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FacebookHow hepatitis probe led to clinic
Old-fashioned legwork yielded clues that came together
Sam Morris
Brian Labus of the Southern Nevada Health District helped tie a cluster of hepatitis C cases to unsafe practices at the Endoscopy Center of Southern Nevada. Investigators were taken aback by what they witnessed at the clinic.
Sun, Mar 2, 2008 (2 a.m.)
A Professional Approach
There was no cause for alarm when, on Dec. 4, health investigators learned of a case of acute hepatitis C.
And there was no telling it would lay the groundwork for the largest health scare of its kind in the country — and possibly a criminal investigation into conduct that put 40,000 lives at risk.
Acute hepatitis C is contracted a couple of times a year in Southern Nevada, but the Southern Nevada Health District annually investigates more than 1,300 cases of other common ailments. So the initial acute hepatitis C report didn’t cause extraordinary concern when it crossed the desk of one of the six disease investigators. There were routine questions to ask the victim.
Interviews can be touchy because they’re so personal, and frustrating because they are often inconclusive. The investigator asked about new tattoos, blood transfusions, sexual contact — and then got what would later become a crucial clue.
Have you had any medical work done?
Yes, the patient said. A procedure on Sept. 21 at the Endoscopy Center of Southern Nevada.
The clue would remain dormant for weeks.
On Dec. 18, a second case of acute hepatitis C was handed to investigator Devin Barrett. It struck her as odd. Barrett, 26, who had been working at the Health District for three years, remembered the earlier case.
Hmmm ... what’s going on here?
“Anytime we get two unusual cases at the same time we’re definitely more curious to find out these risk factors,” Barrett said.
Barrett called the patient’s doctor to find out how to get hold of victim No. 2, then left a couple of messages for the patient. The patient returned the call Dec. 28, and Barrett conducted her interview.
Barrett was walking out to lunch when she overheard a colleague ask her boss for advice on the first hepatitis case. Where in the paperwork, she wondered, should she note that the patient had undergone a colonoscopy?
Barrett stopped in her tracks.
She told their boss, Epidemiology Supervisor Linda Verchick, that her patient had also had a colonoscopy — long known as a risk factor for hepatitis C transmission — on July 25. They realized both patients’ procedures were performed at the Endoscopy Center of Southern Nevada.
Bingo.
And there was a rush of relief, Barrett said, “because that means we can do something about it. We can stop it.”
Still, the two cases could be a coincidence, the investigators knew.
On Jan. 2, Senior Epidemiologist Brian Labus, 33, who holds a master’s degree in infectious diseases, learned of the “cluster” of cases.
Epidemiology is a science that focuses on the public incidence and outbreak of diseases. As a scientist, Labus is trained to conduct investigations using observation, interviews and records.
“If you get emotional about this, your judgment gets clouded and you can’t find the source to stop it from happening in the future,” Labus said.
That same day, Jan. 2, in between consultation calls to the Centers for Disease Control and Prevention, an e-mail arrived in Labus’ in-box.
“We got a third case,” it said.
This interview went quicker. The patient had undergone a procedure at the Endoscopy Center of Southern Nevada on Sept. 21, the same date as the first patient.
Labus called the state Licensure and Certification Bureau, which investigates ambulatory surgical centers such as the Endoscopy Center of Southern Nevada. They agreed to send investigators. The CDC would send two epidemic intelligence officers, both medical doctors, to assist.
The cause of the outbreak was still unknown. Maybe this was still a coincidence.
“You can’t just go on suspicion,” Labus said.
On the afternoon of Jan. 9 the 25-member Outbreak Investigations Team — compiled from the county, the state and the federal government — assembled at the Health District to map out a plan: Five of them would notify the endoscopy clinic’s administrators that it was the suspected source of an outbreak.
To deliver the news, they didn’t have far to go. The Endoscopy Center was across the street, on Shadow Lane — a street thick with medical services clustered around two of the valley’s largest hospitals.
