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On July 24, 2008, Southern Nevada Health District official announced that genetic testing has traced seven hepatitis C infections to two patients who underwent procedures at the Endoscopy Center of Southern Nevada last year.

Brian Labus, Health District Senior Epidemiologist, said one of the sources underwent a procedure July 25 and the other Sept. 21. The Sept. 21 patient was a known carrier of hepatitis C, meaning both the health care provider and patient knew the virus was in the patient’s bloodstream at the time of the procedure.

It was unclear if the source from July 25 was a known carrier, Labus said at Thursday’s meeting. “We know when it started and where it went,” Labus said, referring to the transmission of hepatitis C to seven former patients of the facility at 700 Shadow Lane on those two dates.

Six people have tested positive who underwent procedures at the clinic on Sept. 21. One tested positive following a July 25 visit. An eighth hepatitis C case has been linked to the clinic based on a procedure in 2005.

Health officials now will concentrate on determining how many more of the Shadow Lane facility’s 50,000 patients may have been exposed during procedures between March 2004 and Jan. 11. That is the time frame in which health officials believe it was common practice among nurse anesthetists at the Shadow Lane facility to reuse single-dose vials of medication and syringes.

The number of acute hepatitis C cases linked to the clinic probably will remain at seven, unless the health district receives a report by the end of the month, Labus said.

Acute hepatitis C occurs when someone becomes ill within six months of exposure. July 11 marked the last date a former patient of the endoscopy center would have developed acute hepatitis C, based on a Jan. 11 exposure date.

“Within the next week or so, we should be done with getting acute cases,” Labus said.

Chronic hepatitis C cases are a different story. In such cases, a patient won’t become symptomatic within the incubation period, and the disease usually isn’t identified until years after exposure.

Seven of the eight cases linked to the Shadow Lane facility are acute. The eighth case, which was announced is a chronic case.

“This person had no symptoms,” Labus said. “They wouldn’t have known they had it unless they had been tested.”

The remaining case is linked to an affiliated clinic on Burnham Avenue.

Dr. Dipak Desai, a Las Vegas gastroenterologist, is majority owner of both clinics, which were closed shortly after the outbreak was announced.

County prosecutors will fold the new hepatitis case into the ongoing criminal investigation, Deputy District Attorney Scott Mitchell said.

The investigation was hindered by a wall of silence by the clinic’s nurse anesthetists, who will be key witnesses in any prosecution, Mitchell said.

The lack of cooperation changed in recent weeks when prosecutors subpoenaed the nurses to testify before an investigative grand jury, he said.

“We have broken through that wall,” Mitchell said, adding that some nurse anesthetists now are cooperating with investigators.

The grand jury also helped separate potential witnesses from potential defendants, allowing investigators to “whittle down the case against core people who we have good evidence against,” he said.

The investigation will probably continue for a couple of months before any charges are filed, Mitchell said.

Desai and one of his partners, Dr. Eladio Carrera, have had their licenses suspended pending an investigation by the Nevada Board of Medical Examiners. The board has scheduled hearings for Desai and Carrera in September and October.

Both performed procedures at the Shadow Lane facility on July 25 and Sept. 21, dates when CDC and health district investigators believe nurse anesthetists contaminated single-dose anesthesia vials with syringes that were reused.

One nurse anesthetist told CDC investigators that the clinic’s staff had instructed him to reuse syringes and single-dose vials of propofol, a fast-acting sedative.

Debra Scott, executive director of the Nevada State Board of Nursing, said 36 complaints have been filed against nurses affiliated with the endoscopy center.

Hearings have been scheduled for Oct. 22 and 23. However, Scott said, the regulatory board has not filed any charges against nurses.

She said complaints or charges brought by the nursing board could be filed 30 days in advance of the hearing.

“We have evidence at this point that there are witnesses willing to come forward saying some of the CRNAs used single-dose vials for more than one patient,” she said.

The nursing board still needs some reports from law enforcement to complete its investigation, Scott said.

Six nurse anesthetists with ties to the Shadow Lane facility have voluntarily surrendered their licenses.

Health officials also announced that a hepatitis C registry launched by the health district last month is making progress. So far, 6,000 patients have responded to the registry.

The registry was launched in an effort to reach more of the clinic’s population to identify those who may have been exposed.

During the July 24, 2008 meeting, Dr. Joe Hardy asked if any former patients of the Shadow Lane facility had tested positive for hepatitis B or HIV, the virus that leads to AIDS.

Labus said they had not.

“That would be called good news,” Hardy said.

The popularity of motorcycle riding is at an all time high. Sales of all types of two-wheelers reached approximately 1,158,000 in 2006, a level not seen in nearly 30 years. Death rates from motorcycle accidents have increased steadily since states began weakening helmet laws about a decade ago, according to a Gannett News Service analysis of federal accident reports.

As deaths have increased, so has the proportion of older riders killed. Dying on a motorcycle could soon become a predominantly middle-aged phenomenon, the GNS analysis shows.

Most states once required all motorcycle riders to wear helmets. But a trend in the other direction began accelerating after 1995, when the federal government decided to stop withholding highway money from states without helmet laws. Ohio requires riders wear helmets for one year.

As states weakened or repealed the laws, the percentage of riders who wore helmets began dropping, which caused fatality rates to increase.

In 1996, 5.6 motorcyclists were killed for every 10,000 registered motorcycles, according to federal transportation officials. By 2006, the most recent data available, the rate had risen to 7.3, the GNS analysis shows.

