Media Library

Las Vegas Doctor Facing Criminal Charges as Story Unfolds

March 10, 2008

Dr. Dipak Desai, owner of the now closed Endoscopy Center of Southern Nevada may soon be able to tell his side of the story to criminal investigators.

The Nevada Attorney General’s office is investigating whether he defrauded the government by overbilling Medicaid or insurance companies while practicing medicine at several of his now closed clinics, the most notorious, the Endoscopy Center of Southern Nevada.

Meanwhile former co-workers are telling investigators plenty.

The Las Vegas Sun is reporting that the center had a practice of doing assembly-line colonoscopies as a way to save money. Investigators have found that appointments were often double booked and patient waits of two hours were not uncommon.

Patients were hurried through the procedure in minutes, whereas a careful examination of the colon should take at least 15 minutes. Nurses would have patients out the door to a recovery area then send them home.

A nurse says of Dr. Desai, the owner of the clinic, “Time is money. The faster we would go the happier he was.”

“He’d say, ‘I’m the fastest endoscopist, the best endoscopist, in town,’” recalled a doctor, who like others asked for anonymity for fear of reprisals. “That was his pride and joy.”

Unfortunately that speed also caused two patients to have their colons perforated investigators have found.

78-year old Duke Breuer underwent a colonoscopy at the center. A nurse left a bandage on his arm. She told him to take the tape off when he got home. That’s exactly what he did but when he pulled the tape he found the IV needle had been left in his arm. He had accidentally pulled it out and it started gushing blood.

“The darkest blood” he’d ever seen went all over his pants and Chinese silk rug.

Amazingly when he returned for a second procedure he told the nurse about the rug and suggested he should sue them for its value.

Her response astounded him.

“You ought to sue us for a lot of other things that go on here,” Breuer says the nurse replied. “You don’t know what goes on here. I hate my boss.”

That nurse and others are now talking to investigators who are telling a frightning story of unsafe medical practices and the employees of Dr. Desai who kept their mouths shut.

According to investigators the co-owner of the clinic Dr. Desai ordered the unsafe practices that now have the state scrambling to find 40,000 former patients to have them tested for hepatitis C and HIV. Investigators have found that when a patient undergoing a colonoscopy needed more sedative, the nurses, ordered to save money would dip the same syringe back into a vial.

At least one time that was done on a patient who had hepatitis C and the vial became contaminated. Even though they were intended for single use, they would be reused on other patients spreading hepatitis C to at least six others.

The entire cost savings by reusing syringes? About $5 to $10 per patient. Unrelated to the hepatitis outbreak, the state has found that technicians were told to skimp on detergent used to remove blood and body fluids from endoscopes after a colonoscopy. The cleaning solutions were not being discarded after each use but rather being used to clean the next endoscope.

Clinicians were also reportedly told to cut costs by cutting in half disposable underwear that protects the bed-saving about 21 cents each.

Cost cutting even applied to anesthetists. Dr. Desai used certified nurse anesthetists rather than medical doctor anesthesiologists. By using the nurse anesthetist, Dr. Desai could put them on a salary and bill more like what a MD would charge.

Five nurse anesthetists have voluntarily surrendered the licenses to the state Board of Nursing. A nurse says he also billed for 30 minutes when he never went over 15.

The newspaper reports that Dr. Desai proudly boasted that he ran the most cost-efficient clinic in the entire country.

He attended medical school in India and completed his residency and internship in New York. Dr. Desai has been a professor at the University of Nevada School of Medicine. He and his wife, also a doctor own a $3.4 million, 8,700 square-foot home in Summerlin.

He has not consented to an interview but took out an ad in a local paper to say he did nothing wrong.

Meanwhile a state lawmaker from Las Vegas says that the shoddy practices at the Endoscopy Center of Southern Nevada wouldn’t even be practiced in Iraq.

Nevada State Sen.. Joe Heck has written to Nevada’s Republican Gov. Jim Gibbons. Heck is an emergency room doctor and a member of the U.S. Army Reserves currently serving in Iraq.

