Media Library

Health crisis spurs $26 million request

By STEVE TETREAULT STEPHENS WASHINGTON BUREAU

WASHINGTON -- Congress could be asked to set aside $26 million for Southern Nevada and federal authorities responding to the hepatitis outbreak in Las Vegas, Capitol Hill officials said.

The funding would offset costs incurred by the Southern Nevada Health District in handling issues stemming from the discovery of unsafe practices at the Endoscopy Center of Southern Nevada.

Also, the money would expand efforts by the Centers for Disease Control and Prevention to develop safeguards against the unsafe use of syringes and medications documented at the Las Vegas ambulatory care center and in earlier disease outbreaks in other parts of the country.

Six patients who contracted hepatitis C, a serious blood disorder, have been linked to the Shadow Lane endoscopy center, sparking an examination of procedures at such clinics throughout Nevada.

Notices were mailed to 40,000 patients of the Shadow Lane center. They were advised to get tested for hepatitis and HIV, the virus that causes AIDS.

Federal and Nevada health officials sent spending plans to Sen. Harry Reid, D-Nev., who is considering them for legislation, spokesman Jon Summers said.

Reid and Sen. John Ensign, R-Nev., will try to add the money to a supplemental appropriations bill Congress will take up in the next few weeks to pay for the wars in Iraq and Afghanistan, aides said.

"When you talk about 40,000 people who are affected and now we are learning there are more, there are a lot of unexpected costs that come along with that," Summers said Tuesday.

Reid, the Senate majority leader, "has the ability to leverage his leadership position to bring some money back to the state and not only offset some of the costs but also use some of the money to offset future cases in Nevada and across the country," Summers said.

Michael Walsh, director of administration for the Southern Nevada Health District, said a $5.2 million package was put together in response to a Reid overture.

The district has requested $3 million for blood tests on 15,000 uninsured and underinsured patients and $1.3 million for follow-up testing on persons found positive for HIV or hepatitis strains.

The request also includes $491,000 to organize medical records seized by Las Vegas police from endoscopy and gastroenterology clinics that have been closed and to make them available to patients.

Another $140,000 is sought for hepatitis A and B vaccines recommended for patients testing positive for hepatitis C, Walsh said.

The funds would continue operation of the district's telephone help line, Walsh said.

"The big lump is the testing and the follow-up testing," Walsh said. "The rest of the things we are prepared to try to struggle through."

Reid said the CDC requested money "for things they want to do nationally and Nevada-specific." Summers confirmed the agency's plan totaled $21 million.

The CDC is seeking funding for more genetic mapping of unexplained cases of hepatitis, Summers said. The aim would be to determine whether the infections originated at problem clinics or were present earlier.

The agency's request includes awareness campaigns, with pilot programs to be rolled out in Nevada.

The CDC proposed to underwrite research into infection controls and safer medication packaging, perhaps including syringes that would become disabled after single use.

Records Seized in Las Vegas Hepatitis C Scare a Mess

Patients of six local clinics under investigation in the hepatitis C scare are raising new concerns. After two weeks, they say they have yet to get back their medical records seized by Metro Police.

It wasn't easy for Pahrump resident Terry Sheets to make it down to Metro's Southwest Area Command just to fill out a request form to get her medical records back, but she needs another endocscopy.

"I do have to have one because I'm overdue," she said.

She'll have to wait some more. Metro told her the wait would be several weeks.

"It's better than not getting them. I realize it's going to take a little while but we just have to be patient," she said.

Metro seized more than 2,000 boxes of files from six gastroenterology clinics as part of their criminal investigation. Six acute cases of hepatitis C are believed to be linked to unsafe medical practices at one of these clinics, but Metro says they need help because the files are a mess.

They say the clinics organization of records has made it difficult to pinpoint any single file. In some cases, they are arranged by doctor's name, by procedure date or even the patient's name.

County leaders are working to bring in a third party to organize the files. The health district says three bids have been placed for the job, a job that will cost close to $500,000. Sheets says it's worth every penny.

"I do believe that would be better for everybody's sanity, for feeling of security and feeling that they are doing something to help us, because so many people are feeling so betrayed," she said.

In the meantime, Sheets found another way, "If you have a referring physician that referred you, go back there because they do have medical records and that's how I found mine."

