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Patients and valley residents are wondering what to do next, and all fear the Hepatitis and HIV breakout that occurred at the Endoscopy Center of Southern Nevada could spread beyond those treated at the Center.

Patient and resident safety was completely overlooked and corners were cut, so that the clinic to increase its profits. One of the primary fears at the moment is that some of the patients possibly exposed donated blood and are worried blood recipients are also at risk.

Sleepless nights and worry-filled days are what Cheryl Henderson now faces after learning she could have been exposed to Hepatitis C, B or HIV. Now, she’s trying to find out for sure at the Southern Nevada Health District but that too is proving to be hard.

“They are not going to do testing here. I need to go to my primary doctor,” she said.

It’s frustrating news layered on top of already scary news. “This is just another added expense that I don’t think I should have to pay for,” said Henderson.

But many are questioning how far this problem reaches. Some of the patients possibly exposed to the disease say they donated blood and are now worried blood recipients are also at risk.

In the midst of so much scary news some relief.

“Blood is never released from UBS unless it has completed the testing process,” said Amy Hutch of United Blood Services. UBS says whether it is your first time donating or you’re a regular, all blood is tested before it moves on to hospitals.

If your blood does test positive, UBS gets rid of it.

“There are always positive tests from time to time but it is very rare and we do notify the donor immediately of that,” said Hutch.

UBS says even though they do sometimes get positive blood tests, they don’t know if it’s linked to recent exposure. But for patients like Cheryl Henderson, the frustrations are mounting; knowing the Endoscopy Center that’s causing this frustration remains open for business.

“That’s what amazes me. They’re still open and I have to go back in August for another one because that is the only place my wonderful insurance will let me go to,” said Henderson.

United Blood Services says even though they do test their blood before it is sent out, they are not a diagnostic center and you cannot go to their offices for a blood test.

The Southern Nevada Health District has information available on their website regarding the investigation and a hotline has also been set up.

The largest health scare in the country most likely started with the seed of many problems in medicine. Greed, some doctors say. In reality, it’s unknown why basic medical practices were apparently so abandoned that at least six patients of the Endoscopy Center of Southern Nevada have contracted hepatitis C.

Because the faulty practices that likely led to the outbreak were so entrenched at the Endoscopy and Colonoscopy clinic, health authorities fear as many as 40,000 patients over the past four years may have been exposed to hepatitis B, hepatitis C or HIV. Numerous physicians said the clinic obviously put profits ahead of patient care. The staff cut corners in order to accommodate the high volume of patients, doctors unaffiliated with the clinic surmised. Dr. Dipak Desai, the gastroenterologist who is the majority owner in the practice, is not talking and neither are his partners.

Additional doctors, patients and elected officials become frustrated and enraged when trying to explain the failure to practice basic infection prevention at the clinic. Certified nurse anesthetists at the business, at 700 Shadow Lane, were reusing syringes and single-dose vials of medicine for multiple patients, health officials said. Anesthesiologist Dr. Rodney Borden, who said he did procedures at the practice in 2001, said using a certified nurse anesthetist to administer the drugs is permitted and is known as a cost-saving measure. In past years, he said, the clinic used anesthesiologists, and medical doctors for the procedures.

“I’m really not trying to indict nurse anesthetists as a concept,” he said. “It was just a poorly run operation there. Someone was trying to save on drugs and supplies.”

Some drugs could cost $20 a bottle, he said, so rather than throw away a partially used vial, there would be some motive to keep it for use on another patient. The clinic, he said, was penny-wise and pound-foolish.

An investigation carried out jointly by the Southern Nevada Health District, Nevada State Bureau of Licensure and Certification, and Centers for Disease Control and Prevention found the nurses were doing what they were told in administering anesthesia for procedures, and that it was standard practice.

Six patients who received anesthesia injections at Endoscopy Center have been diagnosed with acute hepatitis C. One picked it up July 25 and five were infected Sept. 21, health officials said. Health officials announced on February 27,2008 that they were sending letters to every patient who had received anesthesia between March 2004 and Jan. 11 for a colonoscopy or endoscopy at the Endoscopy Center.

Disbelief and anger over the crisis spilled over Thursday during the regular meeting of the Health District. Las Vegas City Councilman Gary Reese said it’s a “clear case of cutting corners” to save dollars, and “we can’t let this happen anymore.”

Said a frustrated Dr. Jim Christensen, an allergy specialist who sits on the Health District board: “Everything I do is on a personal trust and this just gives patients another reason not to trust their doctor.”

Elected officials demanded that the clinic be stripped of its business license, which would effectively close the facility. Mayor Oscar Goodman asked city staff to begin the process of forcing the clinic to demonstrate why it should not lose its city business license. Clark County Commissioner Chris Giunchigliani, who also sits on the Health District board, agreed that the licenses should be yanked.

And Bobbette Bond, government and community affairs coordinator for the 120,000-member Culinary Health Fund, said the self-insured union would likely terminate its contract with the Endoscopy Center. For now, Culinary is making arrangements for 3,500 patients to get their blood tested and urging others to use a different gastroenterologist.

