Media Library

Endoscopy Center Doctors Getting Free Ride Compared to DMV Scofflaws

John L. Smith May 22, 2008 Nevada Appeal

Citizens like to complain about the Nevada Department of Motor Vehicles, but that's largely because it's a well-oiled machine.

With the law on its side, it issues driver's licenses and vehicle registrations at a staggering rate. Although lines are sometimes long, the DMV's system appears to work smoothly with relatively little inconvenience to customers. The department's customer service efficiency has improved with the passage of time and the advancement of technology.

Although it doesn't advertise the fact, the DMV also acts as a watchdog for insurance companies and traffic courts. If your auto insurance lapses, even for a short time, you'll be slapped with a $250 fine, which might be reduced if you grovel sufficiently at traffic court. If you've neglected to pay a handful of parking tickets - and I speak from first-hand experience here - you're not allowed to register your vehicle or renew your driver's license until you've paid your fines.

Then there's the annual emission certification to consider. It's about $20 if your vehicle passes the inspection. If it fails, however, you might wind up paying several hundred dollars in repairs before limping back into a department office to renew your registration. In Clark County, many emission exemptions are granted only after a car owner has spent at least $450 in repairs with a certified mechanic.

But that's life at the DMV. Rules are rules. Scofflaws beware. Cough up the cash, or face the consequences.

Driving, after all, isn't a right. It's a privilege.

It's too bad that same hard-nosed approach hasn't existed in other areas of state government.

As the Endoscopy Center of Southern Nevada story grinds on, with more than 50,000 patients potentially exposed to the hepatitis and HIV viruses because of substandard practices at the clinic, perhaps the most embarrassing element to emerge is the abject lack of hard scrutiny given the clinic and its doctors by the Nevada State Bureau of Licensure and Certification.

It's no DMV, I assure you.

In fact, the average procrastinating car owner could easily end up spending more than the amount that the Bureau of Licensure levied against the endoscopy center for each of its three "deficiencies." Although the city of Las Vegas forced the closure of the clinic and muscled a $500,000 fine against the managing doctors, the state penalized the center just $3,000 for three areas of concern. That's just $1,000 per violation despite the fact each of those "deficiencies" could end up costing lives. And the agency never calculated the number of days the center was deficient in an effort to roll up the fines.

Add to the annual car registration costs a few overdue tickets, an insurance lapse, and an emission repair bill, and you're spending upward of $1,000. And there's no grace period.

It has not been that way at the Bureau of Licensure, where, until the health department and the press exposed its downright dainty approach to potentially deadly problems at the endoscopy center, it has been one amazing grace period. Rules were broken, but it was business as usual.

Obviously, some well-connected, politically active physicians have exercised far greater lobbying power than average automobile drivers. Rules are rules, but some are applied more strictly than others.

In part because the state failed to diligently enforce the rules, eventually millions will be spent in an effort to ensure proper testing is conducted. But that's what you get when you let insiders run the system meant to keep doctors honest.

While the state has remained in a daze on this issue, the city of Las Vegas responded rapidly. Not only did Mayor Oscar Goodman and the City Council quickly vote to suspend the endoscopy center's business license, but it recently fined the physicians $500,000.

With a health center, the district attorney's office and Metro police requesting a piece of those funds, that $500,000 won't go far. Anticipating the funding need, Senate Majority Leader Harry Reid recently requested a $5.25 million addition to an upcoming spending bill to pay for blood tests and other expenses related to the endoscopy center mess.

The sad fact is the wrong people are paying this bill.

Thanks to soft laws and softer state scrutiny, Nevadans continue to pay a devastatingly high price in the endoscopy center scandal.

Thousands Still Not Warned of Hepatitis Exposure at Las Vegas Clinics

May 22, 2008 -- The Southern Nevada Health District recently sent over 40,000 letters to patients who were treated at the Endoscopy Center of Southern Nevada. The Las Vegas clinic and its affiliate, the Desert Shadow Endoscopy Center, are both linked to an outbreak of hepatitis C and HIV. However, only patients treated after March 2004 received warnings.