The health district says they hope to have a contract for a third party to organize the records ready for approval by April 24, 2008.

Las Vegas to Subpoena Endoscopy Center of Southern Nevada Doctors

Tuesday, March 25th, 2008

Doctors from the Endoscopy Center of Southern Nevada may finally be forced to break their silence - at least if the Mayor of Las Vegas has his way. The unsanitary practices employed by practitioners at the Endoscopy Center of Southern Nevada are at the center of a hepatitis C scare that could affect thousands of people. Now, Mayor Oscar Goodman says that the doctors who own the clinic will be subpoenaed to testify at a hearing at which the city will consider rescinding the Endoscopy Center’s business license.

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.

According to the Las Vegas Sun, Mayor Goodman said the city is in the process of subpoenaing the physicians who own the practice — majority owner Dr. Dipak Desai, Dr. Eladio Carrera, Dr. Clifford Carrol and Dr. Vishvinder Sharma. Ten other physicians worked at the clinics. None of the owners of the clinic has made any public statements since the scandal broke. According to the Las Vegas Sun, Desai has voluntarily agreed to stop practicing medicine during the Nevada State Board of Medical Examiners’ investigation of his conduct. The others may still be practicing at other affiliated clinics or in local hospital.

To keep their city business license, the owners of the Endoscopy Center of Southern Nevada will need to make their case at a public hearing April 7 in the Las Vegas City Council chambers. The city had suspended the clinic’s business license on February 29, as well as that of its related practice, the Gastroenterology Center of Nevada. The city has alleged that Desai ordered nurses and others at the clinic to reuse syringes in order to save money.

Angry Public, Hopeful Leaders

By Marshall Allen, Las Vegas Sun Tue, Mar 25, 2008 (2 a.m.)

When nurses at a Las Vegas clinic failed to follow basic disease prevention methods they did more than cause the largest hepatitis C scare in the nation.

The nurses at the Endoscopy Center of Southern Nevada — and the doctor who allegedly told them to cut corners to save money — shattered the already tenuous trust patients have in Nevada’s health care system.

The violation of public trust was exacerbated by the failures of state oversight agencies that could have — should have, many argue — caught it.

The crisis has gained steam since it was announced Feb. 27, metastasizing like a community cancer. Now the state faces a defining moment that will determine many future aspects of health care oversight and regulation.

The public, reeling from the revelations, showed up in force at a meeting Monday before the state’s Legislative Committee on Health Care. About 200 people attended.

The public anger was palpable when Reuel Williams, who had undergone a colonoscopy at the Endoscopy Center of Southern Nevada, called on the doctors to be “criminally prosecuted and their assets seized.”

The crowd broke out in applause.

And when Loretta Conner, a retired nurse, called for the doctors’ deportation, there were cries of “Yes” and “Amen.”

While the credibility of the health care system is at stake, the crisis also creates opportunities for long-needed reforms.

“This is a defining moment in the sense it has captured the attention of the people,” said Dr. Maurizio Trevisan, executive vice chancellor and chief executive of the University of Nevada Health Sciences System. “Our state is in need of strong leadership in establishing a strong health care system.”

He pointed to the lack of inspections by the state as an area that needs to be addressed, although he cautioned against overregulation. He also said strengthening academic medical resources would help.

“Strong academic enterprises tend to serve as an impetus to raise the bar for the whole medical community,” he said. “It has been very challenging in Nevada, because of the way we are traditionally underfunded.”

Trevisan acknowledged that with the state facing huge financial shortfalls, it was not the best time to be seeking more money. But he said the health crisis has offered the chance for substantive debate.

“I hope with the attention placed on this issue, we can actually broaden the scope of the conversation,” he said. “I hope we can ask ourselves what we want to be as a state 15 or 20 years from now.”

Assembly Speaker Barbara Buckley said she has never seen a comparable health care crisis in Nevada. The scope and magnitude of 40,000 people being told to be tested for hepatitis B and C and HIV, combined with the disregard for standard medical practices, mean “everybody’s talking about it,” she said.

Buckley said the first message is to the medical community: “You can’t cut corners and put patients’ lives at risk.”