Heck says he is appalled to learn the lack of safety practices that would spread hepatitis C and says “blatent disregard of patient safety” would not even occur in a war zone or the Third World conditions he is currently practicing in.

Jane Aker, National News Desk

Unsafe Practices Revealed at More Health Care Centers

KLAS-TV, NV - Mar 6, 2008

Unsafe practices have been revealed at more health care centers. The legislature's health committee met Thursday to discuss the hepatitis and HIV alert at the Endoscopy Center of Southern Nevada. But during the process, they found out unsafe practices are going on at more than the six clinics already pinpointed.

It's nothing but more unsettling news for valley residents. The Nevada Health Division says they recently inspected 13 surgical clinics, only to find staff re-using vials of medicine and syringes, even after being made aware of the risks.

"That was probably the scariest line of the day," said Speaker Barbara Buckley.

Assemblywoman Sheila Leslie said, "I find it just unfathomable that we are having this problem. It sounds to me like the problem is more widespread than I ever imagined."

It's the last piece of news anyone, including lawmakers, wanted to hear. Unsafe medical practices stretch farther than just the six clinics that have already been closed.

"We're finding problems at a variety of different levels related to medication re-use -- in some cases, syringe reuse," said Lisa Jones, Nevada Health Division.

The health division has recently inspected 13 surgical clinics and found unsafe medical practices at some -- practices that were taking place even after news that 40,000 valley residents were possibly exposed to hepatitis and HIV.

The last time a full inspection was done on the Endoscopy Center of Southern Nevada was back in 2001. The Southern Nevada Health District says there's a possibility exposure to infectious disease could have spread back farther than the 2004 date they're currently investigating, but they don't know for sure.

"I think the people who perpetrated this are absolutely monstrous. They cannot claim that they did not know the consequences of their actions, and I think it is absolutely heinous we have put the public in this position," said Assemblywoman Susan Gerhardt.

Assemblywoman Gerhardt told the entire room she too went to one of the closed clinics back in 2005. She's been tested and now joins thousands of other Southern Nevadans wondering and worrying about her results.

"Sitting on the phone, waiting and waiting for someone to pick up the other line so that we would have some information," said Gerhardt.

Gerhardt hints that government heads might roll for this, but in the end, the doctors are to blame. "We are trusting them to do the right thing, and I think it's their responsibility."

And as more is uncovered, Gerhardt waits for the test results, just like many in her district -- now with an uncomfortable understanding of this deadly topic.

Now, lawmakers are concerned with getting the Bureau of Licensure and Certification enough resources to keep up with inspections to make sure something like this never happens again.

In addition, five certified registered nurse anesthetists who worked at the Shadow Lane clinic were asked to voluntarily surrender their licenses and certificates to practice in Nevada. All five complied. State lawmakers are now asking that the doctors also be given the chance to do the same.

Patients don't need to get tested at this point, because viruses have not been linked to any of these clinics. But state lawmakers say if the infraction puts people's lives at risk, they think the clinics should be closed immediately. The health division says each clinic has to be given due process.

On Tuesday, the Business Licensing Division of North Las Vegas made an attempt to inspect the Gastroenterology Center of Nevada on Lake Mead Blvd., but was unable to make contact with anyone at the office. The City issued a Cease and Desist Order prohibiting any operations, pending further review.

But on Wednesday afternoon, the Business Licensing Division of North Las Vegas was able to inspect the facility and the Gastroenterology Center of Nevada is now allowed to reopen but no procedures or diagnostic testing may be performed at the location. The City found that there was not equipment to perform surgeries at that location so there is no concern of any outbreak.

6 Southern Nevada clinic offices raided by police - FBI

Monday, March 10, 2008

Federal, state and local authorities raided six valley medical offices Monday, seizing mountains of patient records and other paperwork as part of a joint criminal investigation into the clinic at the center of a hepatitis C outbreak.

Las Vegas police, FBI agents, and investigators with the state attorney general's office and Department of Health and Human Services served search warrants at all six locations of the Gastroenterology Center of Nevada and its affiliated clinics.

"We wanted to ensure that records weren't destroyed or anything like that," said Deputy Chief Kathy Suey, who oversees the Las Vegas police Criminal Intelligence Section.

