillingness to vigorously handle the matter.''

The letter came days after the death of Donald Baepler, who was acting president of the board during proceedings concerning the hepatitis C outbreak. Gibbons' office said Friday it hopes by June 13 to name a replacement for Baepler, the board's secretary-treasurer who fought a year-long battle with lung cancer. Gibbons' press secretary Ben Kieckhefer said the appointee likely will be from Southern Nevada.

Anwar, McBride and Anjum recused themselves from issues regarding the hepatitis C oubreak due to relationships with Dr. Dipak Desai, the majority owner of the Endoscopy Center of Southern Nevada. To date, as many as 84 people may have contracted hepatitis C as a result of unsafe injection practices at the facility at 700 Shadow Lane.

"We're extremely frustrated," Townsend said. "Part of that frustration is that we don't have the authority to move this along.''

Clark said he was surprised by the lawmakers' letter and its tone, but that the medical board will respond on behalf of Anwar.

In response to the criticism that temporary board members have not been contacted about the investigation, Clark said they wouldn't necessarily be contacted anyway, since they are adjudicators of facts.

"They are going to be hearing the case,'' he said. "They cannot have any evidence or any facts about this case delivered to them ahead of time.''

Clark said those members have been contacted to set up a meeting next week so that they can elect a new chair. That person would take over Baepler's duties as they related to the hepatitis C investigation.

The board already has filed malpractice complaints against Desai and Dr. Eladio Carrera for their alleged role in the transmission of hepatitis C to six patients at the 700 Shadow Lane facility.

Those complaints were filed because Carrera and Desai performed procedures on those individuals on July 25 and Sept. 21, dates health officials linked to transmission.

Clark said a hearing is scheduled for Desai in September, and for Carrera in October.

The board is now trying to determine which physicians performed procedures on 77 other patients who health officials say possibly acquired hepatitis C at the facility. The Southern Nevada Health District and the federal Centers for Disease Control believe transmission occurred when nurse anesthetists administered anesthesia.

Lawmakers, especially Leslie and Horsford, have continuously accused the medical board of not acting swiftly or on behalf of the public. The two, who are also members of the Legislative Committee on Health Care, recently asked Gibbons in a letter to appoint a special counsel to help with the investigation.

The governor rejected that idea, but turned around and asked them to sign a letter calling for the resignation of Clark, Leslie said.

"He (Gibbons) told us his office was concerned the medical board wasn't acting quick enough,'' she said.

Leslie said she didn't see the point in calling for Clark's resignation because he was set to retire in September and the medical board is in the process of finding his replacement. Instead, she again asked Gibbons to appoint a special investigator.

He refused, she said.

"So when he asked us if we'd add our names to this letter, we said sure,'' Leslie said in an interview.

She added, "I guess at this point it seems futile to continue a war of letters."

An investigation by health authorities that began in early January led to the largest patient notification of its kind in U.S. history. About 50,000 former patients of the Shadow Lane facility are being urged to get tested for hepatitis and HIV. So far, about 400 people have tested positive for hepatitis.

Officials Gripe About Health Probe

By BRENDAN RILEY, Associated Press Writer Friday, May 30, 2008

Gov. Jim Gibbons and several legislators say three temporary state Board of Medical Examiners members, named in early April to help speed an investigation into a southern Nevada hepatitis outbreak, still haven't been contacted by the board.

Gibbons, joined by state Sens. Randolph Townsend, R-Reno, Joe Heck, R-Henderson, and Steven Horsford, D-North Las Vegas, and Assemblywoman Sheila Leslie, D-Reno, also said the board hasn't held a hearing to describe its plan for investigating doctors involved in the outbreak.

"At this point, we see no alternative but to demand an immediate and detailed report of all actions the board has taken to date to address the role any Nevada physicians may have played in the outbreak," the governor and lawmakers said in a letter to Dr. Javaid Anwar, the board president.

The letter also states that Tony Clark, executive director of the medical panel, "has demonstrated an unwillingness to vigorously handle the matter."

Anwar didn't respond immediately to a call Friday seeking comment on the letter. Clark said the letter was being reviewed by the board's legal counsel, and a response from the board wasn't likely until Monday.

Gibbons announced April 2 that Drs. Ronald Kline, Beverly Neyland and Robert Wiencek, all from southern Nevada, would temporarily replace Anwar and two other doctors with ties to Dr. Dipak Desai, owner of a Las Vegas clinic where flawed procedures led to the hepatitis outbreak.