The administrators and doctors were surprised by the news, Labus said. On paper, this was a top-notch endoscopy clinic — and maybe the busiest in Nevada. Its majority owner is Dr. Dipak Desai, a politically connected gastroenterologist, former member of the state medical board and a member of Gov. Jim Gibbons’ transition team in 2006.
The investigators’ mission: identify how the infection was spreading. It would be counterproductive, Labus would say later, to immediately close the clinic or order the staff to change its procedures in a wholesale manner because “we’d never find out what went wrong.”
The investigative team entered the clinic in full force the next day. Barrett was in the group that commandeered a conference room to cross-reference a log of clinic patients with a computer database of more than 20,000 known hepatitis C carriers in the county, to determine whether any recently identified carriers might have contracted it at the clinic.
The clinic performs 50 to 60 endoscopic procedures a day, so they started with the two days when the three patients were known to have been infected — July 25 and Sept. 21. Then they expanded to other dates. It took several days to compare all the patients, and more interviews had to be conducted to be certain they weren’t confusing chronic cases with new cases.
In the end, the team identified three more Endoscopy Center patients who had been infected with hepatitis C at the facility.
All three had visited the clinic Sept. 21.
The CDC doctors took the lead in observing the four certified nurse anesthesists in action in the two procedure rooms. Labus and Barrett assisted. What they saw, when announced later, seemed to enrage everyone who heard the news.
A nurse would administer an injection of Propofol, an anesthetic, to put the patient to sleep before a colonoscopy. If the patient started to wake up before the procedure was finished, the nurse would use a syringe to draw more of the drug from the vial, using a fresh needle — but reusing the syringe, allowing the vial to be contaminated with the patient’s blood.
And here’s how other patients would be infected: The vials were labeled as single-dose. One per patient. But nurses used that same contaminated vial to draw anesthesia for the next patient. And as vials were drawn to near empty, nurses would combine them to fill new vials — passing along any possible infection to still more patients.
Wide-eyed investigators could not intervene to stop the process because they needed to document every step without disturbing the nurses’ routine, for sake of the larger mission.
“If we shut it down, another place opens and they do the same procedure,” Labus said. “We had to look at the big picture. We had to think of the community in the long term.”
Nurses later told the investigators they were following the instructions of Desai and other managers. According to a City Hall letter that quoted investigators, Desai had ordered his nurses to engage in a life-threatening routine “in order to save money.”
The investigators spent about a week at the clinic, identifying the problem that led to the infections and ensuring that the flawed procedures — a violation of basic medical practices — were corrected. This is how the Licensure and Certification Bureau justified allowing the clinic to stay open.
Unresolved, though, was the task of calculating how many people might have been exposed to contaminated anesthetics. It became a math problem.
In March 2004, the clinic increased its volume by adding a second procedure room, Labus said. Logs showed that administrators bought medicine in bulk — in 20 cc or 50 cc single-dose vials. Going back to March 2004 it was clear that there were many more patients than vials of anesthetic. The conclusion: vials had been being reused for years.
Investigators concluded that 40,000 patients had anesthetic-required procedures since the facility’s expansion. And it seemed the practice that allowed patients to be infected with the blood of others had been in place the entire time. Unless they’re tested, most would never know they’ve been infected because symptoms, such as jaundice and nausea, appear in only one out of five cases.
So they issued the largest ever notification in the United States: 40,000 patients needed to be tested to determine if they had been infected by hepatitis B or C, or HIV, the virus that causes AIDS.
In two days, more than 5,000 frantic patients called the Health District’s hotline.
And on Friday, in the face of growing outrage over what had occurred at the Endoscopy Clinic of Southern Nevada, Las Vegas officials ordered the clinic shut and its business license suspended. The reason: The clinic owners were profiting by willfully endangering their patients.
Discussion: 31 comments so far…
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The Sun
Locally owned and independent for more than 50 years.
