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They've almost given me a death sentence

Michael Washington doesn't know what the rest of his life holds for him. But the 67-year-old knows how he doesn't want his life to end.

"I don't want to die of cancer. I don't want to die of HIV," he said on Saturday in his home in Sun City Anthem. "I'd rather pass away of old age."

Blood-Borne Diseases: Patients on clinic's bottom line

In a city known for its games of chance, something resembling Russian roulette in its potential for disaster played out quietly for years in the operating rooms of a Las Vegas endoscopy clinic.

Clinic Sued by patients who contracted virus

At least five people not yet identified by health officials say they contracted hepatitis C during visits to a Las Vegas medical clinic that reused syringes and improperly cleaned medical equipment, a lawyer for the patients said Friday.

They represent a fraction of what Ed Bernstein believes will be more than 100 people infected with potentially deadly diseases at the Endoscopy Center of Southern Nevada at 700 Shadow Lane.

"This is one of the worst catastrophes we've ever had here in Southern Nevada," said Bernstein, who has practiced in Las Vegas for 30 years.

Bernstein filed lawsuits Friday for two of those patients and another patient whose hepatitis C infection was one of six already linked to the clinic by the Southern Nevada Health District, Bernstein said.

The health district is urging 40,000 people who underwent procedures at the clinic between March 2004 and Jan. 11 of this year to get tested for HIV and hepatitis B and C. Health officials believe the patients might have been exposed to the diseases when staff reused syringes to inject medications at the high-volume gastrointestinal clinic.

The investigation also found other unsafe practices at the clinic such as improper cleaning of equipment used in colonoscopies and upper gastrointestinal procedures.

In their lawsuits, Nancy Shaw and Deborah Hall-Hilty say they contracted the potentially fatal hepatitis C while undergoing colonoscopies at the Endoscopy Center. Shaw's procedure was on Feb. 16, 2006. Hall-Hilty's was on Oct. 20, 2006.

Health officials have not connected their infections to the center, Bernstein said.

However, Michael Washington's hepatitis C infection has been confirmed by the health district, the attorney said.

The retired military veteran contracted the disease during a colonoscopy on July 25, 2007, his lawsuit says. His wife, Josephine, is a retired nurse.

Washington got the procedure as a precautionary measure suggested by his doctor, Bernstein said. He started showing symptoms of hepatitis C after the procedure, and a test later confirmed it, he said.

But Washington can't undergo treatment for the infection because the medications would cause complications for his diabetes and glaucoma, Bernstein said.

"If this was a restaurant and there were bugs in it, they would have closed it down," he said.

Bernstein also filed a class- action lawsuit Friday on behalf of the 40,000 patients who might have been exposed to infections. Lawyers Jan Paul Koch, Peter Wetherall and Will Kemp have filed similar class-action lawsuits against the Endoscopy Center of Southern Nevada and the doctors who own it.

Those lawsuits join about a dozen medical malpractice lawsuits filed in the past decade against the doctors, the Endoscopy Center of Southern Nevada and its sister clinic, the Gastroenterology Center of Nevada.

The malpractice lawsuits include the pending case of Kevin Rexford, who says doctors failed to diagnose his colon cancer because they were too busy to adequately review his case.

-Brian Haynes, Review-Journal

In-Office surgery ignored by state

Most free-standing surgical centers go six years between state inspections. In some cases, Nevada falls far short of even that federal goal.

Even when a center is inspected and deficiencies are found, inspectors usually don't return to the facility to make sure changes have been made.

And unlike some other states, Nevada doctors who do surgical procedures in their offices don't need office surgery licenses and face no health inspections at all.

Some doctors and other health care experts say that's an invitation to the kind of unsafe practices now under scrutiny in Las Vegas, where a surgical center using unsanitary anesthesia practices allegedly caused at least six patients to contract hepatitis C. Since then, state officials found that three surgical centers in Northern Nevada also were using unsafe practices.

They said the lack of regulation is a prescription to allow unsafe practices to fester for years before they are discovered. That leaves thousands of patients at risk.

About 40,000 patients of the Las Vegas clinic have been notified that they should be tested for hepatitis and HIV.

