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Ex-Desai Colleagues Open New Offices

By PAUL HARASIM REVIEW-JOURNAL April 19, 2008

The South Hills Gastroenterology Clinic in Henderson has been opened by Drs. Carmelo Herrero and Albert Mason. The doctors are former associates of Dr. Dipak Desai. Photo by Martin S. Fuentes/Review-Journal

A physician who was part of Dr. Dipak Desai's gastroenterology practice, which is at the center of a massive hepatitis alert, said Friday that he has opened offices in Henderson because patients deserve the best in quality medical care.

Dr. Carmelo Herrero said he and another former associate of Desai, Dr. Albert Mason, will evaluate patients at South Hills Gastroenterology, 2625 Wigwam Parkway, but will not do procedures there.

"We want to get back to the community and give good quality medical care. Our patients deserve the best," said Herrero, who added that he and Mason have not determined whether they will perform endoscopic procedures at hospitals or area ambulatory surgical centers. "I want to assure my former patients that I am here for them."

Other former associates of Desai also are opening offices in the Las Vegas Valley.

According to documents on file with the Nevada secretary of state, Drs. Dipesh Banker, Snehal Desai, Ranadev Mukherjee and Shahid Wahid, all physicians who helped Desai create a multimillion-dollar gastroenterology empire in Las Vegas, have formed a medical company known as Digestive Associates LLP in North Las Vegas.

Yet to open, it will be at 2031 McDaniel Street, near North Vista Hospital.

Those doctors were unavailable for comment Friday.

Another former Desai physician might be preparing to open an office. A business license for Great West Medical Associates, at 5915 S. Rainbow Blvd., is pending. That medical business would be in the suite of one of the gastroenterology offices associated with Desai.

The owner of Great West was not named in state records, but the corporation's name is "Great West Medical Associates (Faris) LLP."

Dr. Frank Faris worked for Desai. He was unavailable for comment Friday.

The fact that former Desai physicians are publicly resuming work in the Las Vegas Valley was troubling to some former patients.

"All those doctors should lose their licenses. They all knew what was going on," said Becky Blessing, who received one of the Southern Nevada Health District's 40,000 letters that were sent to former patients of Desai's Endoscopy Center of Southern Nevada on Shadow Lane. The notices urged the patients to be tested for blood-borne diseases, including hepatitis C, an incurable and potentially fatal disease that attacks the liver.

Six cases of acute hepatitis C have been traced to the Shadow Lane clinic, and a seventh is linked to the Desert Shadow sister clinic on Burnham Avenue. Officials have said the cases are linked to risky injection practices at the clinics.

"What do they think we are, idiots?" Blessing asked.

Blessing had a colonoscopy at the Shadow Lane clinic in August. She has tested negative for blood-borne diseases, but her doctor says she must be tested again in six months.

Desai's entire practice and its 14 physicians remain under investigation. Investigators are uncertain which practitioners worked at which clinics for Desai, who voluntarily agreed not to practice until the investigation is completed.

Las Vegas physician Dr. Julian Lopez said Friday that physicians who worked for Desai should not practice locally again.

"They violated the public trust," he said. "We need to get that built back up."

Herrero won't talk about his past affiliation with Desai.

"My lawyers don't want me to talk about the past," he said. "But in the future I will."

PUBLIC HEALTH CRISIS: Two Clinics May Have Buyer

By PAUL HARASIM REVIEW-JOURNAL More Info

* Hepatitis C Investigation

Dr. Rudy Manthei Henderson physician was chairman of governor's health transition team

A Henderson physician who is a top health care adviser to the governor is seriously considering buying two of three clinics owned by Dr. Dipak Desai, whose gastroenterology practice is at the center of a massive hepatitis alert.

If Dr. Rudy Manthei goes ahead with the deal, he said the physicians who worked for Desai will be encouraged to practice at the two facilities.

"Until the medical board (the state board of medical examiners) has determined wrongdoing, it would be inappropriate to treat them any differently," Manthei said Tuesday. "They need to have due process. We are talking about some excellent physicians."

Manthei, the founder of Nevada Eye & Ear and principal owner of Seven Hills Surgery Center, said his interest in buying the clinics is simple -- the people of the Las Vegas Valley need the treatment facilities.