In raw numbers, the annual death toll rose from 2,160 to 4,810 over that same period. Meanwhile, fatality rates for other passenger vehicles have been falling, transportation officials say.

The numbers appear to contradict claims by some motorcycle groups that helmet laws alone don’t save lives.

“The data are pretty compelling,” said U.S. Transportation Secretary Mary Peters, herself an avid motorcyclist who survived a crash thanks to a helmet she displays in somewhat battered condition in her office. “It’s discouraging to see the (fatality) numbers going up. But at least people are talking about it now.”

GNS analyzed data from the federal government’s Fatality Analysis Reporting System on thousands of motorcycle deaths between 2002 and 2006. The analysis found that:

• About 42 percent of riders killed were not wearing helmets.
• Nearly half of the riders killed in 2006 were 40 and older, and nearly a quarter were 50 or older. The average age of motorcyclists killed in accidents was about 38.

Transportation officials say the age trends reflect the growing popularity of motorcycles among older people with increasing incomes but decreasing physical dexterity and reaction times.

• Half of motorcyclists killed between 2002 and 2006 lost control and crashed without colliding with another vehicle, underscoring the inherent risks involved in riding a motorcycle. Motorcyclists account for about 2 percent of vehicles on the road but 10 percent of all traffic fatalities, according to federal statistics.
• Southeastern states had some of the highest fatality rates in 2006. Some of these states require all riders to wear helmets, but they also have long riding seasons that expose bikers to more risk over time.
• A consistently large majority of those killed about 90 percent were men.

Critics of motorcycle helmet laws say riders should be guided by common sense rather than a government mandate when deciding whether to wear a helmet. They argue that wearing a helmet is uncomfortable and obstructs their view.

They promote their view through advocates across the country, including ABATE state groups, which track helmet legislation and lobby against it. The ABATE acronym stands for different names, depending on the state.

“It’s my body and I should have the right to do with it as I choose,” said Terry Howard, state coordinator for ABATE of Colorado, which vigorously fought the state’s recent adoption of a helmet law for riders under 18.

Not all bikers agree.

Simon Rosa, 22, of northern Virginia, doesn’t have a problem with the helmet law there. In 2003, he crashed his Honda sportbike making a turn.

“I still have the helmet and it has scratches all over it, so I could have suffered a nasty head injury,” he said. “You just never know what’s going to happen, regardless of how good a rider you are.”

As states seek to save lives and cut government medical costs, there are signs that helmet laws may become popular again.

Also last year, 25 states considered laws to increase motorcycle safety, including laws mandating helmet use, according to the National Conference of State Legislatures.

Delaware, Hawaii, Kansas, Montana and Oklahoma took up bills that would have required all motorcyclists, rather than just young riders, to wear helmets. None passed.

The National Transportation Safety Board unanimously recommended last year that states require all riders to wear helmets. It was the first time in its 40-year history that the independent panel had weighed in on motorcycle safety.

“Medical and other costs for unhelmeted riders involved in crashes are staggering,” the board notes on its Web site.

Opponents of helmet laws passionately dispute such claims.

“It’s just a myth that states without helmet laws are an extra burden on society,” said Jeff Hennie, vice president of the Motorcycle Riders Foundation.

Health officials in the United States announced on July 24, 2008 that at least 1,013 people died of overdoses in several U.S. cities from 2005 to 2007 after illegally injecting the highly potent painkiller fentanyl.

The fentanyl, at least some of which came from Mexico, was sold illegally by drug dealers on U.S. streets, sometimes mixed with cocaine and heroin, according to a report issued by the U.S. Centers for Disease Control and Prevention.

The Chicago area had the most deaths with 349, followed by Philadelphia with 269, the Detroit area with 230. Additional deaths were reported in St. Louis, Missouri, and the states of Delaware and New Jersey.

Emergency medical personnel reported finding some victims with the needle still in their arms, not having completed the injection because the drug was so powerful, said retired CDC public health service officer Dr. Stephen Jones, who wrote the report.

The fentanyl caused perhaps hundreds of other deaths not reflected in the official tally of 1,013 deaths, Jones said in a telephone interview.

“I think this is an extraordinary episode of fatal drug overdoses. But it’s got to be recognized as part of the bigger problem of the increasing numbers of drug overdose deaths in the United States.”

The number of deaths from drug overdoses and other cases of unintentional drug poisonings jumped from 11,155 in 1999 to 22,448 in 2005, the CDC noted, with powerful painkilling drugs playing an important role.

The fentanyl used in Chicago and Detroit was believed to have come from an illicit production facility in Toluca, Mexico that was shut down by authorities in May 2006, the CDC said.

Fentanyl is used medically to treat pain in cancer patients and others but also is abused for recreational use.

“One gram of pure fentanyl can be cut into approximately 7,000 doses for street sale. Manufacture of (fentanyl) requires minimal technical knowledge, and recipes for making (fentanyl) are available on the Internet,” according to the report.

“The unknowns of what somebody can obtain on the streets and misuse are a very obvious message from this outbreak,” Nick Reuter of the U.S. Substance Abuse and Mental Health Services Administration said in a telephone interview.

Jones said the recent deaths marked the worst known outbreak of U.S. fentanyl deaths. An earlier series of deaths in the 1980s included at least 110 fatal overdoses, he said.