"This letter serves as notification that you have been identified in clinic records as a former patient of the clinic who was placed at risk for possible exposure to bloodborne pathogens. As a precaution, and in order to take appropriate steps to protect your health, we recommend you get tested for hepatitis C, hepatitis B, and HIV."

"It is not possible to determine specifically which people were exposed, but all patients who received injected anesthesia at the center have been placed at increased risk for exposure."

The Health District has not yet warned patients who were treated before March 2004 that they were exposed to infection, although several such patients have already reportedly contracted hepatitis C and HIV. Investigators recently uncovered records of another 10,000 patients who have not yet been warned of their exposure to these very deadly and contagious diseases.

"The Health District should issue a nationwide health advisory to all patients who were treated at the clinics since they opened in 2000," according to Mike Hissey, an attorney with Hissey Kientz, LLP in Austin, Texas.

An investigation by the Health District found that staff members at the Endoscopy Center of Southern Nevada and the Desert Shadow Endoscopy Center were reusing the syringes and medicine vials used to inject anesthesia, as well as biopsy forceps and other medical equipment. Nurses who worked at the two clinics said they were told by doctors to reuse single-use medical equipment, according to investigators.

Because of these unsafe injection practices, more than 50,000 patients may have been exposed to hepatitis C, HIV or another serious blood-borne illness. More than 850 former patients have already filed cases after being exposed to or contracting hepatitis C; seven additional patients have reportedly contracted HIV according to their attorneys.

Investigators also discovered that clinic doctors were routinely performing colonoscopies in as little as two minutes. These procedures ordinarily require 15 to 30 minutes in order to be performed safely. Medical records also show that doctors sometimes performed colonoscopies on two different patients at the same time.

Malpractice complaints filed against Dr. Dipak Desai and Dr. Eladio Carrera--the co-owners of the Endoscopy Center of Southern Nevada--allege that both doctors performed colonoscopies on patients who later tested positive for hepatitis C (Case No. A561921 and A561922). A judge recently issued a temporary restraining order against Dr. Desai and Dr. Carrera to prevent them from practicing medicine pending an investigation by the Nevada Board of Medical Examiners.

Health authorities are investigating the doctors for possible criminal behavior, insurance fraud and medical malpractice. The city of Las Vegas has already forced the two clinics to surrender their business licenses and pay $500,000 in fines as a result of the unsafe injection practices which occurred there.

DA's Office Gets Big Break in Health Crisis Investigation

May 21, 2008 KVBC.com

The District Attorney's Office says it's just gotten a major break in their investigation against the Endoscopy Center of Southern Nevada. The CDC has decided to turn over the results of its local investigation into the hepatitis-C outbreak.

News 3's Jesse Corona shows us what that means for investigators here.

District Attorney David Roger says corporate attorneys are representing former Endoscopy Center of Southern Nevada former employees, telling them not to cooperate with the criminal investigation.

Roger says that was a major stumbling block, until now. "Now's the time to step forward and talk to detectives because if they do not talk to detectives and we're able to put cases against them, it's going to be way too late to talk once the handcuffs are on them."

Roger says the CDC is turning over the results of their investigation into the Endoscopy Center on Shadow Lane. That investigation includes the names of the doctors and nurses who performed the procedures that led to the hepatitis outbreak.

Roger says they will be contacting those people and giving them one more chance to cooperate. "If they don't talk then we'll have to use other options."

Roger says it's still too early to discuss when or even if a criminal complaint will be filed against the Endoscopy Center. "Our objective is to put together a case that we can prove beyond a reasonable doubt and when detectives and prosecutors get together and conclude there's sufficient info to move forward we'll do so."

Of course there is an incentive to filing a complaint. A $100,000 incentive. The City of Las Vegas promised that money to the DA's Office, but only if a complaint is filed or an indictment is returned.

The FBI and State Attorney General are focusing their investigations on medicare and insurance fraud. Criminal charges on any kind against the Endoscopy Center of Southern Nevada have yet to be filed by any organization.

Clinic Employees Responsible For Hepatitis C Outbreak

By Dee Chisamera May 17th 2008

A report released by the Centers for Disease Control and Prevention on Friday established that workers at a Las Vegas clinic were directly responsible for over 80 cases of hepatitis C, after improperly handing injection equipment and medicine vials. An investigation conducted by Nevada health officials unveiled that approximately 84 patients have been infected with hepatitis C due to the reuse of anesthesia syringes, which is unacceptable in a health clinic.