The criminal investigation stemmed from a Southern Nevada Health District inspection of practices at the Endoscopy Center of Southern Nevada. The public health investigation found that nurse anesthetists reused syringes on patients carrying hepatitis C and contaminated single-dose vials of medicine used on multiple patients, which spread the infection to at least six other patients.

Clinic staffers told health investigators they were ordered to reuse supplies to save money, according to a city of Las Vegas administrator.

Health officials have urged 40,000 clinic patients to undergo blood tests for HIV and hepatitis strains B and C.

Five nurse anesthetists who worked at the clinics voluntarily surrendered their licenses Wednesday, and the endoscopy center's majority owner, Dr. Dipak Desai, agreed late Friday to stop practicing medicine until the Nevada Board of Medical Examiners completes its investigation. The board's executive director, Tony Clark, said Monday said he has asked the attending physicians of the six patients who contracted hepatitis C to follow in Desai's footsteps.

He could not release the doctors' names Monday because no official action had been taken, he said.

Authorities began serving the search warrants about 6 a.m. Monday, starting with the clinics at 700 Shadow Lane and 4275 Burnham Ave., Suey said.

The Shadow Lane address houses the Endoscopy Center of Southern Nevada, while the Burnham address is home to the Desert Shadow Endoscopy Center. Both locations have an office of the Gastroenterology Center of Nevada.

While they searched those locations, authorities temporarily closed Gastroenterology Center of Nevada offices at 3150 N. Tenaya Way, 5915 S. Rainbow Blvd., 2610 W. Horizon Ridge Parkway in Henderson and 1815 E. Lake Mead Blvd. in North Las Vegas.

They searched those four locations later in the day, Suey said.

Many of the clinic offices, shut down last week by various city and county officials, eventually had been allowed to reopen on an administrative or limited basis.

Detectives didn't know how much paperwork they would collect during the searches or where it would take the investigation, she said.

"We're not sure exactly what we're going to find once we look at all the documents," Suey said.

Police would likely focus on potential medical negligence involving patient care, while state and federal authorities would look at potential insurance fraud, she said.

The FBI has assigned its "most seasoned" agents to the health care fraud investigation, which will cover "anything and everything," Special Agent Joseph Dickey said.

"It's a complex case, but that's our specialty at the FBI," he said.

As part of their search, investigators seized patient records from the various offices and made sure to file them in an orderly manner so the records can be found if patients request them, Suey said.

Police planned to announce by Friday the procedure for patients to obtain copies of their clinic records from the agency, she said.

Meanwhile, investigators will begin working closely to pore over the patient and billing records before ultimately deciding which criminal angle each agency will handle.

"It's going to take a long time," Suey said.

Brian Haynes, Review-Journal

How can patients at closed clinics get their records

March 7, 2008 06:55 PM CST

Since the doors are locked at half a dozen clinics across the valley former patients are running into some major roadblocks when it comes to getting their medical records.

Action News reporter Tania Reyes has the story.

Diana Gerety said, "I would like to have my records of course. I would love to have my records!"

Gerety went through a procedure at the Endoscopy Center of Southern Nevada.

Now that the medical facility shut its doors she is wondering where to get her medical records.

Gerety explained, "I should have a copy and I do not have a copy. I should have a copy of my records and what they did."

Gerety told Action News she is one of the 40,000 people who may have been exposed at the clinic due to bad medical practices.

The Health District of Southern Nevada says they have received many calls from former patients of clinics closed after the Hepatitis exposure.

The Health District says it is working with the State Health Division to find a way to get records to their owners.

Right now, only patients from one clinic can get their records.

People who were seen at the Gastroenterology Center of Nevada in Henderson located on West Horizon Ridge Parkway can call the Henderson City Attorney to locate their records.

In the meantime, Gerety says she will wait worried.

She is expecting to get her test results back in a week.

"My blood pressure has been up. My heart rate has been up," explained Gerety.

KTNV, Action News

North Las Vegas Clinic Remained Closed Friday

March 7, 2008 05:27 PM CST

One of the six clinics that was closed in the wake of the investigation of medical practices at Gastroenterology clinincs throughout the valley was supposed to reopen Friday, but it did not.