Not long ago an organization named "Keep Our Doctors in Nevada" pressured the Nevada Legislature into an emergency session and persuaded the Nevada citizens to vote for medical malpractice protection, all in the name of a phony "medical malpractice crisis." Dr. Dipak Desai and the Endoscopy Center of Southern Nevada were behind the Keep Our Doctors in Nevada group, shelling out at least $25,000 to buy protection from injured patients. As a result, medical providers, INCLUDING DR. DESAI AND HIS CLINIC, are protected by caps on damage awards. Does anyone now think $350,000 is adequate compensation for the pain and suffering that will be endured by any patient of Dr. Desai who contracts HIV/AIDS, Hepatitis B, or Hepatitis C?
Like many lawyers who represent injured medical patients, our law firm, Myers & Gomel, fought against the caps, and I can tell you this is precisely the type of situation we were concerned about when the doctors and their insurance companies used the "Keep Our Doctors in Nevada" fear campaign to achieve their selfish goal of protective caps. The truth is we shouldn't keep doctors like Dr. Desai in Nevada, and doctors like Dr. Desai don't deserve protective caps so they can practice sub-standard medicine with no fear of a jury's verdict.
This is a real "medical malpractice crisis," and it will not be the last one unless and until doctors like Dr. Desai can be held accountable in full for the pain and suffering caused by such blatant and irresponsible malpractice. Nevada voters should demand that the doctors' special shield laws be repealed and that they be treated like the rest of us.
WHAT? Do I understand this correctly? I hear the writer and the CDC explaining that the investigators could do nothing but watch the nurses contaminate vials as they prepare a patient for surgery so that they could learn the extent of problems at the clinic. Am I the only one screaming WHAT? WHAT? WHAT? I totally understand the need for an investigation, but to watch them prepare for more surgeries this way and LET THEM continue on with the surgery and inject the unsuspecting patients for surgery so that they could learn more or what else they may be doing to contaminate. Did this really happen? AM I UNDERSTANDING THIS CORRECTLY? Have those particular patients been documented, advised and/or immediately treated for anything they may have been cross contaminated with? Somebody please tell me or define the purpose of the Southern Nevada Health District. I thought it was to protect the public of health related issues and disease control.
Myers and Gomel. The average citizen needs the how to. Who do we go to, to make this demand. Do we do it by mail, by telephone calls, or calm and peaceful protests?
Exactly Snippy! The thought that unsuspecting patients were injected while ivestigators looked on for the sake of "the bigger picture" is mind boggling. So...they are writing these poor souls off as collateral damage because it serves the need of the community? Sounds like the investigative practices need a hard looking at as well.
I am still waiting for results and i am so scared. I went in October 06.I am so angry about this, I have never been a needle user or had multiple partners. I have always been a safe girl. I went to have a colonostopy because my mother has pre cancerous polups. If I have anything I will be a mess. But I will make sure my kids will be ok$$$$$$$$$$.
Oh my God!!! Where is our governor? Where are the Federal Authorities? Do you know what this means to us as citizens? We are number one on the terrorists list to attack in one way or another. If one of our own protective government entities is capable of doing this, where on earth do we pull faith from that they will be there to protect us? What about all the emergency preparedness we have been hearing about. It didn't sound like they were even under the gun or rushed in any way, but they let our citizens go down with the ship. I am at a total loss. What is a person suppose to do with that. I feel sick to my stomach. Why am I paying taxes again? It's just a vicious money hungry cycle isn't it. You know, I felt a little ill when I heard they didn't close the Endoscopic Center down. If it wasn't for the Mayor and a few select others, the Endoscopic Center of Southern Nevada would have gotten away with it with only a few insignificant lawsuits. Insignificant because as the laws are, the victims can only sue for up to $50,000 medical malpractice. The Health Department was willing to let it slide with as little as a slap on the wrist and open trust that they just wouldn't do it again. This has got to be another.... its all about who you know.
