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On August 11, 2008, a Nevada Highway Patrol officer said that tire failure might have caused a casino worker shuttle bus crash that injured 29 people. “There’s evidence that the bus may have suffered tire tread separation,” Trooper Kevin Honea told The Associated Press. He said the findings were still preliminary.

Federal officials also reported evidence of tread separation in the crash in Texas of a bus chartered by a church group. That wreck, which took place on August 8, 2008, has taken the lives of at least 17 people.

Those injured in the Nevada crash on August 10, 2008, on Interstate 15 were casino and mall employees returning to Las Vegas from Herbst Gaming Inc. properties in nearby Primm, said Ferenc Szony, company president.

Clark County fire spokesman Scott Allison said the crash scene stunned him.

“The driver’s side front tire looked like it went through a meat grinder,” Allison said. “It was just shredded completely.”

Honea said witnesses saw the bus veer suddenly to the left, where a guardrail sheared off its wheels and undercarriage. The coach section crashed into the center median and remained upright. He said the bus did not appear to have been speeding.

Three people remained hospitalized Monday at University Medical Center in Las Vegas, said hospital spokeswoman Tammy McMahan. She said patient privacy laws prevented her from disclosing medical conditions.

Honea said the bus driver was among those still hospitalized.

Bus owner AWG Charter Services of Las Vegas released a statement saying more information would be made available when the investigation is completed, but it referred questions to an insurance adjuster.

The adjuster, Duane Ford, said the driver was not fatigued and the bus well maintained.

“The wheel and the remnants of the tire are still intact on the bus, so it looks like something deteriorated in the tire,” Ford said.

It was the second crash this year involving Herbst casino workers being shuttled 40 miles between Las Vegas and Primm, a freeway casino town on the Nevada-California state line. A Jan. 17 wreck injured at least 25 people, but everyone got out before the bus was destroyed by fire. Herbst Gaming, not AWG, owned that bus.

A casino bus also was involved in an accident Sunday in Mississippi that killed three people and injured more than 30.

The bus belonging to Harrah’s Tunica was carrying 43 people when it overturned at an intersection in Tunica, authorities said. Rain was falling at the time but Mississippi Highway Patrol Sgt. Leslie White would not speculate on the cause of the wreck.

An additional, 77 more people diagnosed with hepatitis C might have been infected during treatment at a Las Vegas outpatient clinic, Southern Nevada Health District administrators said on May 8, 2008. The 77 people are among about 400 former patients of the Endoscopy Center of Southern Nevada who tested positive for the potentially fatal liver virus since an outbreak was made public Feb. 27, 2008.

After testing, they matched with patient lists and were interviewed, said Brian Labus, senior health district epidemiologist. Investigators can’t say for sure how the 77 people were infected, Labus said, but they know each was treated between March 2004 and Jan. 11 this year at the clinic.

“They have the obvious risk factor, but we can’t say for certain,” Labus said. “This is as far as we can go with these cases. We know they didn’t have a positive test before they went to the clinic, and now they’re positive.”

Health district investigators found no obvious exposure clusters like those found with seven acute hepatitis C cases linked by DNA testing to several dates last year at the Endoscopy Center of Southern Nevada. An eighth case was traced to a sister clinic, Desert Shadow Endoscopy Center.

Doctors Dipak Desai and Eladio Carrera, whose Nevada medical licenses have been suspended pending resolution of a state Board of Medical Examiners complaint, headed the clinics.

“This is the first of many of these types of reports that will come out when we have data,” Labus said. “There is no way to project how many people will test positive.”

Many people who tested positive for hepatitis C have yet to be interviewed, Labus said. Interviewers ask if each has a history of intravenous drug use, blood transfusions, organ transplants or kidney dialysis, if they received blood-clotting agents prior to 1987, or if they have had sexual contact with a person known or suspected to have hepatitis C.

Labus and Jennifer Sizemore, spokeswoman for the Las Vegas-based health district, said local labs have reported receiving about 50,000 hepatitis virus tests since officials issued a call on Feb. 27 asking former patients at the clinic to get tested for hepatitis strains C, B, and HIV, the virus that causes AIDS.

Authorities have said at least that many patients may have been exposed when clinic staff reused syringes and single-use vials of medication during anesthesia.

“Because the patient list we received was not complete, we cannot say for certain if all of the affected patients have been tested,” Dr. Lawrence Sands, chief district health officer, said in a statement released on May 8, 2008.

“The health district continues to receive a higher number of positive test results than we did before the notification in February,” he said, “which means people are getting tested and that is a positive outcome.”

Sands said patients who underwent procedures at the clinic in late 2007 or early 2008 will need to be tested in coming months because it can take up to six months for a positive test result to occur.

Labus said no cases of hepatitis strain B or HIV have been linked to the Endoscopy Center outbreak.

Las Vegas police seized medical records from the clinic, and the FBI, the Nevada state attorney general and the Clark County district attorney are all involved in a criminal investigation.

The owners of the clinics have surrendered business licenses and paid a total of $500,000 in fines.

Fourteen physicians and three surgery centers tied to the hepatitis C outbreak in Nevada have had their contracts suspended by three of Nevada’s largest health insurances providers.

Representatives of Anthem Blue Cross Blue Shield, Sierra Health Services and Cigna HealthCare said on March 27, 2008 that the contracts were suspended or terminated after they received information from the Southern Nevada Health District about six hepatitis C cases linked to one of the surgery centers affiliated with the Gastroenterology Center of Southern Nevada.

The Endoscopy Center of Southern Nevada is believed to have spread the potentially deadly blood-borne virus by reusing syringes and vials of medication.

Some doctors worry that taking 14 gastroenterologists out of the mix exacerbates a shortage of these physicians.

Assemblyman and doctor Joe Hardy estimated that the 14 doctors who worked within the Gastroenterology Center group represent more than one-third the gastroenterologists in southern Nevada.

He said the large practice served a majority of patients who had gastrointestinal problems.

“Without the 14 physicians, it’s going to be a real difficult time for patients in Las Vegas,” Dr. John Gray, a Reno gastroenterologist, told the Las Vegas Review-Journal.

Gray said his practice was contacted by a Sierra Health executive this week about providing medical services in Las Vegas.

According to the American Medical Association, Nevada has 2.5 gastroenterologists per 100,000 residents, well below the country’s ratio of four gastroenterologists per 100,000.

Sierra Health insures roughly 650,000 Nevadans between its Health Plan of Nevada, Senior Dimensions and Sierra Health and Life plans. Anthem Blue Cross Blue Shield insures 317,000 Nevadans. Cigna HealthCare insures approximately 100,000.

Leigh Woodward, a spokeswoman for Cigna HealthCare Arizona-Nevada, said the company issued termination letters to the Gastroenterology Center of Nevada group on March 3.

She said Cigna members have access to ambulatory surgery centers and roughly 30 gastroenterologists within 25 miles of the terminated endoscopy centers.

“We are aware that some gastroenterologists (not affected by the terminations) in Las Vegas are not accepting any new patients and that there is a capacity issue,” she said.

Though the majority of the physicians have privileges at most Southern Nevada hospitals, it is unclear if they are still practicing medicine. None have lost their medical licenses.

Dr. Dipak Desai, majority owner of the Endoscopy Center of Southern Nevada, has voluntarily agreed to quit practicing medicine. The other physicians within his group have been asked by Tony Clark, executive director of the state Board of Medical Examiners, to do the same. They have not agreed to do so.