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Apr. 17, 2008
Copyright © Las Vegas Review-Journal

AMBULATORY SURGERY CENTERS: Mandatory accreditation urged

Hepatitis C cases spur lawmakers to seek changes

By ANNETTE WELLS
REVIEW-JOURNAL
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Accreditation soon might be more than an option for ambulatory surgery centers. It might be a requirement.

Several Nevada lawmakers plan to introduce legislation that would require ambulatory surgery centers to be accredited or inspected by an organization other than the state's licensing bureau.

Still, that might not solve problems with the centers that have come to light following an outbreak of hepatitis C in Southern Nevada.

"The centers that had the most egregious problems, some were accredited and some were not," Mike Willden, director of the state Department of Health and Human Services, said during a meeting Wednesday of the Legislative Commission.

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    • At the very least, Willden said, the state needs to "look at our relationship with the national accrediting organizations."

    Currently, the accreditation of ambulatory surgery centers is voluntary. Of the 50 ambulatory surgery centers in Nevada, 32 are accredited by one of three organizations, the American Association for Accreditation of Ambulatory Surgery Facilities, the Accreditation Association for Ambulatory Health Care, and the Joint Commission.

    Representatives of the organizations will testify on Monday before the Legislative Committee on Health Care. The meeting, which will be held at the Sawyer Building, is dedicated to examining the hepatitis C outbreak.

    Assemblyman Joe Hardy, R-Boulder City, said he, along with state Sen. Joe Heck, R-Henderson, and Assemblywoman Heidi Gansert, R-Reno, plan to introduce legislation that would either require ambulatory surgery centers to be accredited or inspected by an organization other than the state's Bureau of Licensure and Certification.

    "With respect to inspections, the state's licensing bureau has had to work from behind because it is understaffed," Hardy said. "The bottom line is inspections did not take place through no fault of the people, and because of our budget crisis it is probably time to look at something outside the budget.''

    The state's licensing bureau licenses ambulatory surgery centers and, under an agreement with the federal Centers for Medicare and Medicaid Services, conducts inspections and complaint investigations of the facilities.

    Hardy said Tuesday's announcement by the licensing bureau -- ordering the Lake Tahoe Surgery Center at Round Hill cease patient care procedures after an inspection revealed unsafe infection-control practices -- is another reminder that Nevada still faces "challenges" ensuring patients are safe while undergoing procedures at those facilities.

    It was the second inspection of the Northern Nevada facility in a month during which unsafe practices were documented.

    Since learning of unsafe injection practices at two Las Vegas endoscopy centers, Hardy said, the three lawmakers have had ongoing discussions, primarily through e-mail because Heck is in Iraq, about possible legislation.

    Nearly seven weeks ago, 40,000 letters were sent to former patients of the Endoscopy Center of Southern Nevada on Shadow Lane by health care authorities after they discovered unsafe injection practices at the clinic. The patients were urged 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.

    "If I owned an ambulatory surgery center, I would want somebody looking over my shoulder. And, as that owner, I would want to pay for those inspections," Hardy said. "I would want the public to know that my facility has been inspected by an experienced accrediting agency."

    Those inspections are typically done by highly trained medical professionals.

    According to the state Health Division's Web site, the Endoscopy Center of Southern Nevada was not accredited.

    Jeff Pearcy, executive director for the American Association for Accreditation of Ambulatory Surgery Facilities, said his recommendation when he testifies on Monday will be that the state go a step beyond ambulatory surgery centers and require accreditation of physician's offices where outpatient surgical procedures are also taking place.

    "This was a terrible adverse event. Everybody knows that. But Nevada is in a really great position to make strides in patient safety," said Pearcy, whose organization uses surgeons to inspect surgery centers.

    Willden mentioned on Wednesday several other issues related to the hepatitis C outbreak that need to be addressed during the upcoming legislative session, including:

    • Reorganizing the state's Bureau of Licensure and Certification.

    • Setting steeper fines and penalties for ambulatory surgery centers found to have deficiencies.

    • Creating better channels of communication among the state's regulatory agencies.

    Willden said there was a lag getting information to various boards because some require that information be delivered in writing. Some require written notification to be notarized.

    "We need to streamline the notification process, particularly from professional to professional," Willden said. "It needs to be instantaneous."

    Tony Clark, executive director of the state's Board of Medical Examiners, said he supports Willden's efforts to streamline communications among the regulatory boards.

    When the licensing bureau learned of problems at the Lake Tahoe clinic, Clark said, "they notified us immediately."

    He said the medical board has "opened an investigation for a potential investigation," into the Lake Tahoe facility.

    Clark's wording seemed to irritate Sen. Randolph Townsend, R-Reno.

    "Don't look into looking into it," Townsend said. "The thing that irritated me about Southern Nevada is, while everybody was pointing fingers, nobody said, 'Round up all the people we're concerned with and get them tested.' You've got to protect the people you serve, not your licensees. And you got to learn to work together."