As an EMT and future RN, I am outraged by this blatant disregard for patient safety. I understand it is easy to blame the clinic's owner or medical director, but I feel that the RN/CRNA's (nurse anesthetists) involved should be down right ashamed of themselves. Whether an RN anesthetist or even an MD anesthesiologist, they have the responsibility of having the patient's life in their hands while the patient is under. It is shocking, and shameful, to hear that any licensed professional would knowingly take orders from a clinic manager, owner or whatever which would put people's lives in danger just to save a few bucks.
Shame on those nurse anesthetists. If I were one of the people involved, I strongly urge you to report the RN/CRNA's involved in your care to the proper state nursing boards so that they may be disciplined for their role in this shameful practice. How could this have been allowed to go on for 2+ years without any one of them speaking out about such an obviously unsafe practice?? This is terrible.
For information on the Nevada State Nursing Board's disciplinary and complaint process, go to:
http://www.nursingboard.state.nv.us/dact...
Wow , so let me get this clear. While they keep injecting this for days and these people kepy watching just for their professional glory. If he saw one or two cases was that not enough. Something very Fishy is going on..........
Double whammy. First it's the doctors and the state and now it's these blood sucking parasites(lawyers). This Myersand gomel comment(same comment) is on every BLOG. Are they advertising themselves and using a back door entry at people's expense.Blood sucking parasites.
people are being told that they were exposed through the 11th. it sounds like the team started investigating on the 10th. so in like 24 hours they picked apart an entire medical clinic and fixed a problem that had existed for 4 years so that no one else got sick. 24 hours? i wish the lines in the DMV moved that fast.
This is outrageous! What went on in this clinic is something that anyone in their first year of medical school would immediately know is WRONG. It just isn’t done. Not only were they reusing the syringes and the vials, they weren’t even cleaning the colonoscopy equipment properly. This isn’t a lapse in procedure; this was done to improve the bottom line at the expense of the health of these trusting patients and possibly something that could lead to their death. That is called criminal! I’m amazed that for now the line is being drawn at 2004 to 2007. Do you honestly think that these doctor(?) who are so driven by the almighty dollar weren’t cutting corners back in 2000/2001 whenever they first opened? What don’t we know? The facility is not a hospital, it is a clinic, and upon investigation it should have been shut down right then and not just corrects the problem. Was the County Health Department concerned about this so called doctor being so politically connected and I would think wealthy? I have to wonder how they could have gotten away with this for so long. The County Health Department inspects restaurants, does the County Health Department not inspect clinics and hospitals. If they do, they really dropped the ball and I’d like to know why. Maybe we need a change in management and thinking down there in the Health Department since they allowed the citizens of the community to be victimized so they can investigate, while it is as clear as the nose on a first year medical students face what happen. I commend and thank the City of Las Vegas for stepping up to the plate and doing the RIGHT thing by yanking the facilities license. Now when is the County going to step up to the plate and do something about their sister facility on Burnham (in the County), which was also reusing vials as reported in the paper today. Even one life ruined is too much. Not only should the doctors be criminally charged but any of the nurses and anesthesiologist who went along with this stupid policy should be charged. They shouldn’t even be allowed to continue to practice. None of them should be allowed to practice ever again. They can't be trusted. They should publish all their names in the paper so we all know who they are. I don’t know how these people live with themselves. Now I must wait for my results to come back.
I still don't see why the patients on the 11th needed to be exposed while the CDC just watched in order for the CDC to complete their investigation. I wonder how those patients would feel about it they find out they have Hepatitis or AIDS.
I am a one who administers propofol. My comments:
Hepatitis C is carried by 1-2% of the population, so that might give some measure of risk to others. Any one room would likely have no patients with hepatitis C on any given day.
