While acknowledging the seriousness of the crisis that has caused concern among thousands of Nevadans who have been told to get tested for blood-borne diseases, health officials also said taking 14 gastroenterologists out of the mix exacerbates a shortage of these physicians.

Dr. Joe Hardy estimated at the district's Board of Health meeting Thursday that there are 32 gastrointestinal physicians in Southern Nevada, including the 14 who worked within the Gastroenterology Center group.

Though the 14 represent 44 percent of the area's gastroenterologists, their practice served a majority of patients who had gastrointestinal problems, Hardy said.

Dr. John Gray, a Reno gastroenterologist, said in a telephone interview Thursday: "Somehow, there needs to be some solution because there's already a shortage of GI doctors in Las Vegas. Without the 14 physicians, it's going to be a real difficult time for patients in Las Vegas."

Gray said his practice was contacted by a Sierra Health executive this week about providing medical services in Las Vegas. In Southern Nevada, other doctors have received similar inquiries.

According to the American Medical Association, Nevada has 2.5 gastroenterologists per 100,000 residents, well below the country's ratio of four gastroenterologists per 100,000.

Sierra Health insures roughly 650,000 Nevadans between its Health Plan of Nevada, Senior Dimensions and Sierra Health and Life plans. Anthem Blue Cross Blue Shield insures 317,000 Nevadans. Cigna HealthCare insures approximately 100,000.

Of seven endoscopy clinics alleged to have engaged in risky medical practices, three held contracts with Anthem: the Endoscopy Center of Southern Nevada and the Gastroenterology Center of Nevada, both at 700 Shadow Lane, and the Desert Shadow Endoscopy Center at 4275 S. Burnham Ave.

Those contracts have been canceled, said Sally Vogler, a spokeswoman for Anthem.

"The endoscopy centers received credentials under a distinct tax ID number, therefore when the individual clinic contracts were terminated, all providers billing under the same tax ID number were terminated," she said.

That means, if those physicians treat a patient insured by Anthem, they will not receive reimbursement.

Vogler said late Thursday that the terminated contract means members could not see physicians within this group under any circumstance. However, because of the way groups are structured, it's not always clear to the insurer the current status of a physician within the group and where the physician is currently practicing.

Amanda Penn, a spokeswoman for Sierra Health, said the insurance provider is trying to answer this very question.

Leigh Woodward, a spokeswoman for Cigna HealthCare Arizona-Nevada, said the company issued termination letters to the Gastroenterology Center of Nevada on March 3.

She said Cigna members have access to ambulatory surgery centers and roughly 30 gastroenterologists within 25 miles of the terminated endoscopy centers.

"We are aware that some gastroenterologists (not affected by the terminations) in Las Vegas are not accepting any new patients and that there is a capacity issue," she said.

Though the majority of the physicians have privileges at most Southern Nevada hospitals, it is unclear if they are still practicing medicine. None have lost their medical licenses.

Dr. Dipak Desai, majority owner of the Endoscopy Center of Southern Nevada, has voluntarily agreed to quit practicing medicine. The other physicians within his group have been asked by Tony Clark, executive director of the state Board of Medical Examiners, to do the same. They have not agreed to do so.

Dr. Julian Lopez, a Las Vegas gastroenterologist not affiliated with the Gastroenterology Center of Nevada, said he understands there will be a shortage of these specialists.

Nevertheless, Lopez thinks that the remaining physicians will be able to fill the void and that there is an opportunity for other gastroenterologists to negotiate contracts with the major insurance providers.

"It's not like the remaining doctors are going to be overwhelmed because the Gastroenterology Center isn't available to them. They had a monopoly. They kept everybody small," he said. "I have no doubt my practice can handle more patients."

Lopez said his office has already seen new patients in recent weeks. Within the past week, he said, he has been approached by the state's largest insurance provider about a contract.

"This crisis highlights the dangers of having exclusive provider lists," he said. "It should really be up to the patients to decide who they want to see."

Penn said Sierra Health members have access to Southwest Medical Associates' Gastroenterology Department, which has four gastroenterologists. Southwest Medical Associates is a wholly owned subsidiary of Sierra Health.

She said Sierra Health's staff is diligently prioritizing the demands of its members to provide immediate access to gastrointestinal services to those affected by the hepatitis C outbreak.

Penn said the insurance provider doesn't know the exact number of members who received care at the Endoscopy Center of Southern Nevada. However, the company did send a second notification to its members to reiterate the health district's urging to seek testing for hepatitis and HIV, the virus that causes AIDS.

Neither Anthem nor Cigna could say how many members were affected by the crisis or had tested positive for hepatitis C.

Contact reporter Annette Wells at awells@reviewjournal.com or (702) 383-0283.