A year later, hepatitis outbreak’s upshot

[Guest guest]

http://www.lasvegassun.com/news/2009/jan/09/year-later-hepatitis-outbreaks-upsho\

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A year later, hepatitis outbreak’s upshot

Nation has recommitted to patient safety; Desai is under investigation by

police, who source says are finding culpability

By Marshall

Fri, Jan 9, 2009 (2 a.m.)

Hepatitis scare

A year after the Southern Nevada Health District noticed a suspicious cluster of

acute hepatitis C cases, repercussions of the crisis — including the criminal

investigation of the doctor at the center of it — are coming into focus.

The outbreak led to the largest infectious disease scare in the country. Health

officials estimate 110 patients of a downtown Las Vegas endoscopy center were

infected with hepatitis C and 50,000 were urged to get tested for infectious

disease because the clinic staff reused syringes and single-use medicine vials.

A source familiar with the Metro Police investigation told the Sun that the

evidence shows that Dr. Dipak Desai, the owner of the clinic that spawned the

outbreak, the Endoscopy Center of Southern Nevada, was responsible for all the

factors that would have caused the outbreak. Desai, a former president of the

Nevada Board of Medical Examiners, controlled how procedures were performed, how

much time they took, how careful the staff was with patients and whether the

staff reused supplies designed for single use, the source said.

“All those factors were under his exclusive control,” the source said.

If that proves true, Desai could be held criminally responsible for the

outbreak, according to state law. He could face counts of criminal negligence, a

felony punishable by one to five years in prison for each count.

Desai’s attorney declined to comment.

Desai also faces a litany of civil lawsuits, investigations of possible billing

fraud and possible discipline by the medical board. He has been enjoined from

practicing by a court order. Other doctors and staff members at the practice are

also under investigation.

The hepatitis C outbreak sparked a national emphasis on infectious disease

prevention in nonhospital health care centers. A large part of the outrage

toward Desai was fueled by the assumption that it was rare — even unheard of —

for a clinic to practice such unsafe injection practices. Even Third World

providers don’t reuse syringes, many doctors exclaimed. It turns out, what

happened at the Endoscopy Center has happened enough in the United States to

alarm public health officials.

A study by Centers for Disease Control and Prevention researchers, published

this week in the journal ls of Internal Medicine, examines the troubling

trend of lax infection control standards by health providers. Health care is

increasingly being delivered in outpatient clinics and long-term care

facilities, and “in these settings, infection control resources and oversight

have traditionally been lacking,” the CDC reported.

There have been 33 identified hepatitis B and hepatitis C outbreaks in the past

decade in nonhospital settings, like the Endoscopy Center, the report said.

However, the outbreaks are notoriously difficult to track, so there probably is

a wider problem that demands immediate attention, the report said.

The outbreaks detailed by the CDC were most often caused by reusing syringes,

which contaminated medicine, and, in nursing homes, sharing diabetic fingerstick

devices and glucometers. The Las Vegas outbreak was far and away the case that

put the most people at risk, the report said.

Nicola , the CDC epidemiologist and the study’s lead author, said it’s

always a shock when health care providers fail to protect the public, but the

Las Vegas outbreak was especially noteworthy because of its magnitude. She said

the common thread among all the outbreaks is that they occurred in nonhospital

settings, which raises questions about whether licensing and regulation of the

facilities is adequate.

As a result of the outbreaks, Nevada will be the pilot site of a national effort

to educate patients and medical providers about injection safety standards. The

initiative will be officially announced in February.

[Guest guest]

http://www.lasvegassun.com/news/2009/jan/09/year-later-hepatitis-outbreaks-upsho\

t/

A year later, hepatitis outbreak’s upshot

Nation has recommitted to patient safety; Desai is under investigation by

police, who source says are finding culpability

By Marshall

Fri, Jan 9, 2009 (2 a.m.)

Hepatitis scare

A year after the Southern Nevada Health District noticed a suspicious cluster of

acute hepatitis C cases, repercussions of the crisis — including the criminal

investigation of the doctor at the center of it — are coming into focus.

The outbreak led to the largest infectious disease scare in the country. Health

officials estimate 110 patients of a downtown Las Vegas endoscopy center were

infected with hepatitis C and 50,000 were urged to get tested for infectious

disease because the clinic staff reused syringes and single-use medicine vials.

A source familiar with the Metro Police investigation told the Sun that the

evidence shows that Dr. Dipak Desai, the owner of the clinic that spawned the

outbreak, the Endoscopy Center of Southern Nevada, was responsible for all the

factors that would have caused the outbreak. Desai, a former president of the

Nevada Board of Medical Examiners, controlled how procedures were performed, how

much time they took, how careful the staff was with patients and whether the

staff reused supplies designed for single use, the source said.

“All those factors were under his exclusive control,” the source said.

If that proves true, Desai could be held criminally responsible for the

outbreak, according to state law. He could face counts of criminal negligence, a

felony punishable by one to five years in prison for each count.

Desai’s attorney declined to comment.

Desai also faces a litany of civil lawsuits, investigations of possible billing

fraud and possible discipline by the medical board. He has been enjoined from

practicing by a court order. Other doctors and staff members at the practice are

also under investigation.

The hepatitis C outbreak sparked a national emphasis on infectious disease

prevention in nonhospital health care centers. A large part of the outrage

toward Desai was fueled by the assumption that it was rare — even unheard of —

for a clinic to practice such unsafe injection practices. Even Third World

providers don’t reuse syringes, many doctors exclaimed. It turns out, what

happened at the Endoscopy Center has happened enough in the United States to

alarm public health officials.

A study by Centers for Disease Control and Prevention researchers, published

this week in the journal ls of Internal Medicine, examines the troubling

trend of lax infection control standards by health providers. Health care is

increasingly being delivered in outpatient clinics and long-term care

facilities, and “in these settings, infection control resources and oversight

have traditionally been lacking,” the CDC reported.

There have been 33 identified hepatitis B and hepatitis C outbreaks in the past

decade in nonhospital settings, like the Endoscopy Center, the report said.

However, the outbreaks are notoriously difficult to track, so there probably is

a wider problem that demands immediate attention, the report said.

The outbreaks detailed by the CDC were most often caused by reusing syringes,

which contaminated medicine, and, in nursing homes, sharing diabetic fingerstick

devices and glucometers. The Las Vegas outbreak was far and away the case that

put the most people at risk, the report said.

Nicola , the CDC epidemiologist and the study’s lead author, said it’s

always a shock when health care providers fail to protect the public, but the

Las Vegas outbreak was especially noteworthy because of its magnitude. She said

the common thread among all the outbreaks is that they occurred in nonhospital

settings, which raises questions about whether licensing and regulation of the

facilities is adequate.

As a result of the outbreaks, Nevada will be the pilot site of a national effort

to educate patients and medical providers about injection safety standards. The

initiative will be officially announced in February.