Hospitals are scrutinized to a much greater extent; they would not get away with doing something like this as a matter of policy. Of course, not having to follow strict procedures keeps outpatient center costs lower. Some of the rules imposed on hospitals do not contribute to safety, some do.
The nurse anesthetists are likely employees of the clinic or functioned like an employee as far as making the rules of how the work was done, that's inherently a compromising situation if you are told to do something by your boss. It's not clear who the boss was here, the doctor-owner or a clinic manager. This procedure is so bad I am a little surprised that the nurse anesthetists did not do things correctly once they saw inspectors present.
Propofol in a 50 cc vial is a vial size is a larger than needed vial size for this procedure ( depends on the procedure length, although they seem to be short based on the patient volume and the number of procedure rooms). Propofol supports bacteria growth very well and mixing vials might also place patients at risk for bacterial infections, including sepsis.
I can understand the observation team not interfering with the procedures and I would understand the big picture could include finding something else other than propofol contamination that might apply to other facilities, Another poster made an inference that the procedure was corrected on the 11th, and I would say this was fast action.
There is another story about the use of multiple dose vials. The risk of cross contamination would be zero for multiple dose vials if proper procedure of only entering a multiple dose vial with a never used syringe and needle ( never used means not used even on the current patient.) Propofol does not come in a multiple dose vial.
snippy, i can understand your concern for the patients on the 11th. i dont think anyone involved wants to see people infected including the people who were doing the inspections. im sure it wasnt an easy position to be in. at the same time, if they had said something to the nurses or doctors right then, they might never have found the problem. no one would ever know, and thousands more people could be infected.
lvlights - sorry to hear that you are on the list. if you read some of the other stories about this, you will see that the health department doesnt inspect this place. some group from the state called BLC(?) does. it doesnt matter who inspects it tho. the doctors have to do the right thing even when no one is watching. and the state cant just close them down because they want to. like the guy in the story said, they cant just go on suspicion. the doctors connections werent strong enough to stop anything. the health department managed to tell 40000 of his patients that they were infected, and oscar closed em down.
I'm sorry Jalan but if it were you that were infected with something in this manner, I think you would feel differently. I truly feel... they found that to be a huge problem. They should have stopped the procedure, cleaned up the equipment and proceded on with their investigation. They could have done this without saying why or showing any concern if they just didn't want the nurses to know anything. I hardly think the nurses would do anything different that what they were doing anyway for fear of doing something new or different wrong and getting sited for that. For the inspector to be standing right there and for them to do the syringe and vial WRONG right in front of the inspector leads me to believe they wouldn't have hid anything further. I mean even non-medical people know not to contaminate by reusing needles, etc. Do you work for the CDC? I don't write this to be argumentative. I just believe it was unnecessary and if we just except this, what the hell do we have to look forward in our future healthcare.
As horrifying as it is to watch *possibly* contaminated vials being used, the investigators COULD NOT stop the procedure because OTHER THINGS could have been happening to cause the hepatitis infections. Possibly WORSE clinical acts could have been in practice. Syringe re-use is criminal, but stopping the investigation at that point would be like arresting somebody for child porn and thinking you're done, but there's a cage full of children in the basement.
I have been stunned, angered, scared, in a state of disbelief since learning of the exposure thousands of people who are someone’s sisters, fathers, mothers, brothers, uncles, aunts, friends, sons, daughters, nieces, nephews, grandmothers, grandfathers faced this past week.
Greed, stupidity, fear of losing a job are some of the reasons which will come forward but I am having the most difficult time with wrapping my head around this:
The investigative team entered the clinic in full force the next day. Barrett was in the group that commandeered a conference room to cross-reference a log of clinic patients with a computer database of more than 20,000 known hepatitis C carriers in the county, to determine whether any recently identified carriers might have contracted it at the clinic.
Wide-eyed investigators could not intervene to stop the process because they needed to document every step without disturbing the nurses’ routine, for sake of the larger mission.
“If we shut it down, another place opens and they do the same procedure,” Labus said. “We had to look at the big picture. We had to think of the community in the long term.”