"We hope the state becomes more involved in providing oversight," said Jovanna Lee, who serves on the boards of the Nevada Ambulatory Surgery Center Association and the national Ambulatory Surgery Center Association. "We welcome that. What's happened (in Las Vegas) really hurts our image. The reality is that, nationwide, the infection rate is less than 1 percent.

"What happened is unfortunate. We don't really understand how somebody puts practices like that into place."

Inspections rare in state

State records show the Endoscopy Center of Southern Nevada, which was shut down two weeks ago for reusing vials of anesthetic and plastic syringes, had not been inspected by state officials since 2001. Other ambulatory surgery centers contacted last week said they had not seen a state inspector in more than six years.

Nearly all of Nevada's stand-alone surgical centers are approved for the Medicaid/Medicare programs, and so the federal government, not the state, makes recommendations about how often they should be inspected.

"This year, the federal recommendation is for inspections every six years," said Martha Framstead, spokeswoman for the Nevada Division of Health. "They make recommendations yearly based on funding."

In Nevada, as in 24 other states, ambulatory surgical centers must be accredited by a national accrediting organization. Most are certified by the Accreditation Association for Ambulatory Health Care, records show.

The AAAHC does on-site "surveys" of centers every three years unless previous violations require a more frequent schedule.

"The AAAHC usually arrives unannounced and it's a pretty rigorous survey," Lee said.

Dr. John F. Gray of Gastroenterology Consultants in Reno and Carson City, whose facilities were inspected by the state last week and passed without violations, said the AAAHC conducts an "intense reaccredidation process" that acts as an extra quality-assurance program.

"Inspection is good for us," he said. "Our first obligation is to do no harm."

He said the industry would welcome more oversight if it were offered, but said he doesn't think the lack of state inspections affects the quality of most surgical centers.

"To me, the real problem that goes unrecognized is endoscopy and other procedures that happen in some doctors' offices, and those aren't even being looked at by the state," Gray said. "Medicare also provides financial incentives to doctors to do endoscopies and colonoscopies in their offices.

"I think that's a perverse incentive."

Some states, such as New York, require doctors to obtain a "certificate of need" to do such procedures in their offices. Those states regulate office surgeries the way free-standing surgical centers are now regulated.

The need for strengthened quality oversight for office-based surgery has grown as the number of increasingly complex surgical and invasive procedures performed in doctors' offices has more than doubled in the last decade, with nearly 10 million surgical procedures performed annually in office-based settings nationwide since 2000, according to the Joint Commission, a health care facilities accreditation agency.

Problems fester for years

In Nevada, the surgical centers are almost ignored by state officials.

The Nevada State Health Division's Bureau of Licensure and Certification is supposed to do one initial inspection for a new ambulatory surgical facility, followed by routine surveys every three years. The rules are different, however, for ambulatory surgical centers that accept Medicare patients. Based on an agreement with Medicare, such centers only need to be inspected every six years.

According to the bureau, only three of the 19 ambulatory surgery centers in Northern Nevada don't take Medicare patients: Reno Orthopedic Surgery Center, Eye Surgery Center of Northern Nevada in Reno and New River Surgical Arts in Fallon.

That means the overwhelming majority of ambulatory surgical centers in Northern Nevada are only inspected every six years based on guidelines set by Medicare.

"These facilities basically aren't surveyed unless CMS (Centers for Medicare and Medicaid Services) asks us to do so," said Pat Andrews, a health facilities surveyor for the Bureau of Licensure and Certification. "It's a matter of funding, and Medicare sets up the criteria for how often they need to be inspected. Since we have a contract with Medicare, we have to follow what they say as far as what time to go back (to survey these facilities)."

The length between inspections makes it difficult to determine whether deficiencies that are found are part of an ongoing trend.

"If a deficiency involves standard procedure and they've been doing it wrong, that usually means that they've been doing it for a long time," Andrews said. "But it could also mean it's a one-time thing. You just don't know."