It is located on Lake Mead in North Las Vegas.

Action News reporter Heather Klein tried to find out why the clinic remains locked up.

A medical building is busy with customers on a Friday afternoon, but one office inside is still closed for business.

"I do not think they should be reopened, if there was negligence once there will be negligence twice," one patient said.

The Gastroenterology Center of Nevada East Lake Mead location received notice from the city of North Las Vegas, they can reopen.

That announcement is angering some former patients who want the opposite.

"(I want the clinic)shut down permenantly," said one former patient.

Another patient said, "I am very angry at the fact, how can the state let this happen, let them open an office like this, it is not right."

But their doors are still locked.

"Maybe a fear of retaliation from people. Maybe a fear that they do not have the right to answer to the people," commented one person.

Even though the gastroenterology clinic's doors are closed, the lab right upstairs has it is doors wide open,filled with patients waiting to get tested for Hepatitis C.

One person giving blood at the lab said, "There was a long line here this morning it took about an hour and a half for me to get my blood drawn."

Quest Diagnostics lab in the same building as the gastroenterology center is staying busy.

Filled with patients looking for more than just test results.

One vistor to the lab said, "File charges to whoever, technicians, doctors, whoever, they should not be allowed to practice anymore."

KNTV, Action 13 News

Las Vegas clinic at Center of Hepatitis C. Scare

Thursday, March 6, 2008 | 12:44 PM ET

Almost 40,000 patients who visited a Las Vegas clinic have been told to get tested for hepatitis B and C, as well as HIV, after health officials say they found that nurses there were reusing syringes and dosing out contaminated medicines.

So far, six new cases of hepatitis C have been traced back to the Endoscopy Center of Southern Nevada, officials announced last week in shutting down the clinic. Five of those patients visited the facility on the same day, Sept. 21.

Anyone who was treated at the facility between March 2004 and Jan. 11 has been advised to get tested. Investigators say that nurses often reused syringes on several patients and shared vials of medicines between patients — practices that can spread disease.

A Nevada man who came forward Thursday suggesting he was the source of the Sept. 21 infections said he has had hepatitis C since 2000 and visited the medical centre on that day for a colonoscopy.

"I know it wasn't my fault rationally, but you can't help but feel guilty," the 58-year-old, who asked to remain anonymous, told the Los Angeles Review-Journal newspaper.

"I was there that day. I was one of the first patients treated. I have hepatitis C. Common sense would tell you, it was me."

Majority owner offers no comment The clinic's majority owner, Dr. Dipak Desai, an immigrant from India who has practised medicine in Nevada since 1980, has not made any public comments on the case.

He did, however, take out an ad in a local newspaper saying, "Some of our patients may have been exposed to blood-borne diseases at our facility. In cooperation with the Southern Nevada Health District and other agencies and officials, we have carefully reviewed our procedures and implemented changes they recommended."

Local police and the FBI are investigating, and at least two class-action lawsuits were filed earlier this week. A third lawsuit against the clinic's doctors, nurses and other staff was filed Wednesday, alleging medical malpractice, fraud, civil conspiracy and negligence.

Three of the Endoscopy Center's sister facilities in Clark County, Nev., have also had their business licenses suspended.

Hepatitis C is a virus of the liver that spreads through direct contact with an infected person's blood and can lead to liver cirrhosis and cancer, though it is not usually fatal. There is no vaccine.

When was the Endoscopy Center Of Southern Nevada Last Inspected

March 6, 2008 06:42 PM CST

The medical practices at the Endoscopy Center of Southern Nevada may have put 40,000 patients at risk for several viruses.

Legislators at a public hearing Thursday wanted to know why the state licensing bureau allowed the centers to stay open.

Officials want to find out who knew what, and when.

They are trying to determine when people knew about the reuse of syringes and drugs vials.

Lisa Jones with the State Bureau of Licensure and Certification said, "I think we heard a strong message from our legislators today. They would have liked to have seen more action. We have always gone forward on the language that is in the statute that dictates that we take action based on the facility's response and correction and that administrative sanctions are in place."

