How the culture of cost-cutting in Nevada’s capital contributed to the Endoscopy Center scandal

By Jon Ralston

Sunday, March 9, 2008 | 3:01 a.m.

If the world as we know it were to come to an end, we always knew it would start here.

I have visions of a Crichtonesque warren of underground laboratories, with a team of scientists racing against the clock to find the right strain of hep C, while overhead Dustin Hoffman and Cuba Gooding Jr. are helicoptering for help before the Big One is dropped on Las Vegas, thus saving the world from infection.

So many story lines — some old, some new — have intersected since word first broke nearly two weeks ago of The Great Hepatitis Scare of 2008 that some kind of apocalyptic climax hardly seems unlikely after the frenzied fortnight.

This is a national, nay, international embarrassment for the state and its most famous city, a toxic mixture of questionable medical practices, illogical governmental regulation, opportunistic political posturing and media sensationalism. And the current, horrifying state of affairs, as federal inspectors alight here and every agency imaginable has launched an investigation, finds too many valley residents frightened they have contracted potentially fatal diseases and too many afraid to go for tests (colonoscopies or other procedures) that could save their lives — if they can even find a specialist who can schedule them.

Attorney Will Kemp was the first to invoke the “Third World” analogy to describe the medical practices at the Endoscopy Center of Southern Nevada, and Health District epidemiologist Brian Labus went him one better, saying they would have to be bumped up to make it to Third World status.

Hackneyed it may be, but it is an all too apt metaphor for a state where social services are derided as a luxury, regulation is considered a dirty word and politicians are skilled at ex post facto fulmination but deficient in progressive foresight.

My guess — and fervent hope — is that despite the hyperventilation by too many media folks and too many politicians, very few people will have been infected at local clinics. But based on what already has been discovered — ambulatory surgical centers (50 in the state) are inspected only every three years and regulatory divisions of the state are grossly underfunded and always the first victim of budget cuts — that will be as much luck as anything. (And what of practices at hospitals, doctors’ offices, dialysis centers? We’ll get there eventually.)

Nevada is a Third World country when it comes to most serious funding issues, be it schools, roads or medical clinic oversight. And at some point, as I have been haranguing for years, the infrastructure would begin to buckle — and will break if too many “no new taxes” and “let the market decide” brains populate Carson City. Welcome to that moment.

No new taxes (or fees) have reduced the number of inspectors — the Legislature actually had to reinstate what the governor cut — and the market has decided that if health care facilities need to cut corners, government has no imperative to keep track. Perhaps more inspectors wouldn’t have caught these unsafe procedures at the Endoscopy Center and God knows where else — but it certainly would have dramatically increased the likelihood that they would have been detected earlier.

All of this is par for this Third World course.

“We are already one of the worst states in the nation in terms of access to health care,” Health and Human Services Director Mike Willden lamented in a conference call with reporters Friday as he announced other clinics would be cited.

Doctors, nurses, other trained professionals who knowingly put patients at risk — that’s the easy part of the story. If that can be proved, they will lose their licenses, their livelihoods and, maybe, their freedom.

But let’s assume for the sake of argument —and sanity — that kind of attitude does not pervade the state’s medical system, ridiculed for so long but enhanced in recent years by new facilities such as the Nevada Cancer Institute and the Lou Ruvo Brain Institute. As state epidemiologist Dr. Ihsan Azzam told me, as puzzled as he is by these discoveries, he doesn’t believe any of it was intentional.

“It is about what you know and what you do,” he said of practices such as reusing syringes. “How many of us know we need to wash our hands? And how many do?”

Maybe if the state devoted more resources to ensuring antiseptic procedures in health care facilities — and this is a microcosm in our Third World — we wouldn’t see so many Pontius Pilates now, from the politicians to the regulators to the medical community, trying to claim clean hands.