In response, the center, at 7135 W. Sahara Ave., provided a 90-page document detailing how the problems would be addressed, promising a commitment to providing quality care.

But when state and federal health officials reinspected the eye and foot surgery center in May, they turned up 32 deficiencies.

Further surgical procedures at the center have now been banned, a result of a sanction letter hand-delivered to the facility Thursday night.

Steve George, a spokesman for the state's Department of Health and Human Services, said the agency is surprised with the inspection results in light of all the recent attention concerning unsafe practices in ambulatory surgery centers.

Health officials are calling the deficiencies at Shadow Mountain serious but say patients were not placed in immediate jeopardy.

"Deficiencies were identified in March; they submitted a plan of correction in April, and they just didn't bother doing anything about making those corrections,'' George said Friday afternoon. "It's just hard to believe.''

Some of the problems noted during the most recent inspection included deficiencies in sterilizing equipment, an inability to document that staff had been immunized against tuberculosis, and a failure to properly store drugs.

The center was fined $9,400 for those infractions along with others. Its physicians will not be allowed to perform procedures until the facility demonstrates "substantial compliance based on a follow-up, unannounced survey,'' according to state health officials.

In addition, the center has 90 days to correct the deficiencies or face the loss of Medicare reimbursements.

The center, located in a medical complex, also must provide evidence that some physicians who contract there have the proper credentials to perform procedures.

In essence, state officials said they took the more serious action because the center wasn't following the plan of correction it sent in after the first inspection.

That plan included documents provided by Dr. David Malitz, the center's governing body chairman. Attempts to reach Malitz for comment Friday were unsuccessful. According to the Nevada State Board of Medical Examiners, Malitz is listed as an ophthalmologist with an out-of-state address.

A center administrator, James Hogan, appeared agitated as he spoke briefly with reporters in a conference room at the medical complex Friday afternoon.

Asked to comment about the inspection reports and the ban, Hogan would only say, "We take this matter very seriously. We plan on rectifying the situation.''

Asked if the center planned to appeal the state's decision or whether physicians were following up with patients, Hogan said, "I'm not at liberty to talk at this time,'' and left the room.

The 32 violations were identified during a May 7-9 inspection by surveyors with the Centers for Medicare and Medicaid Services and Nevada's Bureau of Licensure and Certification.

During the initial inspection, on March 13, surveyors found that the center failed to maintain a governing body and was storing food and drugs in the same refrigerator.

But as with the second inspection, the center's administration could not show proof in March that its staff had been immunized against tuberculosis, a transmittable disease. The center also could not prove that staff knew how to properly sterilize equipment, and staff were not removing from stock drugs that had expired.

In response to the first survey, the center's administrative staff said it was committed to providing the highest quality of clinical care.

"With difficulty in recruiting staff with expertise in documentation and management, documentation has lapsed," it explained. "The Governing Body is committed to ensure corrective action is taken, and the center is in compliance with all state and federal regulations.''

But in the May survey, after interviewing several surgical technicians, inspectors learned that one technician had not gone through orientation on sterilizing instruments and another did not know where to find the manual on sterilization policy and procedures.

Surveyors also noticed outdated medical equipment. On one occasion, they discovered that eye pads that had expired were being applied to patients' eyes.

Additionally, the center's administration could not provide updated credentials for five of the facility's 13 physicians, according to inspection reports. Documentation being sought included updated licenses from the medical board, the Board of Podiatric Medicine and the Nevada State Board of Pharmacy.

On Friday, the center was dark and empty. Paperwork could be seen through a window on top of chairs and couches in the waiting area, and people could be seen working.

No sign was posted outside the door alerting patients of the ban.

Shadow Mountain is the second facility in recent months to be ordered by the state to cease operations.

The other facility, the Lake Tahoe Surgery Center at Round Hill, was issued a "cease patient care" order in mid-April after a second inspection found unsafe infectious-control practices.

The city of Las Vegas and Clark County shut down several facilities in Southern Nevada shortly after the Southern Nevada Health District on Feb. 27 announced that unsafe injection practices at the Endoscopy Center of Southern Nevada may have led to six people contracting hepatitis C.

Most of the facilities closed are affiliates of the Endoscopy Center's 700 Shadow Lane facility and are owned by Dr. Dipak Desai.

The hepatitis C outbreak is the impetus behind the inspections of the state's 50 ambulatory surgery centers. Those initial inspections found that 24 facilities had no deficiencies, 17 had minor deficiencies, and seven had major deficiencies.

In late March, the licensure bureau's acting chief announced that a second wave of "surprise" inspections would occur at about 20 of the ambulatory surgery centers.

Officials with the Centers for Medicare and Medicaid Services have said they are not impressed with the results of the second round of inspections, and there are plans to conduct a third round.

Dan Kulin, a spokesman for Clark County, said late Friday that "we are certainly concerned by this and looking into this matter to determine if any further action is necessary."

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