"We had 25,000 endoscopic procedures done in this area last year and we'll probably have that many again," said Manthei, who remains an adviser to Gov. Jim Gibbons after serving as chairman of the governor's health care transition team. "You just can't get rid of three clinics when you have such a need."

What Manthei is considering disgusts Dr. Julian Lopez, a local gastroenterologist not associated with Desai's practice.

"None of those physicians in that group should ever be allowed to practice again," he said. "I see patients running scared every day because of them. These people don't know who they can trust any more. Everybody in that medical group knew what was going on. They used to go around and brag about how many procedures they could do. That's how they got compensated, for how much they could do."

Former Desai patients have complained to the Review-Journal that the physician's clinics herded them through procedures like cattle.

While Manthei said he doesn't agree with how Desai's clinics were run, he did say that no one has accused the Desai centers of doing unnecessary procedures.

However, the Review-Journal spoke with a former physician at the Endoscopy Center of Southern Nevada who said unnecessary biopsies were routinely done to run up patient charges.

Manthei, who was trained as an opthalmologist, said that because he is in negotiations with Desai, whom he described as "devastated by what happened," he can't divulge what the cost of the clinics would be.

"I'll know in a week whether I'm going to go forward," he said, adding that Desai and his partners, whom Manthei wouldn't name, "turned to him" for the business deal.

Manthei, who served on Gibbons' transition team with Desai, said he would be buying equipment and assuming the leases at Desert Shadow Endoscopy Center on Burnham Avenue and the Spanish Hills Surgical Center on Rainbow Boulevard.

"I am not buying the buildings," he said, adding that he is also not buying either patient or physician referral lists.

Manthei said he has no desire to buy the clinic on Shadow Lane because it is not "free standing," meaning it had uses other than a surgical center.

Nearly seven weeks ago, some 40,000 letters were sent to former patients of Desai's Endoscopy Center of Southern Nevada on Shadow Lane by health care authorities urging them to be tested for blood-borne diseases including hepatitis C, an incurable, potentially fatal condition that attacks the liver. Six cases of acute hepatitis C have been traced to that clinic, and a seventh is linked to the Desert Shadow sister clinic on Burnham.

Health care authorities said syringes and single dose vials of medication were reused.

Desai's entire practice and its 14 physicians remain under investigation. Investigators are uncertain which practitioners worked at which clinics for Desai, who voluntarily agreed not to practice until the investigation is completed.

Another local gastroenterologist, Dr. Frank Nemec, said a lack of facilities for endoscopic procedures isn't the problem in Las Vegas. "We have a manpower problem," he said.

But Lopez said the problem goes beyond the number of physicians and facilities.

"I can't believe this is going to happen when we've lost the public trust. Believe me, this isn't the way to regain it," he said. "All this guy (Manthei) is doing is trying to make a financial advantage for himself. We have hospitals and plenty of places to do this work."

One former patient of the Shadow Lane clinic, Cecilia Avila, said it would take a lot more than a new owner to bring her back to any of the associated clinics.

New doctors and nurses would have to be part of the equation, she said. Most of the clinics' employees, she believes, knew about the substandard practices yet failed to report them.

"Why didn't they come forward?" she asked.

Manthei, who is also one of the founders of the Desert Canyon Rehabilitation Hospital in Las Vegas, said he understands that public confidence in medical treatment in Las Vegas must be restored. He said that could partially be done by having licensing and accreditation for the facility in order.

"The way you get the public's trust is by doing things the right way," he said. "There are no exceptions."

He said he would hire a medical director, probably an anesthesiologist, to oversee the operation. He would also hire office staff and a nursing director, who would in turn hire nurses. Physicians who used the center, he said, would hire their own anesthesiologists.

Manthei added that surgical centers devoted to a speciality can be more cost effective for both patients and insurance companies. By doing just colonoscopies and other endoscopic procedures at a surgical center, Manthei said, treatment can actually be better than in hospitals because medical professionals are focused on just one discipline.

Lopez said Manthei really doesn't care about re-establishing public confidence in the medical profession in Las Vegas.

"He's just trying to help those guys (former Desai doctors) survive," he said. "He wants them to invest in the clinics one day."

Manthei said that if all goes well he would like to eventually see the doctors working at the clinics invest in the business.