Greed is the most likely root of the problem, local doctors said, because there’s just no other credible reason the staff at the Endoscope Center could have been so careless.

“The amount of money you save on those syringes is pennies,” said one local gastroenterologist. “This was a volume issue.”

If 40,000 people are being notified for work performed in less than four years that represents a lot of patients for a two-bed facility said the specialist, who did not want to be identified.

The specialist said he couldn’t imagine the infections were passed intentionally, but in pursuit of money there “is less time to stop and apply the appropriate safeguards.”

In March 2004, the Endoscopy Center was licensed by the state as an ambulatory surgical center, allowing multiple doctors to perform procedures there. It is one of the highest-volume endoscopic clinics in Nevada.

The controversy at the Endoscopy Center comes as the practice was growing. The center is affiliated with Gastroenterology Center of Nevada, a 14-physician practice started by Desai. One of them, Dr. Vishvinder Sharma, is also an owner of Desert Shadow Endoscopy Center, at 4275 Burnham Ave., Las Vegas. And Desai and Sharma just licensed Spanish Hills Surgical Center last month at 5915 S. Rainbow Blvd., records show.

The Bureau of Licensure and Certification investigation found five other violations on Feb. 1 at the Desert Shadow site, but those will not be made public until the clinic finishes its plan of corrective action. Health officials said the violations are not related to the problems at Endoscopy Center that caused the infectious disease crisis.

In Feb. 2004 the Bureau of Licensure and Certification found failures with the Endoscopy Center’s patient discharge practices.

It’s unknown whether nurses, doctors or both are responsible for the various failures that led to the hepatitis C emergency. Health officials did not make that question a subject of their probe, but the answers may be forthcoming as other agencies get involved. The Health District is filing complaints with the Nevada State Board of Medical Examiners and Nevada State Board of Nursing.

Doug Cooper, chief of investigations for the medical board, said he has launched his investigation. The board has never received more calls on a single subject from doctors, patients and state legislators, he said. To Cooper’s chagrin, the board did not know about the hepatitis C outbreak until Cooper heard it on the news. But the investigation has been given the highest level of urgency, he said.

Cooper would not speculate on possible disciplinary action because the allegations are unproven. Punishment for a physician could range from probation to losing his license, depending on the offense. The same severe punishment could be meted out on offending nurses, said an official from the nursing board.
It’s also possible the investigation could lead to criminal prosecution.

“I’ve asked our major fraud deputies to get together with Health District investigators to see if criminal charges are warranted,” Clark County District Attorney David Roger said Thursday. “This is a pretty unusual case and I’m not familiar with any cases like it that have occurred in Clark County.”

U.S. health officials on February 28, 2008 said 40,000 people may have been infected with HIV and hepatitis in a major health scare after a Las Vegas clinic was found to have re-used syringes and medicine vials. Authorities in southern Nevada said they were notifying some 40,000 patients who received anesthesia injections at the clinic’s endoscopy center between March 2004 and January 11, 2008 about potential exposure to hepatitis and HIV.

Officials suggested in a statement that the patients “contact their primary care physicians or health care providers to get tested for hepatitis C as well as hepatitis B and HIV.” This move comes after several acute cases of hepatitis C showed up in the area. Six people have been diagnosed with the disease since January, which is three times higher than the yearly average for the Las Vegas region.

The original three cases came to light in January, and three other patients were subsequently found to have been infected with hepatitis C. Five of the infected people all received anesthesia injections on the same day at the Endoscopy Center of Southern Nevada.

No cases of HIV or hepatitis B infections related to the clinic’s practices have been detected yet, authorities said. After an investigation, “the health district determined that unsafe injection practices related to the administration of anesthesia medication might have exposed patients to the blood of other patients,” it said.

“The joint investigation identified the re-use of syringes (not needles) and the use of single dose vials of anesthesia medication on multiple patients as the potential sources of contamination.”

Action has since been taken by the clinic to end such practices.

“It appears the injection practices that can lead to the transmission of hepatitis C and other blood borne infections have been occurring at this clinic for several years,” said chief health officer Lawrence Sands.

“We are recommending all patients during this timeframe to get tested because we cannot determine which patients may have been exposed.”

Hepatitis C can result in severe liver damage, but the symptoms may not show up for several years so even if patients are feeling well they should be tested, he warned.

The health authorities added however that the risk to the general population was low, as hepatitis cannot be spread by casual contact.

The clinic said in a statement that it has taken corrective measures.

“On behalf of the Endoscopy Center of Southern Nevada, we want to express our deep concern about this incident to the many patients who have put their trust in us over the years,” the statement read.

“As always, our patients remain our primary responsibility and we have already corrected the situation,” officials at the facility said. “We have already taken steps to ensure that it will never happen again, We want to be sure that every patient who may have been exposed is informed and tested.”

The Endoscopy Center of Southern Nevada said it was working with “nationally renowned experts who have extensive epidemiological experience” on how best to proceed, as it tried to tamp down public fears.

“We wish to emphasize that the actual risk of anyone being affected by this is extremely low, but as a precaution, anyone who has undergone procedures at the Endoscopy Center wo required anesthesia should be tested.”