I wonder about those moments when Labus and Barrett looked into the eyes of the person lying on the table, about to get that injection, had it been a relative or friend of theirs, would they only have been capable of being Wide-eyed or would they have done what they should and stopped the procedure.
Their logic reminded me of Star Trek The Wrath of Khan - Don't grieve, Admiral -- it's logical: the good of the many outweighs --
... the good of the few... Or the one.
Each and every person who was treated at that clinic deserved better, The people who were at that clinic on Jan 10 while Labus and Barrett assisted have to live with knowing that help was there, just not for them.
Here's something pretty interesting - I am checking to see if there are any other things people should be hecked for and went looking for a list that the State of Nevada monitors - when I found this right on their website - Notice the word vacant?
http://health.nv.gov/index.php?option=co...
Public Health Preparedness Home
Vacant
Program Manager
4150 Technology Way, Suite 200
Carson City, Nevada 89706
Public Health Preparedness (PHP) at the Nevada State Health Division has a unique role in public health emergency preparedness and response. This website is a one-stop preparedness resource center, with consistent, up-to-date information and tips to help Nevadans prepare for a public health emergency.
This website is supported by the Nevada State Health Division through Grant Number U90/CCU916964-05 from the Centers for Disease Control and Prevention (CDC). Its contents are solely the responsibility of the authors and do not necessarily represent the official views of the Nevada State Health Division nor the CDC.
I hold the nurses who were ordered by their bosses to reuse vials and syringes as much to blame as the bosses. They are medical professionals. Lets hope all involved are given jail time and never allowed to work again in this state. And while we are at it, send that piece of garbage Desai back to India.
I am still appalled and disgusted. I am still keeping all victims in my thoughts and prayers. Keep talking and speaking out, it is your voices that need to be heard. These victims were VIOLATED. Bottom line. Here are the words of my Aunt whom had a procedure back in 2006:
In her own words, my Aunt faxed this to me today...
"On Wednesday 09-06-06, I went to the Endoscopy Center of Nevada at 700 Shadow Lane for a colonoscopy. Dr. Depak Desai did the procedure. I was sent home in pain after the colonoscopy and through the entire night, I huddled in severe pain. The next day I called the Center and they told me to go in for a belly x ray. I went to the local hospital for all the scans, and they informed me my bowel had been perforated during the procedure. At midnight I was taken by ambulance 65 miles into Las Vegas for emergency surgery, and in the wee hours of the morning a colostomy bag was inserted. I then spent 3 days in ICU, more time in the surgery unit, then on to a rehabilitation hospital. I finally returned home on 09-23-06. I spent a year of pure hell, until another physician was able to reverse the colostomy.
My husband and I contacted the malpractice carriers, and were told sorry, too bad, and also a physician that did not see me gave information, that I believe was inaccurate. Where are the ethics? No attorney would take my case, more I am sorry's, too bad etc. Now that I read all the stories, look at the possible greed involved, and palm greasing, the doctor was very well protected. WHO PROTECTS US, THE VICTIMS, THE PATIENTS. WHO PROTECTS OUR RIGHTS?
Now on top of everything I have gone through, I have to worry about what could have been contracted through more negligence.
I am sorry is not enough this time."
Please people, for yourselves, families, etc., get together, keep the talking, start petitions(both for criminal charges, and financial compensation), the support you are giving each other, the prayers going.
"illsaywhatsonmy mind"...I read with shock your aunt's fax to you. Please tell her my thoughts are with her tonite and I am so glad that she found a doctor to repair the damage Desai did. I was also a patient of the clinic, as an overflow from HPN but only 1 or 2 of the 5 or 6 procedures I had while "under their care" was at their clinic. 1 or 2 too many as it seems. I spent a sleepless nite waiting for my lab results and wait some more. When HPN took me back under their fold, the first thing my new doc said to me was "I'm gonna make you better". What he did do was take me away from more chances of Russian Roulette!
thank you imsuzie2, i have relayed your kind words.
and i was laughing with you too on the posting by kerla
Dr. Dipak Desai, I would say it is safe to say your medical opinions or advice are no longer wanted. And your patients WERE exposed, NOT may have been, quit playing with words and stand up and be accountable for your actions. You are a cheapskate, at least be man enough to admit it.