"This guy (Manthei) is part of the problem we have in Las Vegas," Lopez said. "He's just trying to help these physicians who shouldn't be practicing anymore re-establish themselves."

Manthei said he was by no means limiting use of the clinics he might buy to former physicians of Desai. "I would hope many physicians would show up," he said.

Billie-Marie Morrison, an attorney for Craig P. Kenny & Associates, which is representing nearly 300 clients who claim they contracted hepatitis C at the Shadow Lane clinic, said she worries about an opthalmologist running a gastroenterology center.

"I'm sure he's a great opthalmologist but he's not somebody I would want to pin my hopes on rebuilding the public trust when it comes to gastroenterology centers," she said.

Morrison said that if Manthei goes forward and has former Desai doctors working there, people should remember who they are.

In addition to Desai, at least 13 other doctors practiced at his clinics: Eladio Carrera, Clifford Carrol, Vishvinder Sharma, Dipesh Banker, Snehai Desai, Frank Faris, Carmelo Herrero, David Manuel, Albert Mason, Ranadev Mukherjee, Sanjay Nayyar, Shahid Wahid and Nicolae Weisz.

"It's up to people if they want to buy a house from a builder who's had his last 10 houses fall down," she said.

Manthei said he understands that people are now terrified of surgical centers, but that fear could be hurting them.

"In our screenings here, we were picking up 1,500 colon cancers a year," he said. "But now people aren't being screened."

Review-Journal writer Brian Haynes contributed to this report.

Tahoe Surgery Center Shut Down

The Associated Press Tue, Apr 15, 2008 (12:12 p.m.)

Nevada public health officials said Tuesday the Lake Tahoe Surgery Center at Round Hill has been ordered to stop all patient care procedures following an inspection that revealed unsafe infection control practices.

The inspection was conducted by a federal Center for Medicare and Medicaid Services team as part of random surveys at 20 surgery facilities around the state following the discovery of flawed procedures linked to a hepatitis C outbreak at a Las Vegas clinic.

The state Bureau of Licensure and Certification, which issued the "cease patient care" order to the Tahoe center, said there was no evidence of any disease transmission as a result of practices there.

Representatives of the Tahoe center didn't immediately return calls seeking comment about the state action, the first stemming from the follow-up surveys by the federal teams.

The Tahoe center went through an initial survey conducted by the state in mid-March, and was told that improvements were needed to prevent problems such as the spread of disease or infection.

The facility was closed from March 14 to March 18 to make the required changes, and its owners submitted a plan detailing the efforts on April 1. Federal inspectors made an unannounced visit to the center on Monday.

In southern Nevada, two Las Vegas medical clinics at the center of the hepatitis C outbreak have surrendered their business licenses and paid a total of $500,000 in fines.

Mayor Oscar Goodman and lawyers for the Endoscopy Center of Southern Nevada and the Gastroenterology Center of Nevada say the clinics won't reopen.

The moves avoided a public hearing at which clinic doctors and nurses had been called to testify about a preliminary revocation of the business licenses after six patients contracted the potentially fatal disease during procedures. A seventh patient has since been identified with the virus.

Health inspectors believe the virus was spread by unsafe injection practices at the clinics.

Las Vegas Hepatitis Cases Linked to Reused Needles

By Ashley Powers Los Angeles Times Sunday, March 16, 2008 12:16 a.m. MDT

LAS VEGAS — Health officials here sensed something was wrong.

It was January, and two acute cases of hepatitis C had been reported to authorities — the number Clark County averages in a year. The patients, they soon discovered, had one thing in common: Both had undergone procedures at the same medical clinic.

When investigators arrived at the Endoscopy Center of Southern Nevada, they witnessed staffers reusing medicine vials and syringes during anesthesia, a practice that can transmit blood-borne diseases.

The safety lapses — purportedly in place to cut costs — dated to at least 2004.

As a result, 40,000 people have been told to seek testing for hepatitis and HIV, the virus that causes AIDS, in what federal officials are calling the largest notification of its kind in history.

The public-health scare has cut across racial and socioeconomic lines, bringing Southern Nevada residents together through a shared sense of panic and mistrust.