Jones says that is to preserve the public's access to medical services.

Contact 13 Chief Investigator Darcy Spears has also been looking into why the state does not seem to be prepared to protect the public in this type of crisis.

The state health division's licensing bureau could have shut the facilities in question down, but did not.

They could have inspected them more frequently, but did not do that either.

That is due to lax state law and not enough money or manpower to properly protect the public.

The last time the Endoscopy Center on Shadow Lane was inspected was in June 2007.

State law does not lay out how often inspections of these types of facilities must happen, so the licensing bureau says their policy is every three years.

But they failed to even do that in this case.

The last full inspection at the Endoscopy Center was done 7 years ago in 2001.

Lisa Jones with the State Bureau of Licensure and Certification said,"We would like to be in facilities much more frequently. We think that that offers a wake up call, an educational opportunity, but people need to remember it is a snapshot in time and nothing is a guarantee."

Jones said they have not been able to put their inspection policy into practice because they do not have enough people.

Last year, the bureau asked the legislature for 17 new positions.

"In that time period of containment no new taxes and all we did go through with authorization for 7 additional positions," explained Jones.

The state says they have got a total of 13 open inspector positions right now, but they have only been able to fill 5, and those 5 are not on the job yet.

Jones says that is because they have so much trouble recruiting qualified nurses to fill those positions.

"We are a state agency with a state pay scale and we are competing with the healthcare industry and people are able to find much more lucrative positions that would pay them there so that seems to be our biggest challenge at the moment," said Jones.

Stay tuned to Action News for further details on the inspections at the Endoscopy Centers of Southern Nevada.

Could Other Medical Centers Be Using Unsafe Procedures

March 6, 2008 11:29 PM CST

The state agency responsible for inspecting 50 surgery centers in Nevada did not perform those reviews as often as required, including at two Southern Nevada facilities where problems with reusing syringes and other unsafe practices have recently been uncovered.

Of the 50 ambulatory surgery centers now being inspected by the state Bureau of Licensure and Certification for unsafe practices, 22 have not had a recertification survey within the six-year time frame required. Some of them have not been inspected for 12 years.

Information posted on the state Health Division's Web site shows that the Endoscopy Center of Southern Nevada, which has been linked to an outbreak of hepatitis C in six patients, last saw a routine inspection in December 2001, just over six years ago.

The Gastrointestinal Diagnostic Clinic on South Maryland Parkway, where inspectors last month discovered the reuse of syringes but no infectious outbreak, had last been inspected in September 1996.

Federal requirements set by the U.S. Department of Medicare and Medicaid Services recommend that inspections occur every six years.

The state lists a three-year inspection rule for ambulatory surgical centers, but the federal requirements trump the state's rules if there's a conflict, said Steve George, spokesman for the Department of Health and Human Services.

Regardless, there are no penalties for not meeting the guidelines.

Jack Cheevers, a spokesman for the federal agency, would not comment on the apparent inspection lapses.

George acknowledged inspections have not been conducted as often as recommended.

"Yes, there are some big holes on there," he said of the inspection dates posted on the Web site.

The Web page listing the centers and inspection dates was removed late Wednesday from the site. It is expected to be back online today.

Part of the reason for the lapses is a shortage of staff due to vacancies, and the fact that other types of facilities overseen by the bureau are required to be inspected more often, George said.

Intermediate care facilities for the mentally retarded and skilled nursing centers, for example, must be inspected every year by the same pool of surveyors who also look at the surgery centers, he said.

There are federal penalties for not completing those surveys in a timely fashion.

When the Endoscopy Center's Shadow Lane clinic was given a full Medicare inspection in 2001, deficiencies focused on construction and safety aspects of the building.

Exit doors were not quite wide enough, ceiling tiles and flooring did not comply with regulations, and some rooms were not equipped with emergency lighting.

The facility failed to ensure it was conducting fire drills, according to the survey.

In 2004, the licensure bureau conducted an inspection at the center based on a complaint from someone regarding the manner in which sedated patients were being released to drivers.

The inspection report does not reveal who made the complaint.