Besides the long gap between inspections, facilities that get cited for deficiencies usually don't get a return visit. In most cases, centers with deficiencies are given 10 days to come up with a plan to address the deficiencies. Even if the bureau approves the plan, it doesn't require surveyors to return to the facility to verify that it's being followed.

The only exception involves deficiencies that either require documentation or are so egregious that they directly affect patient safety, Andrews said. One example is infection because of failure to ensure that equipment is being sterilized properly.

"That would likely lead to a cease and desist and some sort of sanction," Andrews said.

Centers not a priority

"From a licensure standpoint, they're not one of the higher priority facilities that we're required to go in on an annual basis," Andrews said. "Nursing homes are inspected on an annual basis. Intermediate Care Facilities for the Mentally Retarded are also required by the federal government to be inspected annually. Annual inspection of group care facilities is mandated by the Legislature.

"But we do go in and inspect (ambulatory care centers) if there's a complaint or if something happens like what just happened in Las Vegas."

The situation in Las Vegas, potentially affecting up to 40,000 patients, has made headlines around the world.

State officials in part blame limited funding for their failure to meet even the six-year goal, but critics said putting patients at risk for financial reasons isn't acceptable anywhere.

Lawrence F. Muscarella, director of research and development and chief of infection control for The Q-Net Monthly, Custom Ultrasonics, Inc., said money woes and personnel deficiencies promote poor health care practices.

"This debacle in Nevada is another example of failed oversight by regulatory authorities," he said. "... It will probably turn out that the state of Nevada will claim, too, that it was unable to inspect the facilities in question more often, as patient safety requires, due to limited resources.

"These are not legitimate excuses. Either do the job right, or get out of the business."

Muscarella said the only guarentee of patient safety in health care facilities is fair and balanced oversight.

"My experience suggests that the organizations and agencies that perform these inspections are often biased and act more according to political pressure and legal maneuvering than to hints that something may be amiss and a disaster is about to happen," he said.

In Nevada, disaster brought quick action.

Staff members of some northern Nevada surgical centers said they welcomed last week's emergency inspections.

"We haven't seen a (state) inspector in six or seven years," said Mable Guerrero, administrator at the Great Basin Surgical Center in Elko. "When we heard about the Las Vegas situation, we couldn't see how that could happen."

She said the news made her center re-examine all its procedures.

"We found that we're clean, but one thing we decided is to no longer use multi-dose vials," Guerrero said, referring to the larger vials of anesthetic that the Las Vegas clinic workers were using with reused syringes and thus spreading infection from patient to patient.

"We weren't doing what they were doing, but we decided to go with the single-dose vials so that could never happen here," she said. "It's a little more expensive, but what's more important, saving a few dollars or a patient's health?"

-Frank X. Mullen and Jason Hidaglo

Health inspectors scrutinize 3 clinics

March 7, 2008 Amid reports of unsafe practices at three area surgical centers, Washoe County health officials are reviewing existing cases of hepatitis and HIV infections to determine whether any might be linked to the centers.