Second, Buckley said state legislators need to do what is necessary to ensure an aggressive response when there’s a similar breach of trust. When an agency such as the Nevada State Board of Medical Examiners fails to use its discretion in the public’s favor, legislators will tighten the statutes, she said.

For example, in 2005 the medical board decided to stop posting doctors’ malpractice settlements on its Web site. Two weeks ago Buckley sent the medical board a letter asking it to post the information. If it doesn’t, future legislation will require it, she said.

Dr. Jim Christensen, a Las Vegas allergist who sits on the board of the Southern Nevada Health District, said legislators need to give broader power to the medical board. It is currently hamstrung when it comes to meting out discipline by laws that make taking action a matter of interpretation of whether the public is in immediate danger, he said. When a doctor’s livelihood and reputation are at stake, it’s difficult to summarily suspend his license, he said.

In contrast, whenever a police officer is involved in a shooting he is immediately placed on paid administrative leave while investigators gather evidence, he said. A similar legislative mandate would help the medical board in situations like the one with the Endoscopy Center.

“It’s a timeout, it’s a pause, and it allows people the time to gather facts so they can make an objective and informed decision,” Christensen said.

Holly Sweetin, a registered nurse who works at University Medical Center and also operates a patient advocacy business, said the crisis can bring reform on many levels. Legislators could add more laymen to the medical board, which would help avoid doctors’ conflicts of interest when policing their peers, she said. And they could create oversight boards for local hospitals that would investigate sentinel events — deaths directly caused by failure to follow hospital procedures.

Doctors, she said, can be reminded that they need to be more concerned with patient care, and nurses, whom she called the “ultimate patient advocates,” must stand up for what’s right. When something unethical is taking place, nurses must realize their “license is on the line, and the patient’s life is on the line and you have to stop.”

And patients must realize they need to ask doctors questions, she said.

“It’s their body,” Sweetin said. “They have the right to ask questions of any doctor and any medical personnel who may be performing a procedure or giving them medication.”

Bobbette Bond, government and community affairs coordinator of the Culinary Health Fund, said this may be a crucial moment for Nevada health care, but many Las Vegas insiders were not surprised by what happened. People have long known that health care in Nevada is at the “bottom of the heap” nationally, she said.

Health care is suffering throughout the country, Bond said, but Nevada is much worse comparatively in terms of transparency, public reporting, oversight and sunshine on the regulatory and licensing boards, she said.

People know reform is necessary, “but you can’t get good legislation passed without a fight, or good strong regulations passed that are effective, and you can’t get the financial resources devoted to move our health care indices,” she said.

The public will play an integral role in moving forward, she said.

“People have to push back more and expect more,” she said.

Clinic Doctors Finally to Talk — Under Oath

By Marshall Allen, Las Vegas Sun Tue, Mar 25, 2008 (2 a.m.)

The public may finally get answers — from doctors under oath — about the dangerous injection practices that led to the nation’s largest hepatitis C scare, Las Vegas Mayor Oscar Goodman said Monday.

To keep their city business license, the owners of the Endoscopy Center of Southern Nevada will need to make their case at a public hearing April 7 in the Las Vegas City Council chambers.

Goodman said the city is in the process of subpoenaing the physicians who own the practice — majority owner Dr. Dipak Desai, Dr. Eladio Carrera, Dr. Clifford Carrol and Dr. Vishvinder Sharma. Ten other physicians worked at the clinics.

“I’ll be fair, but I’ll be very stern,” said Goodman, who has taken the lead among public agencies and officials in calling for accountability of the clinic’s owners. “I just feel that health care has to be scrupulously examined by the regulatory bodies.”

If they appear, it will be the first time the center’s owners answer questions in public about why the clinic’s nurses reused syringes and single-dose medicine vials.

The hazardous practices were announced Feb. 27 by the Southern Nevada Health District, which discovered them after six people contracted hepatitis C at the clinic. That prompted health officials to urge 40,000 clinic patients to be tested for hepatitis B, hepatitis C and HIV.

Goodman ordered immediate action and on Feb. 29 the city suspended the clinic’s license, as well as that of its related practice, the Gastroenterology Center of Nevada.

Desai has voluntarily agreed to stop practicing medicine during the Nevada State Board of Medical Examiners’ investigation of his conduct. The others may still be practicing at other affiliated clinics or in local hospitals.