On Jan. 30, 2004, state investigators reviewed the medical records of six patients and interviewed staff. Investigators determined the facility did not ensure that patients were discharged in the company of a "responsible adult."

A plan of correction was issued by the clinic, and accepted by the state.

Dr. Lawrence Sands, chief health officer for the Southern Nevada Health District, said inspections only offer one level of assurance.

Ambulatory surgery centers in Nevada probably need to be accredited at the same level as hospitals, he said.

To operate in Nevada, hospitals must be accredited by The Joint Commission, an independent nonprofit organization and the nation's largest and oldest standard-setting health care accrediting body.

Ambulatory surgery centers, under Medicare, also must be accredited but not at the same level.

Sands said approved accrediting agencies offer another layer of oversight and allow more frequent inspections.

"Inspections are just one piece of the puzzle,'' Sands said. "What's the correct frequency of inspections? Certainly we've talked about this with our legislators."

Assemblywoman Sheila Leslie, D-Reno, who held a hearing on the health alert last week as chairwoman of the Legislative Committee on Health Care, said the news "just keeps getting worse. I've run out of adjectives to describe this situation.

"We need to vastly improve our ability to inspect these facilities more frequently and more comprehensively," she said.

The Health Committee will be focusing its attention on improved state oversight, including better and more frequent inspections, an aggressive recruitment and retention plan for health inspectors and creating a culture of safety in regards to medical care, Leslie said.

"We know inspections can save lives, and we need to do whatever it takes to ensure the public's health is not jeopardized," she said.

The information showing the lapses was posted just days after concerns were raised by Leslie about a decision by Gov. Jim Gibbons to oppose hiring 10 new surveyors for the licensure bureau during the 2007 legislative session.

Gibbons rejected the hirings because of his pledge not to raise taxes or fees.

Ultimately, he and the Legislature agreed to fund six new positions. Funding for the positions comes from federal funds and fees charged to the facilities, not the general fund.

Gibbons on Monday rejected the criticism, saying the number of positions approved in 2007 was not an issue in the ability of the bureau to do its inspections. Rather, it is the ability of the agency to fill vacancies, he said.

Of 50 approved positions, the agency has 14 vacancies due to the difficulties in recruiting and retaining surveyors.

Gibbons also said more frequent inspections would not help.

"You do not have enough money, you do not have enough people, to look at every day, every procedure, conducted on every patient," he said. "We could inspect it annually, and then, pretty soon, have we done overkill?

"I think the important thing is to assure the public we have the right policies, the right procedures, in place," Gibbons said.

As of Wednesday, 25 of the 50 centers have been inspected in response to the discovery of hepatitis C cases, 16 in Northern Nevada and nine in Southern Nevada. Infection control issues have been found in seven of the facilities.

Inspectors from the Centers for Disease Control and Prevention on Wednesday began assisting the state with the survey.

Mike Willden, director of the Department of Health and Human Services, has said the inspections of the 50 centers are focusing on basic health care safety issues, the types of things that health care officials know should not be occurring.

He called the basic practices to prevent the spread of infection as "health care 101 stuff" that inspectors haven't necessarily looked for in the past.

"When they do a survey there is an assumption that you may be not reusing a syringe, an assumption of sterilization," Willden said. "They certainly are going to be looking more closely from here forward."

Sean Whaley and Annette Wells, Review-Journal

Three Nevada regualtors withdraw from hepatitis inquiry

12:01 p.m. March 15, 2008

LAS VEGAS – Three members of the body that regulates doctors in Nevada have recused themselves from an inquiry into the hepatitis C outbreak at the Endoscopy Center of Southern Nevada. Drs. Javaid Anwar, Sohail Anjum and Daniel McBride won't participate in the State Board of Medical Examiners' investigation to avoid any public perception of bias or impropriety.

Board director Tony Clark says each doctor has ties to the endoscopy center's majority owner, Dipak Desai. The investigation into six hepatitis C cases has led to a massive public health alert, the closure of the Endoscopy Center and several of its affiliates.

Desai has voluntarily agreed to stop practicing medicine.

The board is still in talks with other doctors affiliated with the center about whether they should continue practicing medicine.