    Debra Scott, executive director of the state's nursing board, also testified Wednesday, saying the regulatory board has received more than 30 complaints about the practices of registered nurses related to the outbreak.

    Scott said six nurses have voluntarily relinquished their licenses.

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

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    Bob Cirelli wrote on April 18, 2008 05:09 AM: He said the medical board has "opened an investigation for a potential investigation..". That says it all. "An investigation for an investigation". The bureaucracy the politicians have created is why these problems have been able to exist.


    David Johann wrote on April 17, 2008 08:44 PM: Dear Close Enough,

    I worked in VA Health Care for 7 1/2 years and the reality you describe about government only applies to military contractors. The hugest example I can think of? Mr. Cheney's and W's best friend: Haliburton.

    The rest of government must shrink so corrupt Halliburton can forever suckle off of corporate welfare.


    David Johann wrote on April 17, 2008 08:24 PM: Dear Close Enough,

    I worked in VA Health Care for 7 1/2 years and the reality you describe about government only applies to military contractors. The hugest example I can think of? Dick and W's best friend: Haliburton.

    The rest of government shrinks so corrupt Halliburton can forever suck from the teat of corporate welfare.


    MisterLabusYerMyHero wrote on April 17, 2008 11:49 AM: The more incompetent you are at your government job, the more likely you are to be called a "hero" by nitwits and wingnuts in the Nevada legislature. It's kind of like Nevada exists in a parallel universe where reality is fantasy and fantasy is reality.


    close enough for government work wrote on April 17, 2008 11:37 AM: It's gotta be great to work for the government. You don't bother doing your job for ten years, then when something bad happens, they keep paying your salary but then let you contract with somebody else to do your job for you. Great work if you can get it.


    BarneyFife wrote on April 17, 2008 11:36 AM: Hey Barn.
    Hi Dipak. How was your trip back to Indiana?
    Fabulous Barn. The curried chicken was great. My Mama can chop off a chicken's head blindfolded.
    Geez Dipak. Not even Aunt Bee can do that. But I seen her whack the nuts off a dog that was barkin' too much.
    Oh my gosh Barn. That Aunt Bee sounds a lot like Mama Desai.
    What else did you do when you went back to Indiana, Dipak.
    I hid all of my gold in an underground vault Barney.
    You are really funny Dipak. Hey, how's your colonoscopy place.
    Well Barn, I decided I should sell this place. I will take the proceeds and donate them to the Desai Hepatitis Foundation which is in Bombay. I will be the executive director.
    Gosh Dipak, that is great that you are devoting your life to stamping out hepatitis.
    Yes Barn. I must go. The Foundation needs a private jet, and I am not sure if we require a Gulfstream or a Cessna Citation. I will be looking at both today.
    Geez Dipak, how 'bout just flyin' TWA or one of them big boys.
    Barney, I would, but the Foundation requires a private jet, just in case we are transferring biohazardous material.
    You are so cautious Dipak. Good thing.
    Yes Barn. I am. Before I forget, how is my good friend Ben.
    Dipak, he is great. His new perm looks wonderful and he just got his belly waxed. You should see the pumps he wears. All the ladies in town are jealous.
    I have a gift for him Barn. I have 100 boxes of Ho-Hos that are for him.
    If I see him Dipak, I will let him know.
    God bless you Barn, just be quiet about the jet.


    Kubrick wrote on April 17, 2008 10:37 AM: Perhaps a few people showing up shot in the face as a gentle reminder to ALL who would be wont to deceive...


    MM wrote on April 17, 2008 08:08 AM: "Magical Regulations" and "David Johann": Thank you, I needed a good chuckle this morning (not that I think there is anything funny whatsoever about the whole Desai scandal).


    David Johann wrote on April 17, 2008 07:16 AM: I am creating a video game called "Vegas Endoscopy."

    The game starts with a waiting room full of patients, and while the timer ticks, the player's job is corral patients through the process of anesthesia, colonoscopy and recovery, before shoving them out the door. Each patient processed through results in a higher score, recorded at the top of the screen in dollars.

    It's a race against the clock. Dr. Desai oversees the procedure rooms, wearing a scowl, and in a heavy Indian accent periodically announces: "You must work FASTER, you must work FASTER!"

    Reusing anesthesia vials and extra-fast colonoscopies result in bonus points, again, recorded in dollars at the top of the screen.

    In each subsequent stage of the game, patients present in the waiting room at a faster and faster rate until the player is eventually overwhelmed by the pace. When the waiting room gets too full and the line starts heading out the door, Dr. Desai appears, wearing a lab coat, and in a thick, Indian accent says: "You are too slow. You are fired! Game Over!"

    With the play now ended, the final screen depicts Dr. Desai jumping into his Bentley and driving away.


    liber wrote on April 17, 2008 07:04 AM: Accreditation-I think we all just assumed they were accredited-the other problem is with the inspectors themselves not doing there jobs-
    also quit punishing whistle blowers that's why they don't come forward is because they usually get fired and made to look like the bad guy


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