To: mctree
How can you possibly say
"I can understand the observation team not interfering with the procedures and I would understand the big picture could include finding something else other than propofol contamination that might apply to other facilities, Another poster made an inference that the procedure was corrected on the 11th, and I would say this was fast action."
You could seriously understand if you or someone you love was lying on that table while the Health Department looked on, "WIDE-EYED"?
I can not understand it - it makes absolutely no sense whatsoever when one human being was in that room and could have stopped the needle from entering another human being. They already saw one of the sources of contamination happen when the syringe or vial was being re-used. They certainly did not need to see it injected into someone and then go to lunch, according to the latest report, before they said anything about not doing it.
Some perspective is in order: The 2nd case of hepatitis was Dec 18. The patient was interviewed Dec 28 - 10 days later. It was another 13 days before the clinic was inspected. 23 days had elapsed since the reporting of the second case. I don't have enough detail in the story to know when the practice was stopped once the syringe reuse became known. The time appears to be a day and overall that appears to be fast compared to the other steps. I may not have some knowledge of the events that others have.
It may have not have been obvious syringes were reused early in the inspection, or how the inspectors came up with the information, by observation or by interview. Frequently the rooms are darkened. An inspector may have followed the path of the endoscope or cleaning procedures in the room without catching on to what was happening with the syringes. Was the information present only at the end of the day (from interview or collaboration with another CDC inspector)? Were the inspectors looking at the procedure from another room? When was the syringe reuse stopped? I have not seen the details.
I just comment the CDC inspection resulted in a practice ending in around one day compared to 23 days to make the inspection happen. I consider that the CDC did a good job. Part of the "big picture" is getting the right people to do the inspection; this took days. Consider the result if an inspection missed the cause, or found a deficiency that was not the cause, so that the real problem went unchecked and patients continued to get infected.
Obviously I would hope no one was infected on that day, but would not all of us wish that the inspection occurred one day earlier, one week earlier, or a month earlier? While it is likely no one got hepatitis on a single day; it is quite possible that over a month it happened.
First, I worked in endoscopy for over 20 years. I am floored that this physician was able to perform 50-60 procedures per day with just 2 procedure rooms. We allowed a minimum of one hour per patient, to allow for anesthesia, the procedure, clean up, patient stabilization, and to allow for high level disinfection of endoscopes (takes 40 minutes at least if done correctly)
By using certified nurse anesthetists, he is sure that patients are completely 'out', not aware of their surroundings, and can be moved in and out so quickly. (I'd like to say like cattle) They know more than the average nurse, but even the average nurse knows how anti principled their techniques were. Patient advocacy was not in control here, and for that, they deserve the worst they can get. No amount of pressure will drive an ethical empathetic nurse to these actions.
I would absolutely suggest that an authority look into the cleaning techniques of the endoscopes. They need to be dismantled as much as possible, all parts scrubbed with a cleaning solution to remove particulate matter, then rinsed and soaked in a highly disinfectant solution for close to an hour after each use. With the patient volume suggested, and the penny pinching attitude that prevailed, I wonder if the nurses were allowed adequate time for scope disinfection, or did they reuse these also from one patient to the next? Did the clinics spend adequate funds to purchase high pressure cleaning/soaking machines (the standard today)?
With the lady who suffered a perforation--I am not surprised with this. Although a perforation can occur with the best performed endoscopies, this kind of volume invites disaster. Was the object to perform safe endoscopies with efficacy, or was the object to run as many patients through the clinic as possible?