No suspicious patterns were detected in the department’s original investigation of those cases and nothing immediately indicates that any disease has been transmitted in Northern Nevada because of unsanitary practices, officials said. Officials on Friday named the three Northern Nevada surgical centers that investigators say were using unsafe procedures that might have put patients at risk: Digestive Health Center on Kietzke Lane, Saint Mary’s Outpatient Surgery Center at Galena on Wedge Parkway and Sierra Center for Foot Surgery in Carson City. At all three centers, officials said the problems have been corrected. “The bottom line is we have not uncovered any reason for immediate concern for the people treated at those facilities,” said Randall Todd, director of epidemiology for the Washoe County District Health Department. The investigation is ongoing, and state officials have yet to inspect each of the area’s 19 ambulatory surgical centers. So far, they’ve inspected 10 this week. Investigators said they found no problems at two centers and minor, procedural problems at the other five centers. Under pressure from local health officials, the Reno Gazette-Journal and the Las Vegas Review-Journal, the state health division began on Friday to release the preliminary results of statewide inspections launched this week in the wake of a hepatitis C outbreak in Las Vegas. The results: o Two area centers, Digestive Health Services and Saint Mary’s Outpatient Surgery Center at Galena, failed to properly disinfect equipment in between patient procedures, according to Mike Willden, director of the Nevada Department of Health and Human Services. o A third clinic, Sierra Center for Foot Surgery in Carson City told investigators that an anesthesiologist had been reusing plastic syringes on multiple patients several years ago, Willden said. Clinics react “Saint Mary’s takes very seriously the findings of the state surveyors and took immediate action to comply with their recommendations while they were on site at our facility,” spokesman Gary Aldax said in a prepared statement. Dr. Thomas Cazes, the medical director for Digestive Health Services, said the two pieces of equipment in question were being properly sterilized “in the same high-quality manner in which the endoscopes themselves are disinfected.” He said the problem seen by the health division was not the sterilization procedure, but the fact that the bite blocks and polyp traps are considered single-use items. Bite blocks are plastic products used to protect a patient’s mouth when a medical scope is inserted down the throat during procedures. And, polyp traps are instruments used during colonoscopies to remove polyps from the colon. Cazes said those pieces of equipment will now be used once and then thrown away. Cazes said the items are labeled for single use, but can be used multiple times if proper sterilization is employed. He said the re-use of the items was a “convenience rather than cost issue” because the center wanted to have plenty of the items on hand. He said the practice wasn’t unsafe and no patients were ever in danger of infection. The investigation is still on-going into the Sierra Center for Foot Surgery’s practices. The center’s proprietor, Dr. Jeff Bean, said the problem occurred with a contracted anesthesiologist, who was confronted by the center’s nurse and asked to stop. “Like most surgery centers, Sierra Center for Foot Surgery uses physicians for anesthesia during surgery,” Bean said in a prepared statement. “Years ago, an anesthesiologist reportedly used the same syringe with a different needle. “The center does not reuse syringes. The center reported the anesthesiologist incident to health officials. No disease transmission occurred.” Pressure prompts clinic identification The state health division is in the middle of inspecting each of the state’s 50 ambulatory surgical centers after a hepatitis C outbreak in Las Vegas was linked to unsafe practices at the Endoscopy Center of Southern Nevada. The health division had delayed releasing the names of centers where unsafe procedures had been observed, frustrating local health officials who wanted to begin investigating whether any disease spread could be linked to those centers. The delays came because of a department policy that gives the centers a 10-day period to respond to the violations. The Department of Health and Human Services decided to release the names Friday after consulting the governor’s office and the attorney general’s office, and after the Reno Gazette-Journal began preparing a lawsuit to compel the state to release the names. “If we have a problem in our community, we want to conduct an investigation as timely as possible so we can get to the bottom of it and negate it,” Todd said. “Would it be helpful for us to know as soon as such a problem is discovered? Absolutely, it would be very useful. That is a system problem that the state will need to fix fairly quickly.” Todd said his investigators have already launched an investigation into whether any of the county’s existing cases of acute hepatitis C, acute hepatitis B and HIV can be linked to any of the clinics with reported violations. “They are literally as we speak starting that process,” Todd said Friday. “According to their preliminary look, most of those (cases) had explainable risk factors.” Since 2004 in Washoe County, there have been 11 cases of acute hepatitis C, 33 cases of acute hepatitis B and 134 cases of HIV infection. Health officials expressed dismay at the violations being discovered by inspectors, saying some of the practices defy the most basic sanitary procedures. “I would not make the assumption that everything is fine in terms of infection control,” Todd said. Some patients visiting area surgical centers on Friday said they were concerned about possible unsafe procedures after news from Las Vegas that 40,000 people were put at risk by an endoscopy center there. “That’s one thing I asked about, and they said they had no problems, they don’t reuse anything,” said Al Tallman, 61, of Fallon, who visited the Digestive Health Center Friday for a colonoscopy.

-Anjeanette Damon, Reno Gazette

Nevada Clinic May have exposed thousands to Hepatitis, HIV

Red Orbit, March 8, 2008

Fearing an outbreak of the potentially fatal hepatitis C virus, authorities are advising nearly 40,000 people who visited a Las Vegas clinic to get hepatitis and HIV tests after the clinic was found to be reusing syringes and vials of medications during a four-year time period.