The Nevada Health Division fined the Endoscopy Center of Southern Nevada $500.000, after the clinic has been linked to multiple cases of hepatitis C from the beginning of this year. Furthermore, health officials suspended the medical licenses of doctors Dipak Desai and Eladio Carrera pending state Board Medical Examiners hearings.

Hepatitis C virus is spread through blood contact, and at this point, there is no vaccine against it available. The infectious disease can cause the inflammation of the liver, and has serious consequences if medical treatment is not sought immediately. Although sometimes asymptomatic, patients usually experience jaundice, nausea and fatigue.

CDC’s report unveiled a frightening fact: employees of the Las Vegas clinic reused syringes to give sedatives, and it looked like a common practice. Hepatitis C is most commonly transmitted by sharing needles and syringes; it is exactly the reason why they’re supposed to be sterile.

Following further investigations, health officials have asked thousands of former patients of the clinic to be tested. According to the report, the patients have been exposed to hepatitis B, C and even H.I.V., and more cases of infections are likely to appear over time.

The strange thing in all this is that reprehensible practices at the clinic have continued for years, without any inspections. It appears that the clinic has not received any inspection since 2001; this goes against state policies, which require an official examination every three years.

Report Assesses Blame in Hepatitis Cases

By JENNIFER STEINHAUER, The New York Times May 17, 2008

Health care workers at a Las Vegas endoscopy clinic linked to more than 80 cases of hepatitis C routinely mishandled injection equipment and medication vials and often failed to perform basic hand hygiene, according to a report from the Centers for Disease Control and Prevention released Friday.

The Endoscopy Center of Southern Nevada, one of the largest gastroenterology practices in the area, was closed and fined $500,000 after the Nevada State Health Division discovered several cases of hepatitis C that appeared to stem from the clinic earlier this year. Two of the center’s doctors, including its owner, Depak Desai, have been required to stop practicing medicine.

The hepatitis outbreak, one of the largest in the United States, was first reported by the Southern Nevada Health District to the federal agency in early January, the report said. The first seven cases were publicly revealed in February.

The report, based on state and federal officials’ observations of patient procedures at the clinic, details a host of unsanitary practices, including nurses’ and anesthesiologists’ failing to wear gloves when they administered intravenous medications.

Officials noted that IV stoppers were sometimes not properly wiped, that syringes and vials were reused and disinfectant cleaning baths for equipment were used for two endoscopic procedures rather than one as recommended. Health officials believe the hepatitis was spread by the clinic’s reuse of anesthesia syringes among patients.

The health district has notified 40,000 patients who had visited the clinic that they might have been at risk for infection with the hepatitis B and C viruses or H.I.V. and asked them to be tested.

Since February, 85 cases of hepatitis have been revealed — seven clearly contracted at the clinic, one from a sister clinic and 77 that most likely stemmed from the primary clinic as well, Nevada health officials said.

About 50,000 panels of blood from patients have been tested in laboratories around the region, and more cases are expected to appear over time, said Brian Labus, a senior epidemiologist with the health district. The federal report “underscores that we have obvious problems at the clinic that exposed thousands of people,” Mr. Labus said.

The outbreak piqued the interest of law enforcement authorities, including the Nevada attorney general, who are investigating possible fraud connected to the clinic.

Nurse Linked to Six Cases of Hepatitis C

By ANNETTE WELLS REVIEW-JOURNAL May 17, 2008

Six patients who tested positive for acute hepatitis C just weeks after undergoing procedures at a Las Vegas clinic received anesthesia from one of two nurses who reported routinely reusing syringes and medication vials, according to a federal report released Friday.

One of the nurse anesthetists told health investigators that the practice of reusing syringes and single-dose vials of propofol -- a fast-acting sedative -- "reflected what clinic staff had instructed him to do," according to the report by the Centers for Disease Control and Prevention.

The other nurse, who was no longer employed by the clinic at the time of the CDC visit, was interviewed by telephone and reported similar practices.

