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Propofol vials carried room to room, witness says in Desai trial

Health inspectors who investigated the 2007 hepatitis C outbreak in Las Vegas believe the transmission from an infected patient to uninfected patients in two separate procedure rooms occurred when open vials of the anesthetic propofol were transferred from one room to the next.

During the trial of Dr. Dipak Desai, who owned the Endoscopy Center of Southern Nevada where the outbreak occurred, nurse anesthetists have testified that used vials of propofol were never transported from exam room to exam room.

Anesthetist Ralph McDowell told a different story Wednesday.

McDowell said he and fellow anesthetist Vincent Mione — who earlier Wednesday said he never gave open vials to another nurse — commonly brought each other containers that had been used.

When Mione brought McDowell open vials, McDowell discarded them, he said.

“You cannot assume anything is sterile unless you know it is sterile,” McDowell said.

Even though propofol is marked “single-use only,” McDowell said, he interpreted that to mean it shouldn’t be left open for more than 10 minutes because a chemical reaction occurs that makes the drug unsafe.

He testified that the same propofol can be used on different patients if each time nurses withdraw from the vial, they change the needle and the syringe. He said in clinics where he worked previously, there was sometimes a large vial of propofol that nurse anesthetists would draw from regularly.

McDowell said Desai chided him for giving patients too much of the sedative. McDowell said when Desai had reached the halfway point of a procedure, he saw the patient start to wake up and started to inject additional propofol. Desai stopped him, saying he was finished.

“It was very easy for me to think he was only halfway finished,” McDowell said. “I wasn’t expecting it to be done that quickly.”

Desai never directed him to reuse needles or syringes, he testified.

Desai, 63, and co-defendant, nurse anesthetist Ronald Lakeman, 65, face more than two dozen charges.

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