The advisory represents the biggest public health notification operation in U.S. history.

Outrage about the practices have brought demands for investigations and caused lawyers to seek out patients for potential lawsuits.

So far six acute cases of hepatitis C have been confirmed.

In letters that began arriving this week, those patients who received injected anesthesia at the Endoscopy Center of Southern Nevada from March 2004 to mid-January 2008 were strongly advised to take tests for hepatitis B and C, and HIV. Officials said that because all three viruses are transmitted by blood, they could have been passed from one patient to the next through clinic’s faulty practices.

"I find it baffling, frankly, that in this day and age anyone would think it was safe to reuse a syringe," said Michael Bell, associate director for infection control at the National Centers for Disease Control and Prevention, in an Associated Press report.

On the advice of his doctor, Michael Washington, 67, a retired airplane mechanic and one of the infected patients, received a routine colon exam in July at the Endoscopy Center of Southern Nevada. In September, he started feeling sick and began quickly losing weight. By January, his stomach pains and dark urine had made it clear what happened.

Washington describes his infection as a "creeping death sentence" and is concerned that others will hesitate before getting preventive care they need upon hearing his story.

The clinic’s unsafe practices were discovered by a health district investigation that began in January after an increase of hepatitis C cases were linked to the clinic .

Although authorities are advising patients who visited the clinic to get tested for three viruses, they are most worried about the transmission of hepatitis C, which shows no symptoms in most people but can cause swelling of the liver, fatigue and jaundice. The virus can slowly damage the liver in even those without symptoms.

An estimated 4 percent of the patients already had the hepatitis C virus when they entered the clinic, compared with 0.5 percent for hepatitis B and less than 0.5 percent for HIV. Officials say hepatitis C also is easier to transmit than HIV.

"You put the two together and hepatitis C is really our big concern," said Brian Labus, senior epidemiologist at the Southern Nevada Health District, in an Associated Press report.

During the investigation of the clinic, health inspectors observed staff using the same syringe twice to extract anesthesia from a single vial, which was then incorrectly used to treat more than one patient. The practice allows infected blood from a used syringe to contaminate the vial and infect the next patient.

Of the six patients so far diagnosed with acute hepatitis C, five received treatment at the clinic on the same day in late September.

According to an Associated Press report, the CDC counts 14 hepatitis outbreaks in the U.S. linked to bad injection practices since 1999. The largest occurred at an oncology center in Fremont, Neb., where 99 cancer patients were infected from 2001 to 2002. At least one died, and the doctor involved in the case acknowledged reusing syringes and settled scores of lawsuits. However, he never explained the reason he reused the syringes.

Bell said such improper practices are more common in surgical outpatient centers that, unlike hospitals, often do not have employees whose sole responsibility is to monitor and educate staff on best practices.

At the Las Vegas endoscopy clinic, staff told inspectors they had been ordered by management to reuse the vials and syringes. Labus described the practice as an unwritten, but long-implemented rule. According to a letter of complaint from the city, investigators were informed the practice was an attempt to reduce costs.

The city revoked the clinic’s business license Friday, and the surgical center and five affiliated clinics have been shut down.

Dipak Desai, the clinic's majority owner and a political contributor and member of the governor's commission on health care, refused to comment on the allegations according to the Associated Press. In a full-page ad in Sunday’s Las Vegas Review-Journal expressing concern for the patients and maintaining that the needles had not been reused and the chances were “extremely low” that anyone would have contracted an infection at the surgical center.

Since the advisory began, thousands of people have been tested, and Labus said many will receive positive results. Over 15,000 have responded to the health district for additional information.

However, it will be easier to determine whether or not a person has become infected than to determine if the virus was transmitted at the clinic. Lawyers abound, and televised “health alerts” soliciting potential clients have begun airing with several lawsuits having already been filed.

On Tuesday, the office of Las Vegas attorney Ed Bernstein’s phone was ringing off the hook at nearly 1,000 a day, he said. Bernstein represents about 1,200 patients at the facility, including Mr. Washington, the infected airplane mechanic. Eight others have tested positive for hepatitis C.

