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Mar. 09, 2009
Copyright © Las Vegas Review-Journal

Deficiencies found at Nevada ambulatory surgical centers

By PAUL HARASIM
LAS VEGAS REVIEW-JOURNAL
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A state health division investigation undertaken after tens of thousands of patients were advised last year to be tested for possible exposure to hepatitis C at two Las Vegas ambulatory surgical centers found that more than half of 49 other such facilities in Nevada had “infection control type deficiencies.”

According to a draft report issued Friday on the state’s ambulatory surgical centers, inappropriate use of single-use items such as syringes amounted to nearly a third of the infection control deficiencies at 25 of the centers in fiscal year 2008, while sterilization and disinfection issues accounted for almost half.

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    • “It concerns me when what is on the books (regulations) aren’t followed,” said Marla McDade Williams, chief of the state’s bureau of health care quality and compliance.

    While the report doesn’t spell out which surgical centers not connected to the hepatitis outbreak investigation had deficiencies, Nevada Health Division spokeswoman Martha Framsted said that by summer, all surveys done by the division will be posted on a Web site for the public to examine.

    What will help ensure that regulations are followed in the future is more frequent inspections by staff surveyors, Williams said. Eleven new surveyors have been requested by the division, Williams noted, which would allow all 1,100 state-licensed facilities — including nursing homes and group homes — to be inspected every 18 months. She now has 34 surveyors and 14 supervisors who do inspections.

    Currently, guidelines set down by the federal Centers for Medicare and Medicaid allow for seven years to lapse between surveys of ambulatory surgical centers, she said.

    “We want them (ambulatory surgical centers) to know far more frequently that there are state standards that they must adhere to,” Williams said.

    In February of last year health officials revealed that authorities investigating a cluster of hepatitis C cases had observed nurses at the Endoscopy Center’s Shadow Lane clinic reusing syringes in a manner that contaminated vials of medication and, they believe, infected patients.

    A total of nine cases have been linked to two clinics owned by Dr. Dipak Desai, and health officials have listed an additional 105 cases as “possibly related.”

    As a result of the outbreak, more than 50,000 people were told to get tested for hepatitis and HIV, the virus that causes AIDS.

    The public health crisis has already spawned several bills by Nevada legislators, including Senate Bill 70 and Assembly Bill 123, which call for annual inspections of ambulatory surgery centers and certain physician offices where surgical procedures require conscious, general and deep levels of sedation.

    Williams said that if the Legislature believes an annual, rather than every 18-month, inspection of ambulatory surgical centers should be done, she isn’t sure what number of additional surveyors will be needed on top of what she has already asked for.

    She did say, however, that since her agency is “fee funded,” the money for more surveyors will come from increased licensing fees charged to facilities that include nursing homes, ambulatory surgery clinics, group homes and hospitals.

    Williams said that in the past, state surveyors spent 70 percent of their time inspecting the third of state facilities that CMS pays Nevada to certify and inspect more frequently, such as nursing homes.

    “I don’t know why that was done,” she said. “The priorities were wrong.”

    She echoed what Richard Whitley, administrator of the health division, wrote in the executive summary of his agency’s 35-page report:

    “While the health division was responsible for meeting its CMS contractual obligations for Medicare initial certification surveys and recertification surveys, the CMS surveys were not balanced with state needs. Despite what happened in Nevada and is happening elsewhere in the U.S., CMS has not changed its priorities to reflect more frequent surveys of ambulatory surgical centers.”

    Contact reporter Paul Harasim at pharasim@reviewjournal.com or 702-387-2908.

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    Tim wrote on March 16, 2009 12:19 PM: The only way to stop the maddness is to take these small surgical centers like red rock and shadow mountain to court.


    To Fred wrote on March 10, 2009 07:33 AM: Fred, you are seriously ignorant on the subject of addictions. A person is not incredibly successful, and on the top of his game, if he is addicted to a mind altering substance. In fact, his condition was exactly the opposite. I am glad he got help. I advise the public to DEMAND that doctor's are drug tested randomly, like all other staff in medical facilities.


    even a doctor who gets C D's can practice medicine.....practice medicine................practice makes perfect wrote on March 09, 2009 10:40 PM:
    the safest way to hide blunders would be to eliminate all forms of paper documentation, that way when all information is held digitally, it can be altered by medical facilities to hide the truth when the doctors messes up.
    and the doc can cover his goof up like an exposure and the public will never know

    so make sure we get rid of all forms of paper documentation and records.
    call the shredder


    Fair and Balanced Fred wrote on March 09, 2009 08:42 PM: Dear Insider:

    Dr. Gregory Baer, an amazing individual, is a retired opthamologic surgeon who was at the very top of his game, incredibly successful, and did everything he'd been told was the right way to happiness from the time he was a kid, and ended up an addicted doctor.

    I heard him speak last week at the Boulder City Hotel. He talked about what was missing in his life: a sense of feeling loved, and being loving, which he maintains is the most basic, but most typically overlooked human need, and, thus overlooked, is the basis of most other human emotional pathology.

    Greg Baer maintains twenty-percent of surgeons are high. If you want more info, Google Greg and "Real Love." If you want to know more, contact him and find out about the Boulder City Real Love project.

    As for the first post below, no comment.


    Insider wrote on March 09, 2009 06:38 PM: Unfortunately human nature transcends all professions. Doctors are not immune. Something that has irritated me for a long time, is why does every freakin' employee of every hospital and ambulatory surgery center have to be drug tested, yet DOCTORS DO NOT!!!!!!!!!!! The public should be outraged about this FACT!! Personality testing also should be considered, but why don't we just start with drug testing.........


    Horrified......... wrote on March 09, 2009 06:27 PM: This is the least of your worries. Start by getting operating room nurses to wash their hands after they use the bathroom. The public would be horrified if it knew some things that went on. Also, please take a serious look at DENTAL OFFICES.........I am glad the red flag has been raised. This is the tip of the iceberg.