As a registered nurse that has worked for years giving conscious sedation to endoscopy patients, I am having a very hard time wrapping my head around the fact that these nurses would be willing to compromise their patients safety for any reason at all. We are the final advocate for our patients and I just can't believe that such gross negligence could occur in the name of greed and cost cutting - I am wondering if these nurses were given bonuses or other compensation if the clinic made a certain amount of money - ANYTIME you throw extra money into the mix - you run the risk of this type of negligence
I fully agree with moscati re: bio-terrorists!
My husband went for a colonoscopy to the Burnham clinic in Nov 2007. Thank God all came back clear on the test. UNTIL this week.
Now we sit in "terror" waiting for his blood results to come back, which he took yesterday at our local drs office.
My heart and prayers are going out to everyone that is a part of this living nightmare.
I blame not only the drs that own these clinics, but even more so I blame the nurses, drs and anyone that "knowingly" used dirty syringes etc,,
Let's face it,,,they are the ones that fired the fatal shot, the owners gave the word and they re: those who intentionally did this due to their own lack of morals, ethics, common sense, etc,,are even more guilty then the one that said lets save some money.
There is NO EXCUSE whatsoever and I believe that anyone who did this should be fully prosecuted to the full extent of the law.
What makes "them" any different then the terrorists we are fighting in Iraq? At least we can see them and are trained to fight our enemies and do it well.
All it took was for 1 person that knew of this disgrace in the clinic to make a call, without giving their name and this could of been prevented.
I know that God will be the final judge on these people.
With hope and prayers to all who have or are suffering now with these diseases, and are waiting for the "results" may God Bless you with HIS PEACE during this time of bio-war in our valley.
This is OUTRAGOUS I just learned that one of their offices has been allowed to reopen oh but theyre not allowed to use needles give meds and such! WHO cares why should these people be able to go on with their everyday lives while the rest of us wait in sleeplessness for our test results (which by the way does anyone know how long it takes to get the results) They should be shut down and prosecuted this is outrageous! I can not believe our system!!
and now come to find that they can only be sued for 350,000 I hope enough people sue them to put them out of business and out of theyre comfortable life syles for the rest of theyre lives!! does anyone know how we can do that?
BMDinLV
From what our personal Dr told us it takes approx. a week to get the results back from the time you have your blood drawn.
My husband asked if it would take longer being there are so many of the tests being done they said NO due to the volume Quest and other places are going to be working 24/7.
I know what you are going through waiting for the results,,,,if there is anything any of us can do to help all those that are waiting to hear, or who are diagnosed I am more then willing to help out.
Also pacing and wandering around in circles waiting for the phone call.
All that is keeping me sane if that is what you want to call it ,,more like a shock,, at the moment is knowing that I do have a relative that has HIV and also a dear friend that caught the HEP C from one of these clinics a few years back,,and both are doing great.
The big miracle can only come from God,,,,and am in prayer for all those that are affected.
Hope your tests come back negative.
I have a couple of horses in this race.
Personally, I have a brother in the at-risk group, having had diagnostic GI procedures in Las Vegas.
Professionally, I am an anesthesia provider who uses propofol daily. I do not reuse syringes, not even on the same patient, not ever.
McTree observed: "The nurse anesthetists are likely employees of the clinic or functioned like an employee as far as making the rules of how the work was done, that's inherently a compromising situation if you are told to do something by your boss. It's not clear who the boss was here, the doctor-owner or a clinic manager."
I respectfully disagree. The PATIENT is the boss. The PATIENT, or others to whom s/he has entrusted the responsibility, is who is signing my paycheck. The "customer's" best interest might be served well by saving money and by hastening throughput in the clinic by cutting corners, but the PATIENT's best interest is not thus served.
Two MINUTES for a colonoscopy? What is that, the "lightning round"?
There is no justification for using contaminated medications on a patient. None. Zero, zip, nada.
Jim