Bernstein’s wife Josephine, a registered nurse, questions how any health care professional could be so reckless, "To maximize profit? For what? What are you going to save?” she said.

Nevada Hep. C outbreak could be the "tip of the iceberg"

InjuryBoard.com, FL - Mar 4, 2008

The CDC says the hepatitis C outbreak in Nevada may be the "tip of an iceberg" of public health safety concerns.

The city of Las Vegas is still trying to find about 40,000 patients who visited the Endoscopy Center of Southern Nevada from March 2004 until this January and may have contracted hepatitis C.

The clinic license has been suspended, and to be cautious, health officials have suspended the licenses of three other clinics managed by the same group, Desert Shadow Endoscopy Center, Gastroenterology Center of Nevada and Spanish Hills Surgical Center.

Lawyers for the clinics walked into court Monday to try and get their licenses back, but were unsuccessful.

The Encoscopy Center was found not to be using standard public health protocols, and instead was reusing a syringe on the same patient which is apparently the way hepatitis C got into a multi-dose vial of sedative which was then transferred to at least five other patients. The five attended the clinic on the same day for colonoscopies.

Hepatitis C is a blood borne liver disease for which there is no cure. Patients are also being urged to be tested for hepatitis B and HIV.

CDC head Dr. Julie Gerberding called this a "never event" that "should never happen in contemporary health care organizations." But unfortunately she says, they have seen this practice in other large-scale organizations that have led to patient exposure.

Senate Majority Leader Harry Reid, D-NV met Monday with Dr. Gerberding and in a conference call with the media, both strongly condemned the practice.

Sen. Reid will work with Congress on an emergency spending bill next month to fund more resources for the CDC still trying to locate the 40,000. So far they don't have correct addresses for 1,400 people.

Dr. Gerberding said, "Our concern is that this could represent the tip of an iceberg and we need to be much more aggressive about alerting clinicians about how improper this practice is," she said, "but also continuing to invest in our ability to detect these needles in a haystack at the state level so we recognize when there has been a bad practice and patients can be alerted and tested."

Part of the problem is that about four percent of the population is walking around with hepatitis C already, undetected, undiagnosed and without symptoms. Hepatitis C can destroy the liver for years without symptoms. Fatal liver disease can result as can jaundice and fatigue. Hepatitis B also attacks the liver but is more rare.

Meanwhile, the clinic co-owner Dr. Dipak Desai took out an ad in the Las Vegas Review-Journal Sunday expressing his "deepest sympathy to all our patients and their families for the fear and uncertainty that naturally arises from this situation." He also denied that reusing syringes was part of the protocol at his clinic. He is setting up a foundation to cover testing costs.

So far several civil lawsuits have been filed and criminal charges are being considered by the Clark County District Attorney working alongside the FBI.

Patient George Madden, who got a colonoscopy at the Endoscopy Center can't believe someone didn't speak up.

He tells Las Vegas Now, "Not one person had a heart, or they flat out didn't know what they were doing. Someone knew and we needed a whistle blower."

-Jane Aker

Justice Department Requires Divestiture in United Health Group's Acquisition of Sierra Health Services

March 10, 2008

The Department of Justice announced today that it will require UnitedHealth Group Inc. (United) and Sierra Health Services Inc. (Sierra) to divest assets relating to United's Medicare Advantage business in the Las Vegas area in order to proceed with United's acquisition of Sierra. The Department said that the transaction, as originally proposed, would have created a combined company controlling 94 percent of the Medicare Advantage health insurance market in the Las Vegas area and resulted in higher prices, fewer choices, and a reduction in the quality of Medicare Advantage plans purchased by senior citizens in the Las Vegas area.

The Department's Antitrust Division filed a civil antitrust lawsuit today in the U.S. District Court for the District of Columbia to block the proposed acquisition. At the same time, the Department filed a proposed settlement that, if approved by the court, would resolve the lawsuit and the Department's competitive concerns.