"These people have psychically cracked," said Dr. Michael Karagiozis, an HIV specialist at the Community Counseling Center in Las Vegas, which has provided more than 100 people with free blood tests. "Their safe harbors no longer exist."

Story continues below Nevada — whose population has more than doubled since 1990, to 2.5 million — has fewer physicians per 100,000 residents and a higher percentage of people without health insurance than many other states, according to the nonprofit United Health Foundation.

Recent checks of other medical centers have turned up more cases in which staff members allegedly reused syringes or vials, said Brian Labus, senior epidemiologist for the Southern Nevada Health District.

"It's important and big in that it should never have happened at all," said Dr. Michael Bell, associate director for infection control at the federal Centers for Disease Control and Prevention.

The CDC sent a team this past week to help Nevada officials inspect the state's 50 or so surgical centers. Political leaders are haggling over whether the facilities should be checked more frequently than once every three years, an idea Gov. Jim Gibbons recently compared to state troopers trying to catch every speeder.

Meanwhile, several law-enforcement agencies, including the FBI, are investigating the now-closed Endoscopy Center, and former patients have filed lawsuits against the center, its doctors and health officials.

Dr. Dipak Desai, the Endoscopy Center's majority owner, voluntarily agreed to stop practicing medicine while the state medical board conducts an investigation.

"As a longtime resident of Southern Nevada," Desai said in a statement, "I share our community's sorrow and concern for those who have been affected by this situation. ... These unfounded allegations will be addressed in a court of law, when facts have been presented and substantiated."

Officials have linked six hepatitis C cases to the center, and have issued a list of questions patients should ask their doctors. Among them: "Can you assure me that I am safe in your facility from the transmission of communicable diseases?"

"You have to wonder how much of the iceberg is showing," said Sally Hardwick, interim director of the Nevada Center for Ethics & Health Policy at the University of Nevada, Reno.

Substandard injection practices have led to 14 hepatitis outbreaks across the country since 1999, according to the CDC, including one last year in Michigan in which 13,000 dermatology patients were urged to seek testing.

Hepatitis C is a potentially fatal liver disease for which there is no cure; its symptoms include stomach pain, nausea, vomiting and jaundice. Treating a single case can cost $60,000 annually.

Lawmakers Just Hate Term Limits

By Erin Neff ReviewJournal.com April 13, 2008

There's never really been any doubt that the term-limits overwhelmingly approved by Nevada voters would someday get a test in the courts.

It's just been a matter of when -- and by whom.

Nothing says bipartisan support in Nevada like an effort under way by Senate Majority Leader Harry Reid to quietly stoke that challenge.

Elected officials of both parties hate the looming term limits. The 2010 impact on the Legislature would be demonstrable, with Assembly Speaker Barbara Buckley, D-Las Vegas, out of a job. And the only thing that could pry the nameplate from Senate Majority Leader Bill Raggio, R-Reno, is term limits, a measure he also opposes.

It's already highly evident where much of the power of the legislative process resides -- and it isn't in the 63 seats of the two chambers.

Beyond stellar leaders such as Buckley and Raggio and a few outspoken legislators who know how to play the system inside and out of the building, the preponderance of power in Carson City is already "behind the glass" partition separating the gallery from the elected officials.

Lobbyists representing a host of interests from gaming, mining, business, local government and social welfare organizations build their own alliances and try to game the system as best they can.

Sometimes, a veteran lawmaker such as Raggio or his Senate Democratic leader Dina Titus, will preface a vote on a bill with a history lesson. Usually that history was culled from somewhere in the recesses of their memory from sessions long ago.

But if Raggio, Titus, Buckley and company are gone, so too, are the memories.

Just about one-third of lawmakers will lose their seats when the first round of term limits takes hold in 2010. A fair chunk of them would be sorely missed.

But if reform is ever going to come to Carson City, it is going to have to include real, transparent lobbying reform.

Under term limits, a lobbyist who has 20 years experience under his belt becomes more than just a powerful special interest. He is able to craft language, build political alliances and commandeer a measure for his client with relative ease.

If you think the lobbyists already largely run the show, you're right. But it's always been the experienced lawmaker, from Randolph Townsend, R-Reno, to Bernice Mathews, D-Sparks, who has at times been able to put the lobbyists in check.

At times.

