Deficiencies found at Nevada ambulatory surgical centers

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Deficiencies found at Nevada ambulatory surgical centers

By PAUL HARASIM

LAS VEGAS REVIEW-JOURNAL

Hepatitis C Investigation

A state health division investigation undertaken after tens of thousands of

patients were advised last year to be tested for possible exposure to hepatitis

C at two Las Vegas ambulatory surgical centers found that more than half of 49

other such facilities in Nevada had “infection control type deficiencies.”

According to a draft report issued Friday on the state’s ambulatory surgical

centers, inappropriate use of single-use items such as syringes amounted to

nearly a third of the infection control deficiencies at 25 of the centers in

fiscal year 2008, while sterilization and disinfection issues accounted for

almost half.

“It concerns me when what is on the books (regulations) aren’t followed,” said

Marla McDade , chief of the state’s bureau of health care quality and

compliance.

While the report doesn’t spell out which surgical centers not connected to the

hepatitis outbreak investigation had deficiencies, Nevada Health Division

spokeswoman Martha Framsted said that by summer, all surveys done by the

division will be posted on a Web site for the public to examine.

What will help ensure that regulations are followed in the future is more

frequent inspections by staff surveyors, said. Eleven new surveyors

have been requested by the division, noted, which would allow all 1,100

state-licensed facilities — including nursing homes and group homes — to be

inspected every 18 months. She now has 34 surveyors and 14 supervisors who do

inspections.

Currently, guidelines set down by the federal Centers for Medicare and Medicaid

allow for seven years to lapse between surveys of ambulatory surgical centers,

she said.

“We want them (ambulatory surgical centers) to know far more frequently that

there are state standards that they must adhere to,” said.

In February of last year health officials revealed that authorities

investigating a cluster of hepatitis C cases had observed nurses at the

Endoscopy Center’s Shadow Lane clinic reusing syringes in a manner that

contaminated vials of medication and, they believe, infected patients.

A total of nine cases have been linked to two clinics owned by Dr. Dipak Desai,

and health officials have listed an additional 105 cases as “possibly related.”

As a result of the outbreak, more than 50,000 people were told to get tested for

hepatitis and HIV, the virus that causes AIDS.

The public health crisis has already spawned several bills by Nevada

legislators, including Senate Bill 70 and Assembly Bill 123, which call for

annual inspections of ambulatory surgery centers and certain physician offices

where surgical procedures require conscious, general and deep levels of

sedation.

said that if the Legislature believes an annual, rather than every

18-month, inspection of ambulatory surgical centers should be done, she isn’t

sure what number of additional surveyors will be needed on top of what she has

already asked for.

She did say, however, that since her agency is “fee funded,” the money for more

surveyors will come from increased licensing fees charged to facilities that

include nursing homes, ambulatory surgery clinics, group homes and hospitals.

said that in the past, state surveyors spent 70 percent of their time

inspecting the third of state facilities that CMS pays Nevada to certify and

inspect more frequently, such as nursing homes.

“I don’t know why that was done,” she said. “The priorities were wrong.”

She echoed what Whitley, administrator of the health division, wrote in

the executive summary of his agency’s 35-page report:

“While the health division was responsible for meeting its CMS contractual

obligations for Medicare initial certification surveys and recertification

surveys, the CMS surveys were not balanced with state needs. Despite what

happened in Nevada and is happening elsewhere in the U.S., CMS has not changed

its priorities to reflect more frequent surveys of ambulatory surgical centers.”

Contact reporter Harasim at pharasim@... or 702-387-2908.