The CDC concludes, as did the Southern Nevada Health District and the Nevada State Health Division, that unsafe injection practices probably resulted in six people contracting hepatitis C at the Endoscopy Center of Southern Nevada on July 25 and Sept. 21 of last year. The nurses would use a syringe on an infected patient, and then reuse the syringe to draw medication for the patient, contaminating the medication vial for patients down the line.

An investigation by health authorities that began in early January led to the largest patient notification in U.S. history. About 50,000 former patients of the 700 Shadow Lane facility are being urged to get tested for hepatitis and HIV. Tens of thousands of tests have been administered, with about 400 people testing positive. Health authorities have linked 84 of these cases, seven of them acute cases, to the closed medical clinic. An eighth acute case has been linked to a sister clinic.

The CDC sent officers from its Division of Viral Hepatitis and Division of Healthcare Quality Promotion to Las Vegas on Jan. 9 to assist with the investigation. CDC and health district investigators spent nearly a week observing procedures at the endoscopy center.

Among other unsafe practices, CDC investigators observed clinic staff "not performing proper or adequate hand hygiene between patients.'' In some cases nurse anesthetists were seen not using gloves. One nurse anesthetist was seen "moving about the room with an uncapped needle.''

Nurses also were observed pre-filling syringes with lidocaine, recapping the needles and storing them in a drawer without labeling or dating them, the report says.

All of the improper infection control practices were pointed out to staff.

The CDC also instructed the clinic's staff not to reuse detergent solution on multiple endoscopes. However, despite identifying problems with the cleaning of endoscopes, neither the CDC nor the health district linked infection transmission to the actual procedures and equipment.

The same two nurses also were responsible for giving anesthesia to a known carrier of chronic hepatitis C on each of the two dates at issue. Those patients are thought to be the sources of infection for patients treated after them.

According to the CDC report, the six patients ranged in age from 37 to 72.

Four of the five patients on Sept. 21 have been linked genetically to the potential source, health officials say. Blood results are pending on the fifth patient. Genetic testing has yet to be done on the July case.

Brian Labus, senior epidemiologist for the health district, said roughly 120 people had procedures on those two days. No other patients treated on those days have tested positive for hepatitis C, he said.

Debra Scott, executive director of the Nevada State Board of Nursing, said the CDC's report offers new details about nurse involvement in the outbreak. The report also identifies two nurses who knew of the unsafe infection control practices but did not report them. This failure could result in disciplinary action being taken against the nurses, Scott said.

Four nurses were identified by the CDC in its report. The other two nurses were not observed reusing syringes. However, one of them admitted "having been instructed to reuse syringes to administer multiple doses of propofol to an individual patient, but did not do so," the report states.

Scott said she has heard that some nurses who worked at the clinic might be remaining silent out of fear they'll be disciplined.

"We really didn't know who knew what and who actually witnessed the misconduct," Scott said. "What we're trying to figure out is where in the hierarchy did communication break down about standard practices."

The CDC's report doesn't identify who instructed nurses to reuse syringes and single-dose medication vials.

When the city of Las Vegas revoked the business licenses of the Shadow Lane facility and its affiliated clinics, the head of the licensing division said investigators learned that some doctors, including majority owner Dipak Desai, had ordered nurses to reuse syringes and single dose vials of propofol.

The six patients who had procedures on July 25 and Sept. 21 were treated by either Desai or Dr. Eladio Carrera, a part owner of the endoscopy center. The two have had their medical licenses suspended pending the investigation.

Six nurse anesthesists have voluntarily relinquished their licenses.

Letter to His Boss Faults Clark

By Marshall Allen May 14, 2008 (2 a.m.)

Two state legislators say the executive director of the Nevada State Board of Medical Examiners has ignored the public interest by delaying the investigation of doctors who may have caused the largest hepatitis C scare in the nation.

In their letter to the president of the medical board, Senate Minority Leader Steven Horsford, D-North Las Vegas, and Assemblywoman Sheila Leslie, D-Reno, complain that Executive Director Tony Clark initially refused to comply with a police investigation and was misleading about his agency’s response to the crisis.