Jim DiFiore, manager of the city’s business services division, said in his letter suspending the business license that the nurses knew that reusing the syringes and vials was dangerous, but that they were ordered to do so by administrators, principally Desai, to save money.

“He had willfully chosen, until he was caught, to mortally hazard his patients for profit,” DiFiore wrote of Desai.

Desai has not returned repeated calls from the Sun since the controversy broke.

When Goodman contacted other agencies he was told they were unable to take immediate action to shut down the clinic.

For example, the state Licensure and Certification Bureau, which regulates ambulatory surgical centers such as the Endoscopy Center, generally favors keeping a facility open if it corrects problems, officials have said. The Health District is concerned with infectious disease outbreaks, not with closing clinics that have corrected flawed practices. And officials from the Medical Examiners Board, widely criticized for not suspending Desai’s license, said they do not have the evidence for an immediate suspension.

Other agencies may take months to conclude their investigations, but Goodman said he’s never heard a greater public outcry that demands a quick answer to questions.

“We’re trying to lead by example on this one,” Goodman said.

Amid Hepatitis Scares in 4 states, D.C. Worries About Doctor, Clinic Liability

By Lisa Mascaro Sat, Apr 5, 2008 (2 a.m.)

Washington — Lawmakers from communities nationwide hit by hepatitis C scares similar to that in Las Vegas are calling for congressional investigations, but they may face stiff resistance from those concerned about exposing health care facilities to liability.

Nevada Democratic Rep. Shelley Berkley and colleagues from New York, Nebraska and Michigan are pushing for Congress to become involved. In all four states, thousands of residents may have been exposed to potentially life-threatening disease because of improper medical procedures at outpatient clinics.

Dr. Julie Gerberding, director of the Centers for Disease Control and Prevention, has said Nevada, where nurses improperly reused syringes and potentially exposed 40,000 patients to hepatitis and HIV, may be the “tip of the iceberg” nationwide.

Yet calls for a congressional investigation apparently are bumping up against concerns by lawmakers who fear health care practitioners could face costly lawsuits.

In Las Vegas, trial lawyers are running ads soliciting clients who received care at the Endoscopy Center of Southern Nevada, where 40,000 patients were potentially exposed.

At a meeting of Nevada lawmakers last week, Republican Sen. John Ensign said he faced resistance to his request for congressional involvement.

Ensign had consulted with a colleague, conservative Republican Sen. Tom Coburn of Oklahoma, a physician. Ensign suggested earlier that Coburn might be in a position to convene a hearing as the ranking member of a government oversight committee in the Senate.

Coburn, in an interview with the Sun, said he didn’t believe the outbreaks in Nevada and elsewhere were broad enough to require federal intervention.

Coburn explained that his state experienced a similar outbreak and “it almost bankrupted our medical liability — doctors’, physicians’.”

The medical professionals involved “need to go to jail ... because they obviously violated all medical protocol,” Coburn said. “But I don’t think we need a hearing because not very many people are that stupid. I think it raises it to an issue where it scares people rather than fixing it.”

Coburn added the issue should be left to the states because they license medical professionals and facilities.

Berkley and four other House lawmakers, Democrats and Republicans, have written to the health subcommittee of the House Energy and Commerce Committee seeking hearings on the subject. Those four are New York Democrats Anthony Weiner and Edolphus Towns and Nebraska Republicans Jeff Fortenberry and Lee Terry. Michigan Republican Rep. Vernon Ehlers has signed on to a letter Fortenberry is circulating among lawmakers to gather more support for a hearing.

“Unfortunately, these are not isolated incidents,” Towns and Terry wrote to the committee. “In the last year alone, an estimated 70,000 Americans will or have received notification from state or county health officials urging them to be tested for HCV, HBV or HIV due to improper infection control practices at outpatient facilities,” they wrote, using medical shorthand for strains of hepatitis and the virus that causes AIDS.

“Tragic events in Nebraska, Las Vegas, New York and Michigan underscore the importance of investigating the current practices and procedures.”

New Jersey Democratic Rep. Frank Pallone Jr., chairman of the health subcommittee, said the agenda is filled through April, but “Shelley has pointed out very dramatically that this is an issue that needs to be addressed.” He said it is under consideration.

