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EDITORIAL: Medical malpractice

Practices of local clinic verge on the criminal

On Shadow Lane near Valley Hospital and not far from the University Medical Center, the Endoscopy Center of Southern Nevada is a high-volume gastrointestinal practice that performs a lot of colonoscopies. Reuse of syringes and vials at the facility was a "common practice" undertaken by everyone from doctors to technicians, county health officials said Wednesday.

The business was also investigated for other unsafe practices such as not properly cleaning endoscopic equipment used in colonoscopies and upper gastrointestinal procedures.


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  • As a result of the investigation, 40,000 Nevadans soon will receive word that they might have been exposed to HIV and hepatitis strains B and C in what a federal health official called the largest notification of its kind in U.S. history.

    A sample letter warns patients that at the facility they were "placed at risk for possible exposure to bloodborne pathogens. As a precaution, and in order to take appropriate steps to protect your health, we recommend you get tested for hepatitis C, hepatitis B, and HIV. ... All patients who received injected anesthesia at the center have been placed at increased risk of exposure. ... We recommend that you be tested at your own doctor's office, as he or she will be able to best advise you on what to do if you test positive."

    Those affected must pay for their own testing.

    Health officials began investigating the endoscopy center in early January after learning of three patients who had been diagnosed with hepatitis C, a chronic, potentially lethal blood-borne virus that can cause liver cancer and liver failure.

    Each of the individuals underwent procedures requiring injected anesthesia at the center between June and September 2007. Five -- three other cases were identified later -- underwent the procedures on the same day at the facility, said Brian Labus, the health district's senior epidemiologist.

    During the investigation Dr. Labus said doctors, nurses and other medical personnel at the facility were asked whether it was the norm to reuse syringes and vials there. "They admitted, 'This is what we were told to do,' " Dr. Labus said.

    Dr. Cheryl Hug-English, associate dean of admissions and student affairs for the University of Nevada School of Medicine, said students are taught from their first year of medical school that what transpired at the Endoscopy Center of Southern Nevada "is not an acceptable practice. ... The proper practice is repeated and ingrained that syringes cannot be reused. ... We take this very seriously.''

    Those who administered the endoscopy center obviously did not.

    This outrage does not appear to fall into the categories of ignorance, or a single mistake due to haste, fatigue or assigning a procedure to staff not properly trained.

    Both patients and regulatory officials have every right to ask why staff members didn't step forward and blow the whistle far earlier. This isn't merely a case of a restaurant owner ordering the help to mix more bread crumbs into the meatballs: Patients may see their lives shortened due to the serious diseases in question, and anyone with any medical training had to know that.

    Was it just about saving money? Or cranking more patients per day through the assembly line -- which amounts to the same thing? Did reduced Medicare and Medicaid reimbursements create perverse incentives?

    Pursuing the less-direct causes is worth some effort. But they don't excuse the behavior, which may very well cross the line into the criminal.

    Right now, the top priority is tracking down every patient who went through that facility in the relevant time period, and making sure they're fully informed.

    So far, there have been no cases of hepatitis B or HIV linked to the center. Here's hoping that remains true.

    But, "Once again, we have an outbreak that involves two common elements -- an outpatient clinic and the reuse of medical equipment that is intended to be used only once,'' comments Evelyn McKnight, co-founder of Hepatitis Outbreak National Organization for Reform. "When we hold our restaurants to higher standards than our doctors' offices, that's a tragedy."

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    Dee Wes wrote on March 03, 2008 02:03 AM: I am so outraged about what has transpired here. I was suppose to have 2 proceedures an endoscopy and an colonoscopy last year for routine checks. Thank god i listened to my gut feeling. And never went. But just to think I could have had my life endangered by entrusting this facility to my health care is just outrageous!
    Personally I hope they hang the people responsible by the highest tree in nevada. This is not neglect this is intent to murder people. How can these nurses and doctors Sleep at night now knowing 40000 people could be dying because of they trying to line their pockets with more money as if they werent rich enough already! OUTRAGE. Dispicable people. I think This every doctor in that facility should be held responsible for allowing this to happen.
    Let them loose their jobs and homes after all they are taking many peoples lives from them.


    Bob wrote on March 02, 2008 10:18 PM: I may be one of the thousands exposed to this tragedy do to incompetent ,greedy foreign doctors.I think their privledges to practice should removed forever and never be allowed in any country to perpetrate this again on unsuspecting patients.I can only think that if the wrong person becomes infected these docs won't make it to court.I would facilitate a defense fund for whoever does react in that manner .The sick feeling I had at the begining of this notice was like losing a loved one ,empty ,alone,fear,and anger.I just hope this is exaggerated and it does not go full blown as suspect


    RJNeedsAnEditor wrote on March 02, 2008 01:31 PM: LOL Leonard, that's funny. You must be from out of town. Getting the facts right is definitely NOT the RJ's strong suit. If you want factually accurate news, check the Sun, USA Today, etc. The accuracy rate for the RJ is down around 30%.