Reid of course is already hyper-focused on his re-election in 2010. Having loyal Democrats down ticket will help generate buzz, if not outright turnout, that spills up if his numbers continue to sag.

Term limits may have passed twice here in 1994 and 1996, but voters tend to have short attention spans. And with both Republican nominee John McCain talking trash about special interests and likely Democratic nominee Barack Obama building an entire campaign around reform in Washington, voters will probably begin to focus more on lobbyists.

Secretary of State Ross Miller has already shown he's a different kind of chief elections officer. He's already issued rules on recall petition gathering.

He's also one of thoroughbreds in the Democratic stable being groomed for who knows what race.

A more likely 2010 governor's candidate is Attorney General Catherine Cortez Masto. Now, while her office may technically have jurisdiction to consider the legality of term limits, any such ruling would be controversial and could impact her as she runs statewide.

What's more, she was chief of staff for Gov. Bob Miller (10 years in office), who knows a thing or two about challenging term limits.

Voters generally have a throw-the-bums-out mentality when it comes to elected officials and term limit legislation is typically quite popular. And while there's little that engenders popular hatred more than runaway spending of tax dollars, some of the biggest bums in Carson City can't be thrown out even with term limits.

Reid understands the political winds better than most politicians. What he sees currently in Nevada is a populist push to raise the gaming tax. That's the closest thing to a lock this election cycle (if it appears on the ballot).

The same emotions that fuel that kind of momentum can easily be translated into a campaign against special interests.

And if the valiant defenders of the public's interest just happen to be term-limited lawmakers, voters may not mind having their will usurped again.

I mean, it's not as if the Legislature pays much attention to that other popular initiative that created the 120-day session.

Nevada's part-time Legislature seems very antiquated when real crises arise, forcing lawmakers to take up critical issues in interim committees.

The Legislative Committee on Health Care, for example, held special meetings and a community forum for those impacted by the hepatitis outbreak in Las Vegas. Legislative leaders are also working with the governor on the pressing $900 million shortfall in anticipated revenue.

But not all interim work is as vital.

Consider a meeting scheduled for tomorrow in Carson City.

The Commission on Special License Plates will hold a hearing to determine whether conservation group Nevada Ducks Unlimited, Inc. "is or is not in compliance" with certain filing requirements.

It's long past time for the whole special license plate racket in Nevada to have its swan song.

PUBLIC HEALTH CRISIS: Insurer Broadens Hepatitis Caution

By ANNETTE WELLS and BRIAN HAYNES REVIEW-JOURNAL April 12, 2008

Although Southern Nevada Health District officials maintain there is no evidence that the unsafe injection practices they believe led to six people contracting hepatitis C at a Las Vegas endoscopy clinic took place before March 2004, at least one health insurance provider isn't taking any chances.

Anthem Blue Cross Blue Shield plans to alert all members treated at the Endoscopy Center of Southern Nevada at 700 Shadow Lane to speak with their physicians about having tests for blood-borne diseases regardless of procedure date.

Anthem spokeswoman Sally Vogler said Friday that the notification will appear in the form of an advertisement in the Review-Journal on Sunday and on April 20.

She said the advertisement stems in large part from the possibility of patients who were treated at the clinic before March 2004 testing positive for hepatitis C or another blood-borne disease.

Vogler and Anthem's senior counsel Molly McCoy said the insurance provider's advertisement isn't alleging that unsafe injection practices occurred at the Shadow Lane facility before the date set by the health district, or that the health agency is not being thorough in its investigation.

"This is really about covering all the bases," Vogler said.

In late February, the health district sent letters to 40,000 patients who underwent procedures at the Shadow Lane facility between March 2004 and Feb. 11 urging them to be tested for hepatitis strains C and B and HIV, the virus that leads to AIDS.

The notification, now considered the largest in U.S. history with respect to blood-borne diseases, was the result of a cluster of people identified with hepatitis C in January.

All six had been treated at the endoscopy clinic, one on July 25 and five on Sept. 21, health officials said. Each of those patients had undergone procedures with the sedative Propofol, health officials said.

Health district officials believe patients were exposed when nurse anesthetists reused syringes on infected patients and contaminated single-use vials of medicine. The infection spread when the vials were shared among multiple patients.