On a parallel track, California Democratic Rep. Henry Waxman’s committee on government oversight is expected to hold a hearing this month on a forthcoming General Accountability Office report on hospital-acquired illnesses that could serve as a venue for questions about the Nevada problems.

The committee is considering a separate hearing on the hepatitis C outbreaks, and the accountability office has received numerous requests which are under consideration, for an investigative report.

Ehlers, the Michigan Republican, said he had little concern about pushback from those trying to shield the clinics from liability and expects a hearing to be held. “Trial lawyers are everywhere. I’m sure they know about this already.”

Desai expected to skip hearing

By Joe Schoenmann Mon, Apr 7, 2008 (2 a.m.)

Las Vegas city marshals will be on hand in the event emotions become too heated. Members of the City Council will make a special appearance. And a large crowd is expected to pass through a metal detector to get into council chambers this afternoon.

Many will want just to catch a glimpse of Dr. Dipak Desai, who is at the center of the scare prompted by health officials’ finding that unsafe medical practices at his Endoscopy Center of Southern Nevada caused the infection of six people with hepatitis C.

In all likelihood, however, they will have to continue waiting for that glimpse.

Although City Attorney Brad Jerbic has issued 15 administrative subpoenas to Desai and other clinic officials, few if any of the major figures are expected to attend the 1 p.m. hearing.

And although there’s nothing the city can do about that — ignoring a city subpoena, unlike one in a court proceeding, does not carry the threat of a contempt citation — their nonattendance would not prevent the city from taking action.

“If they don’t show, we will proceed with the witnesses who do show, then make a decision about whether to take it to District Court,” Jerbic said. “We might not need all those witnesses to make our case.”

The discovery of the six hepatitis cases at the Endoscopy Center led health officials to notify 40,000 clinic patients to be tested for hepatitis B, hepatitis C and HIV.

It also prompted Las Vegas Mayor Oscar Goodman last month to call for a hearing seeking disciplinary action against the endoscopy clinic, of which Desai is majority owner, and another medical business Desai founded, the Gastroenterology Center of Nevada.

“We are locked and loaded, and ready to go,” Jerbic said.

But if none of the targets shows, there’s no immediate penalty.

City code states that failing to appear before such a hearing “shall constitute an admission of all matters and facts contained in the complaint. In such cases the City Council may take action based upon such admission or upon any other evidence ... without further notices whatever to the respondent.”

In the case of the two clinics, the city could permanently revoke their business licenses after today’s hearing. That, though, could be largely superfluous.

The now-closed Endoscopy Center has been so tainted by the hepatitis scare, one attorney close to the case said, that its owners are unlikely to attempt to reopen it. Desai has been dubbed “Dr. Greed” by The Times of India, a moniker stemming from the re-use of syringes and single-dose medication vials in an effort to boost profits.

Principals in the case would appear to have little to gain from showing up at today’s hearing because their answers to questions could provide ammunition to numerous lawyers lined up to file class action lawsuits against the doctors and their clinics.

But the city has options. If no one shows up to testify, the city could take the matter before a District Court judge to ask that the court put its weight behind the subpoenas.

Jerbic admits he has heard the speculation that there may be more people wanting to ask questions than those providing answers at the hearing.

Goodman, meanwhile, refused to discuss the matter Friday, saying he wanted to wait for the hearing to make his comments.

The question is, who will hear them?

Hundreds demand action from state legislators over hepatitis scare

March 25, 2008 11:42 AM CDT

Hundreds of people packed into a Las Vegas hearing room Monday night to share their concerns over the Hepatitis C scare in Southern Nevada. More than a dozen others joined the meeting via teleconference from Carson City.

Members of the public addressed the legislative committee on health care and Governor Jim Gibbons who joined the meeting on the phone from Carson City. Many demanded action, with some of them requesting that the doctors and nurses accused in the health scare be arrested and others asking for the Governor to be recalled.

Many of those who spoke said they were treated at one of the 50 surgical centers now under investigation. Some say they are still waiting for test results to see if they've contracted Hepatitis C or HIV. Others say they already know their fate.

"Today, I just got the results for me and my wife and one of us is positive," one speaker said.

The speakers questioned the actions of the doctors and nurses who put their health in jeopardy.