Besides Anwar, S. Daniel McBride and Sohail Anjum also were replaced. The letter from Gibbons and the legislators said Anwar is still board president and responsible for quick action by the panel.

The Centers for Disease Control and Prevention said in a recent report that the staff at Desai's Endoscopy Center of Southern Nevada likely caused the transmission of the bloodborne pathogen by "routinely mishandling injection equipment and single-use medication vials."

The CDC's report bolsters earlier conclusions by Clark County and state health officials about the outbreak that led to the biggest public health notification operation in U.S. history. Officials have linked 84 cases of the potentially deadly liver disease to the clinic and have notified 50,000 patients that they may be at risk.

Hepatitis C results in the swelling of the liver and can cause stomach pain, fatigue and jaundice. It may eventually result in liver failure. Even when no symptoms occur, the virus can slowly damage the liver.

Health care cynicism

Las Vegas Sun Wed, May 28, 2008

Public mistrust of outpatient surgery centers is high and respondents to a recent survey said they would pay higher taxes to have them more tightly regulated.

Responding to phone calls from UNLV’s Cannon Survey Center, 400 randomly chosen people vented their feelings in the wake of the hepatitis outbreak that has been traced to unsafe practices at the Endoscopy Center of Southern Nevada.

Almost three out of every four said they would be willing to pay more taxes to have such centers placed under greater state scrutiny. That response belies the stance of Gov. Jim Gibbons, who claims to be representing Nevadans in opposing any increase in taxes or fees, even to hire more health inspectors.

More than 80 cases of hepatitis C have been linked to the now-closed Endoscopy Center. Violations of disease-prevention safeguards were discovered there in January by local, state and federal health inspectors, but too late to prevent the outbreak. The center had not been inspected since 2001.

Violations included anesthesia injections administered with used syringes and multiple patients being injected with medicine from vials labeled for single use. Notifications have been sent to 50,000 former patients of the center, advising them to get their blood tested.

Anger toward the Endoscopy Center’s medical staff and overall mistrust of health care providers were expressed by a majority of respondents. They felt that the center’s doctors and nurses should face criminal charges, and that the whole health care system is oriented more toward profits than toward patients.

About two-thirds of the respondents said they would probably not give blood as the result of the hepatitis outbreak, and about 57 percent delivered a blow to preventive medicine in saying they would not likely undergo colonoscopies in Las Vegas.

The level of mistrust expressed by the respondents toward the medical profession should be of great concern to public-policy makers as well as doctors, nurses and health care administrators. We hope medical providers work among themselves and with lawmakers to bring about the changes people are demanding.

Hepatitis Investigation Finds Common Link

May 22, 2008 Las Vegas Now

The Southern Nevada Health District has linked the hepatitis C virus back to one person, on one day, for at least half of the confirmed cases.

This entire investigation started at the Endoscopy Center of Southern Nevada on Shadow Lane. Seven of the eight confirmed acute cases of hepatitis linked to unsafe medical practices came from the clinic. There is now a criminal, federal investigation and a health district investigation.

The health district says they can genetically link four of the hepatitis C cases to one person on September 21, 2007. Shock and outrage do not adequately describe the public's reaction to the massive investigation into unsafe medical practices at the Endoscopy Center.

"It's scary, and every time we have more numbers it just creates that mistrust," said health district board member Chris Giunchigliani.

Giunchigiani is also a Clark County Commissioner. She and her husband were among the initial 40,000 people notified that they may have been exposed to hepatitis C by the center. That news keeps her glued to the meetings when there is an update from the senior epidemiologist assigned to the case, Brian Labus.

He told the board genetic testing on the hepatitis strain in four of the eight confirmed cases will link to one person, but the health district has not found that person yet.

Labus also confirmed why two of the four doctors who own the centers under investigation have been barred from practicing medicine. The state medical board filed temporary restraining orders against Dr. Dipak Desai and Dr. Eladio Carrera to prevent them from seeing patients.

"Those are the two doctors who have the injunctions against them right now. They were the doctors who had treated the patients on that particular day," he said.

That day was September 21, 2007 -- where five people contracted hepatitis from the center.

Finally, Labus says access to the medical records confiscated by Metro has increased as they get more organized.

"It's those initial steps where some of the charts are starting to be organized and some of the records we can find a little easily now," he said.

Still, Labus says the records are only partially complete. Giunchigliani adds the health district will fight to force doctors to keep thorough records. She wants state lawmakers to create legislation making sure that happens.

Labus says in the next few weeks we will know if tens of thousands more people using other centers need to be notified of possible hepatitis exposure. He adds in the next few months, more cases will be linked to this center.