But since there now appears to be blood on his hands, there's no reason others with close ties to Desai should remain in positions to oversee his ilk or the other so-called health clinics that were actually just mills to scope away your money.

The death of James Ray Cromwell shouldn't have to result in a lawsuit, although one is certainly deserving. Cromwell's death from hepatitis C, possibly contracted at one of Desai's mills, the Endoscopy Center of Southern Nevada, back in 2006, if confirmed, could have resulted in Desai's loss of license years ago.

Instead, a full-scale, top-to-bottom failure of government systems allowed years of risky behavior that put thousands more at risk.

Hepatitis C may not have the sheer fear factor of HIV, but people with the disease take incredible precautions to protect their loved ones from it. And, as Cromwell's case may prove, it can be a death sentence.

Desai should be in cuffs. Instead, he still technically has his medical license.

Last week I thanked Gov. Jim Gibbons for finally doing something about the crisis when he called for the resignations of the executive director and some members of the Nevada Board of Medical Examiners. But these people don't seem to fathom that perception has become reality with this case.

And why shouldn't it? Who could think a doctor would knowingly put patients at risk -- in fact, instruct his staff to put patients at risk, as a city of Las Vegas official reports?

Dr. Daniel McBride, a Board of Medical Examiners member, may in fact believe he can distance himself from Desai despite the fact Desai sent scads of surgery patients his way. McBride, with a straight face, says he won't be involved with the Desai investigation.

Maybe so, but he did head one of the state's malpractice companies, Nevada Mutual Insurance Co., and chaired the committee of the state board that hears malpractice cases. He resigned from the insurance company this past week.

The only way you can argue the current hepatitis scare isn't explicitly malpractice is if you take a tougher position and claim it is outright negligent homicide.

In this case, it's still hard for some to see past the trusting relationship so many have with their doctors.

Sen. Harry Reid's wife, for example, is a patient of Dr. Javaid Anwar, the president of the Board of Medical Examiners who has recused himself from the endoscopy center case because of ties to Desai. Reid describes Anwar as a wonderful man and thorough doctor.

It is hard to balance a one-on-one personal relationship with a doctor against the person's business dealings with someone who appeared to put profit over public safety.

Now that Reid has defended Anwar, it should be pointed out that the senator's business partner, Jay Brown, is defending Desai's clinics from attempts by the Las Vegas City Council to strip business licenses.

To be sure, just about everyone is conflicted. So many people have family members who were tested at Desai's clinics (it's a hard fact to avoid since he cornered the market). But there's a difference between casual connections and the real conflict. And when 40,000-plus people are told to get HIV and hepatitis tests, there's no room for typical Nevada doesn't-smell-right relationships, even if they are technically above board.

Blood has been spilled, at least six have been confirmed to have contracted hepatitis and tens of thousands are going through the process to see if they will be spared a possible death sentence or lifelong serious illness.

A conflict of any sort cannot be justified in this case.

And these aren't just casual connections anyway. Anwar did business with Desai. Desai referred patients to McBride, helping that doctor's own bottom line.

McBride can't just wish away the past when the past is so sordid. It isn't enough that he won't be involved in the Desai case. In a very palpable way, he already has been and is neck deep in perceived conflict.

Christians celebrate Easter by believing rebirth is possible. It could, in fact, be possible for Nevada's medical community to be reincarnated into a system of trust.

For now, it is broken from the top down, and the best way to encourage change is to throw out all of the old. That means the business license. It means the people in oversight positions and it means some trusted doctors will suffer a blow to their reputations along the way.

But you can recover nicely from a bruised ego, after all. Sadly, there is no cure for hepatitis C.

Contact Erin Neff at (702) 387-2906, or by e-mail at eneff@reviewjournal.com.