Lawyer Robert Eglet, whose firm, Eglet Mainor Cottle, represents more than 4,000 clinic patients, said Anthem's ad came as little surprise.

"It's not something that anybody hasn't been saying since Day One," he said.

Of his 210 clients who have tested positive for an infectious blood-borne disease, several had procedures well before the March 2004 date set by the health district, he said.

"March 2004 has always been an arbitrary date," he said, noting that it was chosen because the only records kept in the Shadow Lane clinic went back to that time. Earlier patient records probably are stored elsewhere, he said.

Brian Labus, the health district's senior epidemiologist, said the decision was based on the identification of the unsafe injection practices and the determination that these practices had been the standard practices of the clinic since a remodeling in March 2004.

"We are limited to those dates," Labus said, but he added he didn't think it unreasonable for people to speak to their doctors about being tested even if their procedures occurred outside that time frame. "We just don't have evidence to urge patients prior to March 2004 to get tested."

Eglet said he believes it's only a matter of time until the health district sends notification letters to patients of the Desert Shadow Endoscopy Center, at 4275 Burnham Ave., at which health officials have said a seventh patient probably contracted hepatitis C. Eglet represents the patient, a male, who underwent a procedure in 2006 and tested positive for hepatitis several weeks later within the incubation period for developing illness. The case never was reported to the health district.

Labus said the health district is trying to determine whether any Desert Shadow patients should be notified. Disorganization of medical records being held at the Metropolitan Police Department is slowing that investigation.

Labus said police have received several bids from companies experienced with sifting through medical records, but he said the process is going to take some time to accomplish.

In the meantime, he said, the health district continues to receive positive test results and is interviewing patients with positive tests to determine any link to the endoscopy clinic.

Anthem officials said they haven't received any test claims that show positive results since the health district's announcement. The insurance provider has had a contract with the Gastroenterology Center of Nevada, the umbrella of the Shadow Lane and Burnham Avenue facilities, since the late 1990s.

Anthem also plans to send letters to more than 15,000 of its members who were treated at the Shadow Lane facility between the health district's dates to reinforce testing.

"Because of the time span, we felt it necessary to be absolutely accurate with addresses,'' Vogler said.

Eglet characterized the Blue Cross Blue Shield ad as a good preventive step to help identify infected patients so they can begin treatment sooner rather than later.

Two Las Vegas Clinics Lose License in Hepatitis C Debacle

Tuesday, April 08, 2008 By Jane Akre

Two Las Vegas clinics that gave at least seven people hepatitis C had their licenses revoked by the city Monday after they forked over a $500,000 fine.

That saved the executives in charge a face-to-face meeting with the approximately 80 angry citizens in attendance who hoped someone would be held accountable for the public health debacle.

Approximately 40,000 former patients of The Endoscopy Center of Southern Nevada are undergoing testing for blood-borne diseases such as hepatitis and HIV after it was revealed that workers there reused syringes in a cost-cutting move.

The Gastroenterology Center of Nevada, owned by the same group, also will not reopen.

Those who have been tested positive for hepatitis C tell the Las Vegas Review-Journal that the punishment is not enough.

Barbara Botts whose husband died from hepatitis C says those responsible should be held accountable. “I don’t understand why they’re not being indicted” she tells the paper.

The center’s operator, Dr. Dipak Desai is under criminal investigation. He has voluntarily stopped practicing medicine in Nevada.

Las Vegas Mayor Oscar Goodman says the city was prepared to have an extensive hearing on the clinics, but lawyers for Dr. Desai offered to surrender the licenses and avoid a hearing. They then paid the fine during the city council hearing with two checks for $250,000 each handed over to the city.

That money will go to help patients relocate their medical records seized by police. Patients like Michelle Baltz who has Crohn’s disease and needs to see another gastroenterologist but was told police can only access records by date.

"I don't know when my procedure was done," she said. "I'm walking around with Crohn's disease and I can't even see a doctor" she tells the paper.

Kevin Rexford was in attendance at Monday’s hearing. He left feeling “less than satisfied” with the proceedings.

Rexford, 46, has incurable colon cancer, he says was missed by the Endoscopy Center. He filed and has settled a lawsuit.

“I don’t think they were held to task” Rexford tells the Las Vegas Sun.

