That exam must be conducted by an investigative committee-appointed physician before March 30. On that date, another hearing is scheduled to determine if Desai can proceed on to a pre-hearing and eventually a disciplinary hearing, according to hearing officer Patrick Dolan's report, which was released Friday.

The pre-hearing was initially scheduled for March 30.

Dolan's decision followed a Tuesday status hearing at which Desai's medical records indicated his progress "in recovering from his acute stroke had not significantly improved.''

Larry Matheis, executive director of the Nevada State Medical Association, reacted to news of Dolan's order.

"I think many physicians, and certainly the public, feel some frustration at the length of time it takes this process to work,'' he said. "While there's always a balance between due process there is a level of trust that can't be restored until there's closure.''

Nia Killebrew, an attorney representing 22 former patients who believe their procedures at Desai's clinics led to positive hepatitis C tests, said she understands the predicament the medical board is in when weighing the constitutional rights of an individual. She said her clients' primary focus is on their own health.

"Some of my clients have lost their jobs and are uninsured. They don't have access to health care. They can't afford the co-pays for the drugs,'' she said. "I don't get inquiries about the medical process. My clients do want justice and accountability for what's happened but I think they know the (medical) board is going to do what they need to do.

"The wheels of justice are slow,'' Killebrew said.

Dolan's order comes nearly a year after the Southern Nevada Health District sent notification to more than 50,000 former patients of the Endoscopy Center of Southern Nevada urging them to be tested for hepatitis and HIV because of unsafe injection practices spanning a four-year period at the clinic.

Desai and two other physicians have been hit with medical malpractice complaints relating to the care they provided patients.

While the disciplinary hearings for Drs. Eladio Carrera and Clifford Carrol are scheduled for later this summer, scheduling Desai's hearing hinges on his ability to participate in the preparation and presentation of his defense.

Desai's stroke allegedly left him unable to identify a wristwatch.

A stroke occurs when a blood vessel bringing oxygen and blood to the brain ruptures or gets blocked so brain cells don't get the flow of blow they need. Paralysis can occur.

Based on the interim medical records received from Desai's medical care providers, Desai's "ability ... to assist in the preparation and presentation of his response to the pending licensing questions is still in reasonable doubt,'' Dolan's report says.

Deputy District Attorney Scott Mitchell told the Review-Journal last month that a medical expert who examined the 58-year-old Desai's records for law enforcement did not find evidence of residual effects from the stroke that would make the doctor unable to participate in his defense.

"When it comes to the wristwatch, I'd say that he might not have been able to recognize it one minute after the stroke; but an hour later, that would have been different,'' Mitchell told the Review-Journal.

Louis Ling, executive director of the medical board, said he did not know if the medical records law enforcement reviewed were the same as those seen by the board's investigative committee.

"I'm not going to assume they are the same records we have,'' Ling said. "I can only say what we have; they may or may not be the same as what the district attorney is referring to.''

Ling said there are no rules regarding when or if an independent medical exam will be ordered. He said it is up to the discretion of the hearing officer.

The complaints filed against Desai, Carrol and Carrera allege they placed patients' lives in jeopardy, cast the medical profession in disrepute, put financial gain above patients and failed to use "reasonable care, skill or knowledge ordinarily used under similar circumstances."

The complaints allege that Desai and Carrera directly worked on three patients who were infected with hepatitis C.

The allegations concerning Carrol relate to care he provided patients, one of whom has been identified as the source, or "index," patient whose disease officials say was transmitted to seven others on Sept. 21, 2007.

Desai and Carrera have both had their licenses suspended pending the outcome of disciplinary hearings; Carrol is still allowed to practice medicine in Nevada.

Las Vegas police, the FBI, the attorney general's office and the district attorney's office also have investigations open.

The Assembly Health and Human Services and the Senate Health and Education committees will hold a hearing today for residents affected by the hepatitis C outbreak. Legislative bills aimed at preventing outbreaks and regulating ambulatory surgery centers will be discussed.

The special meeting begins at 8 a.m. in room 4401 of the Sawyer Building.

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