Investigations Focus on Las Vegas Clinic in Hepatitis Exposure Case

LAS VEGAS (AP) - City officials denied a license revocation appeal, and police and Clark County prosecutors said they were investigating a medical clinic accused of shoddy injection practices that exposed patients to potentially deadly infections.

"This will be a broad-based investigation. We will be looking at every aspect which may involve criminal wrongdoing," District Attorney David Roger told the Las Vegas Review-Journal for a Tuesday report.

Clark County officials also pulled the business licenses Monday of three clinics affiliated with and managed by the owners of the Endoscopy Center of Southern Nevada, the clinic in Las Vegas at the center of the widening health scare.

The FBI and the Nevada attorney general's office also were probing practices at the clinic, while Senate Majority Leader Harry Reid, D-Nev., and federal Centers for Disease Control and Prevention chief Dr. Julie Gerberding condemned practices at the clinic.

"This should never happen in contemporary health care organizations," Gerberding told reporters on a media conference call. "This is the largest number of patients that have ever been contacted for a blood exposure in a health care setting."

Gerberding said the possible outbreak of hepatitis C because of unsafe practices at the clinic may represent "the tip of an iceberg" of safety problems at clinics around the country.

Nevada health officials have begun trying to contact about 40,000 patients who received anesthesia by injection at the Endoscopy Center of Southern Nevada between March 2004 and Jan. 11, 2008, to urge them to get tested for hepatitis C, B and HIV.

Southern Nevada Health District officials said last week they traced six cases of hepatitis C to the clinic, including five people who were infected on the same day. Genetic testing was used to make the connection, officials said.

Authorities said clinic staff members reused syringes, contaminating vials of medication, which risked spreading disease.

Hepatitis C can cause fatal liver disease as well jaundice and fatigue but 80 percent of people infected show no symptoms. Hepatitis B is a more rare and serious disease that attacks the liver.

Kathy Suey, a deputy Las Vegas police chief, told the Review-Journal that police investigators want to see health officials' findings before deciding whether to pursue a full-fledged criminal investigation.

"Right now we're looking at everything," Suey said.

Several civil lawsuits seeking class-action status have been filed against the clinic and its owners, and Nevada lawmakers have begun calling for wide-ranging state investigations and funding to help patients pay for recommended blood tests.

Assembly Speaker Barbara Buckley, D-Las Vegas, said state lawmakers want to ensure people can be tested whether or not they have insurance or can afford it. The clinic should pay those costs, but a plan is needed immediately to ensure testing is available, she said.

Assemblywoman Sheila Leslie, chairwoman of the Legislative Committee on Health Care, said she was "beyond appalled" by reports of medical practices at clinic. Her committee will meet Thursday in Las Vegas to review the case.

"If the medical staff did this knowingly, they should lose their licenses and be pursued criminally," the Democrat from Reno said. Leslie called the maximum $1,000 per violation fine that can be imposed by the state Board of Licensure and Certification "woefully inadequate."

Lisa Jones, chief of the Nevada State Board of Licensure and Certification, said FBI agents sought her department's investigative report detailing problems at the clinic.

The state attorney general's insurance fraud and Medicaid fraud units also have been reviewing the case, said Nicole Moon, spokeswoman for the department.

Clinic staff told health investigators they were ordered by administrators, principally majority owner Dr. Dipak Desai, to reuse supplies and medications to save money, according to a letter by Las Vegas Business Services Manager Jim DiFiore, who suspended the clinic's business license on Friday.

Dr. Javaid Anwar, president of the Nevada Board of Medical Examiners, said his agency needs evidence that a doctor is a threat to the public before suspending a medical license.

He said the board had not received information from its investigators identifying any violations by the doctors who ran the Endoscopy Center of Southern Nevada.

"Are those physicians posing potential harm to our patients at the center? We don't have the information from our investigators to make that determination," Anwar said.

Anwar said the medical board, nursing board and licensure bureau each have to finish investigations.

"We need to let them come up with what exactly is the problem. In the meantime, that place is closed."

(Copyright 2008 by The Associated Press. All Rights Reserved.)