Individuals eligible for Medicare, primarily senior citizens, may elect to enroll in a privately provided Medicare Advantage plan instead of traditional Medicare. In establishing the Medicare Advantage program, Congress intended that vigorous competition among private Medicare Advantage insurers would lead insurers to offer seniors more affordable benefits, provide a wider array of health insurance choices, and be more responsive to the demands of seniors. As a result, Medicare Advantage plans offer affordable rates, coverage, and benefits not available through traditional Medicare. Approximately 82,000 people in Clark and Nye counties, which make up the Las Vegas area, are currently enrolled in Medicare Advantage plans, accounting for approximately $840 million of annual commerce.

The original transaction would have eliminated competition between United and Sierra, the first and second largest sellers of Medicare Advantage plans in the Las Vegas area, allowing United to increase prices and reduce the quality of Medicare Advantage plans sold to seniors in the Las Vegas area, the Department said. Under the proposed settlement, United must promptly divest most of its assets relating to its Medicare Advantage business in the Las Vegas area. The Department has tentatively approved Humana Inc. as the acquirer, and United must first attempt to sell the assets to Humana before selling to another purchaser.

"This divestiture ensures that senior citizens and others will continue to benefit from competition between sellers of Medicare Advantage products," said Thomas O. Barnett, Assistant Attorney General in charge of the Department's Antitrust Division. "We are committed to preserving competition in the health insurance industry because this competition spurs insurers to lower prices, enhance services, and offer innovative new products."

Under the terms of the proposed settlement, current enrollees of United's Medicare Advantage plans will continue to have substantially the same access to providers, including doctors, hospitals, and other medical services, after the divestiture as before.

The Justice Department worked closely with the Nevada Attorney General's office in its investigation of the United-Sierra merger. Today, the state of Nevada announced its own settlement with United and Sierra. "This is another example of close cooperation between the Department's Antitrust Division and state antitrust officials resulting in an outcome that protects competition and benefits consumers," said Barnett.

UnitedHealth Group Inc., the largest health insurer in the United States, is a Minnesota corporation headquartered in Minnetonka, Minn. In 2007, United reported revenues of approximately $75 billion.

Sierra Health Services Inc., the largest health insurer in the Las Vegas area, is a Nevada corporation headquartered in Las Vegas. In 2007, Sierra reported revenues of $1.9 billion.

As required by the Tunney Act, the proposed settlement and the Department's competitive impact statement will be published in the Federal Register. Any person may submit written comments concerning the proposed settlement during a 60-day comment period to Joshua H. Soven, Chief, Litigation I Section, Antitrust Division, U.S. Department of Justice, 1401 H Street N.W., Suite 4000, Washington, D.C. 20530, 202-307-0001. At the conclusion of the 60-day comment period, the court may enter the proposed consent decree upon a finding that it serves the public interest.

SOURCE U.S. Department of Justice

Newark Woman among those warned in Vegas Health Scare - Clinic's patients at risk of contracting Hepatitis C, HIV

The Newark Advocate, OH - Mar 7, 2008

Between Thursday and March 20, and possibly beyond, Lovette Hughes will be worried.

The former Newark resident who moved to Las Vegas in 2006 is one of the nearly 40,000 people who was issued a warning that a Las Vegas health clinic she visited was found to be reusing syringes and vials of medication for nearly four years.

The discovery has led to the biggest public health notification in U.S. history, as thousands of patients are being urged to test for the potentially fatal hepatitis C virus as well as HIV.

On Thursday, Hughes, 29, went to be tested for the viruses and is awaiting the results, the outcome of which weighs heavily on both her and her husband's futures. "I'm pretty wigged out about it," Hughes said. "I'm pretty mad about it and upset that something like this can happen this day and age."

So far, six acute cases of hepatitis C have been confirmed.

Hughes first heard about the situation on the news as she was in a doctor's office waiting room in Las Vegas.

Since that time, she received a notification advising patients who had received injected anesthesia at the Endoscopy Center of Southern Nevada from March 2004 to mid-January 2008 to get tested for hepatitis B and C, and HIV.

Hughes said she has received anesthesia several times from the clinic and is slightly concerned because her health has been on the decline.

"My health has been worse since last year," she said.