One person said, "These guys have committed crimes against 40,000 people that we know of."

Another said "We're supposed to look up to these people and they're ripping us off."

The legislative committee says it will consider all the comments made at Monday's public hearing. They will decide whether to mandate tougher and more frequent inspections of Nevada's medical centers. The committee will hold its next meeting in April.

Congress Should Find Out Why Clinics Have Ignored Warnings About Syringe Reuse

Tue, Apr 8, 2008 (2:07 a.m.)

What is particularly maddening about the ongoing hepatitis scare in Nevada is that transmission of the disease through unsafe injection practices was well-known in medical circles.

For example, in its December 2002 newsletter, the American Society of Anesthesiologists reported on a hepatitis C outbreak in Norman, Okla. The reuse of syringes at a hospital was identified as a source of the outbreak.

“It is entirely unacceptable and extremely dangerous to reuse ... syringes on multiple patients,” a medical doctor wrote in the newsletter.

The doctor cited a 1990 study confirming the risk of contamination from reused syringes. She also cited a 1995 survey, writing: “Alarmingly, 39 percent of anesthesiologists reported reusing syringes from one patient to the other.”

In 2003, after investigating the Norman outbreak as well as outbreaks in New York and Nebraska, the Centers for Disease Control and Prevention published a paper warning of the cause “unsafe injection practices, primarily reuse of syringes.”

Yet local health officials announced Feb. 27 that the Endoscopy Center of Southern Nevada had been routinely reusing syringes, and that six cases of hepatitis C had been traced to the center. Forty-thousand former patients of the center, dating to March 2004, were notified that they might have been exposed to hepatitis B, hepatitis C and HIV.

Shortly after the news of the outbreak broke here, CDC Director Julie Gerberding said, “Our concern is that this could represent the tip of the iceberg.” Shutting down the Endoscopy Center the city of Las Vegas suspended its business license Feb. 29 and revoked it Monday was an appropriate local action. The city also fined the center $500,000.

What is urgently needed now is national action, given that doctors and nurses have shown a pattern of ignoring stark warnings.

Rep. Shelley Berkley, D-Nev., and representatives from three other states that have had outbreaks are calling upon a House subcommittee on health to hold hearings. We believe congressional hearings would help educate an unwary public and help reveal the national scope of such unsafe medical practices.

Hepatitis Scare May be Much More Widespread Than Thought

Aaron Drawhorn, Reporter April 2, 2008 11:53 PM CDT

Tens of thousands of valley residents are being tested for hepatitis and HIV after being treated at a local clinic, but they may just be the tip of the iceberg. Patients who visited the Endoscopy Center of Southern Nevada between 2004 and 2008 were told to be tested, but the clinic has been open since 2000, leaving four more years in question.

Some patients from before 2004 are now coming forward saying they are positive for hepatitis C and they want to know why the health district isn't warning others.

Larry Estrada used to be perfectly healthy. But he's been battling hepatitis C for nearly five years and has gotten grim news from the doctor, "This was in November. He said, at most, I had a year."

Estrada believes he was infected at the Endoscopy Center in 2003, but the health district has only identified dangerous medical practices there since March 2004.

Another seriously ill patient who visited the clinic in 2002 asked to not be identified.

"I was down to 87 pounds and two weeks to live and it was all due to hepatitis C," she said. "Fortunately, I did receive a liver and kidney transplant in time and here I am today, five years later. But it's been a long five years."

According to a health district memo, the clinic started reusing syringes after a remodeling in March of 2004.

"We don't have any indication that they were conducting those practices before that time," said Jennifer Sizemore with the Southern Nevada Health District. "We can only act on the information that we have available to us."

Attorney Ed Bernstein believes the health district's dates are wrong.

"That's not to imply to any of your viewers that if you had a colonoscopy or endoscopy prior to 2004 that you're safe," he said.

Bradley Mainor represents Estrada and feels they still have a case against the clinic, even though it was one year past the statute of limitations.

"Most people don't understand that there's an exception, and the exception is when people conceal information to the detriment of the community, and we believe that's happened here," he said.

Mainor believes doctors concealed information that they committed malpractice.

The health district has asked for patient records before 2004 but the clinic has not turned that over. At this point, they have not interviewed staff members before 2004 or reviewed any records before 2004.