Inspectors found the center regularly reused vials of medication and syringes.

Rolling the Dice with patient Health: The Law of Averages Catches Up with a Vegas Surgi-Center

By Michael D. Shaw, Contributing Columnist - HealthNewsDigest.com Mar 9, 2008 - 8:19:01 PM

On February 29th, Nevada state health officials closed the Endoscopy Center of Southern Nevada in Las Vegas after six patients were diagnosed with hepatitis C. These cases were noted in January, and the outbreak was traced back to nurse anesthetists at the Center reusing syringes to draw up medicine from single-use vials—for multiple patients. As a result, in the biggest public health notification in U.S. history, more than 40,000 people have been informed that they should be tested for hepatitis and HIV.

"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 Centers for Disease Control and Prevention.

To clarify what happened, according to the Southern Nevada Health District...

A syringe (not a needle) that was used to administer medication to a patient was reused on the same patient to draw up additional medication.

The process of redrawing medication using the same syringe could have contaminated the vial from which the medicine was drawn with the blood of the patient.

The vial, which was not labeled for use on multiple patients, was then used for a second patient (with a clean needle and syringe).

If that vial was contaminated with the blood of the first patient, any subsequent patients given medication from that vial could have been exposed to blood-borne pathogens.

Less than a week after the facility was closed, in an unusual move, five of the nurses involved voluntarily surrendered their licenses. By all indications, the nurses were doing what they were told in administering anesthesia for procedures, and that it was standard practice at the clinic. For its part, the American Association of Nurse Anesthetists (AANA) has condemned the unsafe injection practices.

Listen to Wanda Wilson, PhD, president of the 37,000 member AANA:

"It is astounding that in this day and age there are nurse anesthetists, anesthesiologists, and other health care professionals who still risk using needles and syringes on more than one patient, or know of such activities and don't report them. Published standards and guidelines dictate that single-use and disposal of these products is the best way to ensure patient safety. Patient safety is our primary focus—not cost savings, time savings, or any other factor."

"These types of incidents are completely unacceptable, and the AANA is determined to help uncover the root cause and correct the problem."

It seems to me that the "root cause" here is nothing more complicated than the owners of the clinic wanting to save a little money, and simply forcing the nurses to do what they knew was improper. There is no possibility that health care professionals would be ignorant about such basic infection control practices. Those involved just did not care.

Indeed, in the wake of 2002 hepatitis outbreak in Norman, Oklahoma, AANA had run a survey to learn more about practices and attitudes on needle and syringe reuse. Three percent of anesthesiologists who responded indicated they reuse needles and/or syringes on multiple patients. Nurse anesthetists, other physicians, conventional nurses, and oral surgeons reported reuse at one percent or less. Extrapolating from these findings, we can conclude that approximately 1,000 anesthesia professionals could have exposed more than a million patients to risks of contaminated needles and syringes.

While the Southern Nevada Health District is to be commended for its aggressive investigation, one of its statements peripheral to the matter is perplexing. The District emphasizes that "It is important to remember the transmission of the disease in these cases were not related to the medical procedures, but rather to the anesthesia administered to the patient."

This statement is technically correct, but from a patient's point of view, it is a distinction without a difference. Since anesthesia must always be given for these procedures, why even raise this issue? More than that, the traditional concern in endoscopic procedures has always been about the sterility of the scope, which is far more difficult to ensure. Cold comfort to know that the infections were transmitted by pure malfeasance! When was the last time you heard of someone getting hep C from a flu shot, for example?

As if any more bad news were needed, Lisa Jones, head of the state licensing bureau, revealed that similar violations have been found at 13 outpatient surgical centers, in addition to the clinic that prompted the investigation. "We're finding problems at a variety of different levels - medication reuse, in some cases syringe reuse in different procedures and functions. That's why one of our very first actions is the need to get the word out on the street," Jones said.

Hospitals have complained for years about the lax oversight given to surgi-centers such as the facilities under investigation, and they surely have a point. One hopes that this case will inspire some big changes, including hard jail time for the perps involved and the national (not just statewide) revocation of their licenses.