    If anybody has any spare change and you happen to drive by the Review Journal Building, toss it onto their lawn. They're trying to raise enough money to hire an editor.


    JohnFlip Lockup wrote on March 02, 2008 12:40 PM: Of course, the doctors and nurses who knowingly participated in this outrage will have their medical licenses pulled and be forbidden to practice ever again, right? Right???


    leonard raizin wrote on March 02, 2008 12:33 PM: There were no anesthesiologists involved in the procedures done at the gastoenterology clinic. The original article stated that there were anesthesiologists involved in the case. No retraction by the paper has published. It is important to know that the specialty of anesthesiology is not complicit in this type of misconduct.
    BE AWARE!


    John F wrote on March 02, 2008 10:39 AM: Grumpy,

    Good morning.

    I refer you to the post previous to yours. The market force that was eliminated (or at least mitigated) here was the cost of being found negligent. Medicare didn't have any effect on that. Anyway, my point was that the RJ was unnecessarily politicizing this thing. Using other people's illnesses to score cheap political points seems to be a recurring theme of theirs.

    I agree with you on your basic point. The medical community won't care about the cost of being negligent as long as negligence doesn't equate with obsolescence. But again, Medicare isn't the underlying reason.

    Paying for medical care through Medicare does not remove physicians from market forces any more than paying them through private insurance. Medicare for everyone should not be compulsory, in part, for just that reason. As long as alternatives to Medicare exist, Medicare will have to be responsive to the free market.


    grumpy wrote on March 02, 2008 08:57 AM: John F,
    Assuming medicare was somehow to blame (reduced payments forcing this sort of thing--which I don't buy in the least), it would seem to vindicate my idea of eliminating medicare and medicaid.
    There's no way a health care provider who reacts to the market instead of the government would ever sanction this.
    You work in hospitality don't you? I am sure you keep your kitchen clean and sanitary not because of the health department, but because the market would crush your business otherwise.
    Medicare and medicaid will eventually bankrupt us and leave us with third rate health care. Look at the growing number of physicians leaving the medicare/medicaid network.


    MyersandGomel wrote on March 02, 2008 08:24 AM: Not long ago an organization named "Keep Our Doctors in Nevada" pressured the Nevada Legislature into an emergency session and persuaded the Nevada citizens to vote for medical malpractice protection, all in the name of a phony "medical malpractice crisis." Dr. Dipak Desai and the Endoscopy Center of Southern Nevada were behind the Keep Our Doctors in Nevada group, shelling out at least $25,000 to buy protection from injured patients. As a result, medical providers, INCLUDING DR. DESAI AND HIS CLINIC, are protected by caps on damage awards. Does anyone now think $350,000 is adequate compensation for the pain and suffering that will be endured by any patient of Dr. Desai who contracts HIV/AIDS, Hepatitis B, or Hepatitis C?

    Like many lawyers who represent injured medical patients, our law firm, Myers & Gomel, fought against the caps, and I can tell you this is precisely the type of situation we were concerned about when the doctors and their insurance companies used the "Keep Our Doctors in Nevada" fear campaign to achieve their selfish goal of protective caps. The truth is we shouldn't keep doctors like Dr. Desai in Nevada, and doctors like Dr. Desai don't deserve protective caps so they can practice sub-standard medicine with no fear of a jury's verdict.

    This is a real "medical malpractice crisis," and it will not be the last one unless and until doctors like Dr. Desai can be held accountable in full for the pain and suffering caused by such blatant and irresponsible malpractice. Nevada voters should demand that the doctors' special shield laws be repealed and that they be treated like the rest of us.


    No excuse wrote on March 02, 2008 08:18 AM: Those employees who followed the orders and those who didn't are just as guilty as the doctors. You don't need a whistle blower law to be a moral person. How easy would it have been to send an anonymous letter or make a phone call. They were sheep, willing for the sake of a paycheck or some perverse sense of loyalty to put every patient in danger.

    Whether it is this doctor making big bucks or the nurse making far less the guilt is equal. The only difference is he will be able to afford a far better lawyer to get him off.


    livetoskilaketahoe wrote on March 02, 2008 06:55 AM: It will also be interesting to see whether the extremely talented professionals at R&R Advertising will be able to put a happy face on hepatitis and AIDS.

    It's gonna be an uphill battle but these GI docs have the bucks to huck the best spin money can buy.

    My guess is that the GI docs will try to blame the whole thing on the nurse anesthetists they were directing. I wonder if R&R's strategy will be to trash the nurses on behalf of their high profile GI doctor clients.

    The nurses could fight back in the war of public opinion but there's no way they're gonna have the public relations budget that the GI docs have.


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