Many expected nurses to have to testify at to why they reused syringes and single-patient vials of medication that exposed patients to the incurable virus. Instead the legal team turned over the money.

So far seven patients have been identified with hepatitis C. Several class action lawsuits have been filed.

City Pulls Endoscopy Center's Business License

April 7, 2008 07:28 PM CDT

The Endoscopy Center of Southern Nevada lost its business licenses Monday afternoon. The City of Las Vegas suspended the licenses for the two clinics in February but today decided to revoke them altogether.

The center must also pay a $500,000 fine. That money will be used to help patients who need to be tested as a result of possible contamination.

The doctors at the center of this investigation were not present at the meeting, but they have handed over their business licenses for the Endoscopy Center of Southern Nevada and the Gastroenterology Center, as well as money orders totaling $500,000.

It was not a lengthy meeting at City Hall. Rather than go through a hearing, city leaders and attorneys for the center reached a settlement -- the business licenses were given up and the clinics had to pay the fine.

The doctors can try to open up another clinic, but the city says the doctors who are attached to these old licenses have been flagged. If any of them tries to apply for another business license, the city will already know their background and their ties to the hepatitis scare.

There were a few victims of the clinics on hand to give their statements. Though they are pleased with the outcome of the hearings, many feel it's not enough.

"If that's all they can do, that's all they can do. Once these people go to court, they will probably get more than that, all doctor's licenses revoked and passports revoked so they can't get out of the country," said former patient June Ingram.

Mayor Oscar Goodman says he wants the money that was handed over to go towards getting patients blood tests. He also wants it to go towards hiring a company that can help patients get access to their medical records much faster.

Though many would have liked to have seen more done to the doctors, the mayor says under their jurisdiction, the city did all it could possibly do.

Endoscopy Center of Southern Nevada Loses License, Pays Fine

Tuesday, April 8th, 2008

Yesterday the City of Las Vegas handed out a stiff punishment to the owners of the Endoscopy Center of Southern Nevada, the clinic where unsanitary practices many have exposed thousands of people to hepatitis and HIV. Not only has the Endoscopy Center of Southern Nevada lost its business license, but the owners of the practice were hit with a $500,000 fine. But many angry patients who attended a hearing of the city council said they hoped the investigation into the Endoscopy Center’s abuses would eventually result in criminal indictments.

In February, the Southern Nevada Health District sent letters to 40,000 people treated at the clinic, advising them to get tested for hepatitis B and C, and HIV. The Endoscopy Center of Southern Nevada has been under investigation since early January, after health officials learned of three people who had been diagnosed with hepatitis C after being treated there. Ultimately, the Southern Nevada Health District said a total of six people were known to have contracted hepatitis C after being treated at the Endoscopy Center of Southern Nevada. Five of them were treated the same day in late September; the sixth is believed to have been infected in July, the district said. The Southern Nevada Health District investigation revealed that “unsafe injection practices related to the administration of anesthesia medication might have exposed patients to the blood of other patients.” Last week, a seventh hepatitis C victim, who had been treated at a clinic owned by the same group that owns the Endoscopy Center, was identified.

The hepatitis C virus may have been spread when clinic staff reused syringes and used a single dose of anesthesia medication on multiple patients, the district said. A syringe would become contaminated by the backflow of blood when patients with a blood-borne disease were injected with medication, health officials said. That syringe, in turn, would be reused to withdraw medication from a different vial. That vial could become contaminated and result in infection.

The subsequent investigation of the clinic revealed even more substandard practices. Several staff members told investigators that biopsy equipment labeled for single use was reused for multiple patients after disinfection. Others reported that they were directed to reuse bite blocks - devices put in patients’ mouths for some procedures - on multiple patients.

Attendees at yesterday’s hearing had hoped to hear from Dr. Dipak Desai and others involved in the Endoscopy Center scandal. But there was little legal weight behind the city’s request that they testify. Instead, the Endoscopy Center of Southern Nevada and an affiliated clinic lost their business licenses, which the city had already suspended on February 29. According to a report for in the Las Vegas Sun, lawyers for the clinic had contacted the mayors office looking to avoid a full-blown hearing. They agreed to accept the city’s decision to rescind the business license, and agreed to pay a $500,000 fine. The fine was paid at yesterday’s hearing.