Clark’s actions “have established a clear pattern of unwillingness to uphold the laws of this state and to protect the public,” Horsford and Leslie wrote in their letter to Dr. Javaid Anwar, the board president. The letter was copied to Gov. Jim Gibbons, Nevada Attorney General Catherine Cortez Masto and the other members of the medical board.

Leslie and Horsford were responding in part to a Sun report that Clark initially refused to provide Metro Police with past complaints against Dr. Dipak Desai, who is being investigated because dangerous practices at his clinic led to the possible infection of 85 people with hepatitis C. The law does not mandate that the board turn over the confidential complaints, but allows their release for the sake of a criminal investigation.

Clark’s “abuse of discretion” created “an unacceptable delay for law enforcement in conducting its investigation,” the letter said.

The legislators also said Clark “misled the public in media interviews and testimony” before politicians about the board’s authority to immediately suspend the license of Desai and other doctors at the clinic. It took about two months for the board to obtain temporary restraining orders so Desai and his partner Dr. Eladio Carrera could not practice.

Anwar, who has done consulting work for Desai, has recused himself from any involvement with the Desai investigation. He told the Sun on Tuesday that he could not comment on the letter.

Clark would not comment on the letter, but said his job is “to protect the public and I’m trying to do that with everything I do.”

Leslie said she wants to “put the board members on notice” and “nudge them into taking a more active role” in the way Clark handles the Desai investigation.

Desai, Colleagues May Take the Fifth, Stalling Lawsuits for Years

By Jeff German, Las Vegas Sun May 14, 2008

As if the massive case weren’t complex enough, the first lawsuits over the hepatitis outbreak that health officials linked to the Endoscopy Center of Southern Nevada are facing another major obstacle.

Dr. Dipak Desai and other physicians from the clinics are threatening to assert their Fifth Amendment rights against self-incrimination if forced to submit to the early depositions sought by attorneys for the plaintiffs.

In most civil cases, each side is able to grill the other under oath in preparation for trial. But in this case, Desai and his colleagues are facing the prospect of criminal charges, and they don’t want to risk making a statement in a deposition that could help authorities with the criminal investigations.

Attorneys for Desai and the others are hoping to persuade District Judge Allan Earl, who is coordinating the early phase of the lawsuits, to put off their depositions until the criminal investigations are concluded. That could be a long time from now and could prevent people who allege they were infected with hepatitis at the centers from obtaining information crucial to their lawsuits.

The delay tactics have enraged attorneys for the plaintiffs, many of whom are senior citizens.

“If this thing drags out for years the way the defendants would like to see it drag out, many of these victims won’t be around,” attorney Robert Eglet said. “I’ve got clients who’ve been told they have months to live. We’re going to try and push this through so these people can get their day in court.”

Eglet and the other plaintiffs’ attorneys defeated an initial effort by the doctors’ attorneys to push the target date for the trials to 2011. This week the two sides are settling for a ruling that everyone needs to be ready for trial by Sept. 21, 2009.

“Everyone” includes 93 lawyers from 34 firms — at last count. These figures change almost daily, prompting Will Kemp, an attorney for the plaintiffs, to predict that the number of lawyers in the case eventually will triple. At a hearing Thursday, Las Vegas lawyer Floyd Hale, appointed as a special master to help Earl oversee the start-up phase of the litigation, is expected to approve the trial date and the ground rules for moving the lawsuits through the court system. The final word rests with Earl.

Managing the case isn’t going to be easy.

“This is the worst medical calamity we’ve ever had in Southern Nevada. Everybody understands that,” Ed Bernstein, one of the attorneys for the plaintiffs, said. “But we’re going to be working though a maze of obstacles in the near future.”

Just communicating with all of the lawyers is a difficult task.

On the plaintiffs’ side, attorneys are representing eight people who the Clark County Health District determined contracted the hepatitis C virus while undergoing procedures at the Endoscopy Center or its associated clinics. Attorneys also are representing thousands of other patients who weren’t infected, but who have filed a class-action lawsuit against the clinics for putting them at risk for infection.

On the defense side, attorneys are representing the chief defendant, the Endoscopy Center, which has been accused of infecting patients by reusing vials and syringes. Attorneys also are defending Desai and his colleagues.