Additionally, Hughes worries her husband, who is serving in the military in Baghdad, also is at risk of being infected.

"That's just one more thing he has to worry about while he's over there serving," Hughes said.

Her husband could lose his job if he's found to have been infected, she said.

"This is something that could really affect his career," she said.

Her husband is waiting until Hughes receives her test results before being tested, she said.

If her results are positive, Hughes said she will undoubtedly take legal action.

"If I do test positive, I will be suing and they will hear from me," she said.

-Abbey Stirgwolt, Newark Advocate

More Nevada Surgery Clinics to be Cited

A statewide inspection of outpatient surgery centers like the one believed to have spread hepatitis C to its patients has uncovered dangerous practices at four other clinics, a health official said Friday.

The state swore to quickly inspect all 50 Nevada outpatient surgery centers after it was discovered the Endoscopy Center of Southern Nevada spread the blood-borne virus to at least six patients by reusing syringes and sharing vials of medication.

Of the 18 clinics inspected by Friday, three in northern Nevada and one in Las Vegas will be cited and fined for improper disease prevention techniques, state health division chief Mike Willden said.

Willden said there was no evidence that the clinics were responsible for any outbreaks of disease.

The Gastrointestinal Diagnostic Center in Las Vegas will be cited for repeatedly reusing syringes, he said. Willden could not say whether the center also reused medication vials. Clark County pulled the center's business license, shutting it down shortly after the announcement.

Willden said the Digestive Health Center in Reno had problems with sterilization of equipment, but he did not elaborate.

The center did not immediately return a call for comment.

Dr. Dennis Yamamoto, a partner at the Digestive Health Center, said the infractions found at his clinic were "not even close" to those discovered at the Endoscopy Center.

"We have every confidence that we didn't do anything wrong in the sense of putting any patient's health at risk," he said, adding that the practice in question had been stopped. "They said don't do it, so we don't do it."

At St. Mary's Surgery Center at Galena, inspectors found problems "with the lack of high-level disinfection or sterilization of instruments used between patients," Willden said.

"There have been no known cases of infection from any of our patients, but we encourage anyone who is concerned about their treatment to contact their doctor for appropriate follow-up care or treatment," St. Mary's Center said in a statement.

A staff member at the Sierra Center for Foot Surgery in Carson City reported reuse of syringes. The clinic did not respond immediately to a request for comment.

The FBI is investigating possible Medicare fraud at the Endoscopy Center of Southern Nevada, Rep. Jon Porter's spokesman, Matt Leffingwell, said.

The FBI does not comment on open investigations. The Southern Nevada Health District said it would not confirm the conversation between the congressman and its chief, Dr. Lawrence Sands, for the same reason.

At issue is whether the surgical center may have billed the federal Medicare program for 30-minute appointments that did not last that long, Leffingwell said.

A spokeswoman for Nevada Attorney General Catherine Cortez Masto said the state is also investigating whether the practices may have resulted in insurance or state Medicaid fraud.

"We're looking at whether they billed for two vials and only used one," spokeswoman Nicole Moon said.

Six cases of acute hepatitis, a potentially deadly virus that attacks the liver, have been traced to the Endoscopy Center. Nearly 40,000 patients have been notified that they are at risk and should be tested for hepatitis B and C and HIV.

The clinic has been temporarily closed and fined $3,000.

Health officials believe the virus was spread when clinic nurses used the same syringe twice to administer anesthesia, contaminating the vial. The staff also was found treating multiple patients with vials of medication intended for a single patient only.

Five of the six people infected received treatment at the clinic on the same day.

The owner of the clinic, prominent gastroenterologist Dipak Desai, has refused to answer questions about the outbreak.

Unlike some nurses at the clinic, Desai has not surrendered his medical license. He agreed to "voluntarily cease the practice of medicine" until the state Board of Medical Examiners completes its investigation, the board said Friday.

The state regulatory agency in charge of inspections at outpatient clinics has been criticized for falling behind on its inspection schedule. The Endoscopy Center had not received a full inspection since December 2001, despite a bureau policy of inspecting ambulatory surgical centers every three years.

Kathleen Hennessey, Associated Press