Las Vegas mayor Oscar Goodman said the money could be used to a assist those who were directly affected by the Endoscopy Center debacle. The mayor said it could be spent to offset the cost of blood tests to determine whether the 40,000 people advised to be tested for hepatitis B, hepatitis C and HIV. Goodman also mentioned that it would cost an estimated $500,000 to hire an outside business to organize medical records Metro Police confiscated from the clinic.

Several people attending the meeting - many of them former patients of the Endoscopy Center - told the Las Vegas Sun that they wanted to see more action - preferably in the form of criminal charges - taken against Desai and others. They could have their wish granted soon , as a criminal investigation of the Gastroenterology Center of Nevada’s clinics - one of which is the Endoscopy Center - is currently underway.

Seized Records Hard to Sift Through

By ALAN CHOATE and ANNETTE WELLS REVIEW-JOURNAL

The thousands of medical records from the Gastroenterology Center of Nevada being held as evidence are proving hard to sift through, presenting a significant hurdle for patients, attorneys and investigators seeking access to them as the fallout continued from the largest health notification in U.S. history.

"Close your eyes and imagine looking for a record in 2,200 boxes of records," said Michael Walsh, director of administration for the Southern Nevada Health District, which is looking at spending hundreds of thousands of dollars to organize the records.

Police spokesman Jose Montoya was more succinct: "It's a big mess."

Local, state and federal authorities seized the records in March from six locations of the Gastroenterology Center of Nevada, including the Endoscopy Center of Southern Nevada on Shadow Lane, where the health crisis first surfaced.

The records are now in the custody of the Metropolitan Police Department. The point was to secure them against tampering or destruction as the case against the clinics unfolds, but those seeking access to the records have faced unexpected hurdles.

"Since we recovered them from different locations, some of them are catalogued by date, some by doctor's name, some by location," Montoya said. Finding and making copies of records for people -- there have been about 200 requests so far -- is "a tedious process for us."

It's also a tedious process for the Nevada State Board of Nursing and the health district, which want to review records but can't because they are in the hands of Las Vegas police.

It's a significant obstacle, considering a health notification went out to 40,000 former patients of the Shadow Lane office after investigators linked six cases of acute hepatitis C to patients visiting that facility. Officials reported that unsafe injection protocols at the clinic put patients at risk for blood-borne diseases.

There's another case that could be connected to the Desert Shadow Endoscopy Center, an affiliated clinic on Burnham Avenue, but even if health officials wanted to do a notification, they'd have to be able to find the patients in the seized records.

The records also figure in the investigation of six nurse anesthetists who relinquished their licenses in the days following the initial disclosures.

Debra Scott, executive director of the Nevada State Board of Nursing, said the regulatory board has interviewed some of the nurse anesthetists, but the board doesn't have any "hard evidence" and is still waiting to review the records held by police. Scott said the board is also waiting for information regarding which nurse anesthetist reported being told to reuse syringes and other medical equipment.

"None of the nurses has requested a hearing nor their licenses back," Scott said Tuesday. "But we are still getting information and conducting interviews.''

Some former patients have reported not being able to find their records because, for example, they're filed by date instead of patient name, and the patients don't remember the date of their procedure.

In many cases -- but not all -- patients were referred to the clinics by their primary care physician, who would also have patients' records on hand, Walsh noted.

Now the health district is rushing to get a contract before the Southern Nevada District Board of Health at its April 24 meeting so an outside company can begin organizing the records using a uniform system.

"The records all have to be organized, and the successful vendor will be able to fill the requests of people looking for their records," Walsh said.

An initial assessment put the price tag at $491,000 to index and alphabetize the records, although Walsh said the health district would try to negotiate a lower price.

Some of that cost could be covered by a $500,000 fine collected from the clinics' owners Monday by the city of Las Vegas, which held a hearing to revoke the business license of the Shadow Lane office.

The city is also looking at paying for blood tests recommended for the 40,000 former patients included in the health notification.

"Our goal is to ensure that the money is spent to support the victims of the crisis," said Las Vegas City Manager Doug Selby, who's supposed to recommend a spending plan to the council May 6. "To do this, we need to carefully weigh our options for getting the most benefit to those impacted."