Dozens more lawyers will soon be added on both sides when about 850 additional patients claiming to be infected at Desai’s clinics file lawsuits and the high-powered pharmaceutical and distribution companies that dealt with the Endoscopy Center crank up their defense. Those companies were recently added to the list of defendants in the current suits.

Hepatitis Cases Prompt Federal Recommendations

By BRENDAN RILEY, Associated Press Writer 05/15/2008

CARSON CITY, Nev.—Better surveillance, education and oversight is needed to prevent another hepatitis C outbreak in Nevada, according to a federal Centers for Disease Control and Prevention report released Thursday.

The report follows recent word from public health administrators that more than 80 people treated at the now-closed Endoscopy Center of Southern Nevada tested positive for the potentially deadly virus and had no risk factors other than their treatments.

They're among about 400 former patients of the center who tested positive. Officials have determined the other patients could have contracted the virus through other means, including intravenous drug use, blood transfusions, organ transplants or kidney dialysis, receiving blood clotting agents before 1987, or sexual contact with a person with hepatitis C.

While hospitals regularly evaluate infection-control practices, the CDC report says that may not be the case for outpatient clinics, adding, "As use of these settings grows, appropriate methods will be needed to provide similar oversight" of those facilities.

Public health officials in Las Vegas have said local labs have reported handling about 50,000 hepatitis virus tests following a call for former patients at the Endoscopy Center to get tested for hepatitis strains C, B, and HIV, the virus that causes AIDS.

No cases of hepatitis strain B or HIV have been linked to the outbreak.

The Endoscopy Center and several other clinics were headed by doctors Dipak Desai and Eladio Carrera, whose Nevada medical licenses have been suspended pending state Board of Medical Examiners hearings.

Authorities have said at least 50,000 patients may have been exposed to unsafe injection practices by clinic staff who reused syringes and single-use vials of medication during anesthesia.

Las Vegas police have seized medical records from the clinics, and the FBI, the Nevada state attorney general and the Clark County district attorney are involved in a criminal investigation. The owners of the clinics have surrendered business licenses and paid $500,000 in fines.

The CDC will release a more detailed report to the state soon, but Gov. Jim Gibbons said Thursday's report, which has an accounting of what the CDC found during its inspections, has "essential" information that people need to see.

CDC: Syringe Reuse Linked to Hepatitis C Outbreak

By Scott Sonner, Associated Press May 16, 2008

RENO, Nev. — A hepatitis C outbreak affecting more than 80 people and exposing tens of thousands more was caused by workers reusing syringes at a Las Vegas clinic, federal health officials said Friday.

The Centers for Disease Control and Prevention report bolsters earlier conclusions by state and county officials, which led to the biggest public health notification operation in U.S. history.

State health officials contacted the CDC on Jan. 2 after two people treated at the now-closed Endoscopy Center of Southern Nevada were diagnosed with acute hepatitis C.

The practice of reusing syringes with the sedative propofol "was observed, and interviews suggested it was a common practice," the CDC investigators said in a report to the Nevada State Health Division.

"This was considered the most likely mode of transmission," the report said.

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. Another case was linked to a sister clinic.

The 85 are among about 400 former patients of the center who tested positive. Officials have determined the other patients could have contracted the virus through other means, including intravenous drug use, blood transfusions, organ transplants or kidney dialysis, receiving blood clotting agents before 1987, or sexual contact with a person with hepatitis C.

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.

The Endoscopy Center and several other clinics were headed by doctors Dipak Desai and Eladio Carrera, whose Nevada medical licenses have been suspended pending state Board of Medical Examiners hearings.

Las Vegas police have seized medical records from the clinics, and the FBI, the state attorney general and the Clark County district attorney are involved in a criminal investigation. The owners of the clinics have surrendered business licenses and paid $500,000 in fines.

Former patients at the Endoscopy Center are being tested for hepatitis strains C, B, and HIV, the virus that causes AIDS. No cases of hepatitis strain B or HIV have been linked to the outbreak.

Since 1999, the CDC counts 14 hepatitis outbreaks in the U.S. linked to bad injection practices.

The largest outbreak occurred in Fremont, Neb., where 99 cancer patients were infected at an oncology center from 2001 to 2002. At least one died.