Thursday, March 20, 2008 | 2 a.m.
A dizzying number of public agencies and private organizations are involved in the public health crisis that has resulted in 40,000 people being advised to seek testing for hepatitis B, hepatitis C and HIV.
The result is confusion when the agencies operate in isolation and public frustration when they focus on their own goals and are oblivious to the broader situation.
For example, people criticized the Southern Nevada Health District, which discovered the hepatitis C outbreak at the Endoscopy Center of Southern Nevada, for not shutting down the clinic. But the Health District is concerned with addressing the public health crisis, not deciding in the long run whether the clinic should stay open.
Similarly, officials from the state Licensure and Certification Bureau, which regulates the surgical center, said they were not concerned with the motivations of majority owner Dr. Dipak Desai.
Desai stands accused of causing the infection by telling nurses to reuse syringes and single-dose medicine vials to save the practice money. The public wanted the state to punish Desai, but licensure bureau officials say they always let clinic operators fix problems rather than close down a business.
Sometimes the agencies work together to accomplish common goals, as on March 10 when Metro Police, the FBI and investigators from the Nevada attorney general’s office and the U.S. Health and Human Services Department’s Office of the Inspector General served search warrants on six clinics related to Desai.
Other times, important details slip through the cracks because of a bureaucratic pileup, such as when Lisa Jones, chief of the Licensure and Certification Bureau, failed to notify the Nevada State Board of Medical Examiners about the investigation.
The medical board investigators found out the way many people did — by reading the newspaper — and that hampered their investigation.
What follows is a list of key players related to the health care crisis that started at the Endoscopy Center of Southern Nevada:
Law enforcement, justice system
• FBI: The agency is investigating the case for possible Medicare and Medicaid fraud.
• Nevada Attorney General Catherine Cortez Masto: Her office is investigating the case for signs of fraud at the clinic.
• Clark County District Attorney David Roger: His office is exploring possible criminal charges against clinic personnel. It also provided advice to the county Business License Department on license restrictions for three clinics.
• Metro Police: The department is investigating the Endoscopy Center for possible criminal wrongdoing.
• District Court: It has been flooded with lawsuits from former patients of the Endoscopy Center.
• Attorney Richard Wright and R&R Partners: They are the Las Vegas attorney and the advertising and public relations firm hired by Desai.
• Centers for Disease Control and Prevention: The Atlanta-based agency devised the medical protocols, including testing for hepatitis B and C and HIV, being recommended by the Southern Nevada Health District. Already, CDC chief Dr. Julie Gerberding has criticized the practices at the shuttered clinic.
• Centers for Medicare and Medicaid Services: The agency that manages government insurance for the poor, disabled and elderly is investigating Desai’s clinics for potentially fraudulent billing.
• U.S. Health and Human Services Department’s Office of Inspector General: The agency participated in the serving of search warrants at the Endoscopy Center and five other related clinics in the valley.
• Nevada Health and Human Services Department: It has provided oversight of the State Health Division and its various bureaus.
• Nevada State Health Division: It has provided oversight of its bureaus and has been in communication with the Southern Nevada Health District.
• Southern Nevada Health District: The agency, working with the state licensure bureau, investigated the hepatitis outbreak and sent out notices to 40,000 former Endoscopy Center patients urging them to get tested for the potentially deadly viruses hepatitis B and C and HIV.
• Congress: Rep. Shelley Berkley, D-Nev., has used the case to request a congressional hearing on medical clinics that employ flawed practices. Senate Majority Leader Harry Reid of Nevada also has sharply criticized the Endoscopy Center.
• Gov. Jim Gibbons: After downplaying the scope of the hepatitis case, the governor has asked for the resignations of three members of the State Board of Medical Examiners, along with its executive director and the head of the Nevada State Health Division’s Licensure and Certification Bureau.
• Nevada Legislature: The Legislative Committee on Health Care has taken testimony in the hepatitis case, and there is potential for legislative action during next year’s session with regard to health clinic licensing and inspections.
• Clark County Commission: It approved the actions of the county Business License Department.
• Las Vegas City Council: It voted to hold an April 7 disciplinary hearing against the owners of the Endoscopy Center.
•Medical boards, entities
• American Association of Nurse Anesthetists: In the wake of the Endoscopy Center case, it has urged health care professionals nationwide to use utmost care when performing or observing injections of patients.
• Nevada State Medical Examiners Board: The board is investigating the clinic to determine whether it should take any licensing actions or issue fines against the Endoscopy Center’s doctors. Desai, head of the Endoscopy Center, has voluntarily agreed to stop practicing medicine pending the outcome of the board’s probe.
• State Nursing Board: It is investigating the clinic to determine whether it should take any action against its nurses. Five nurse anesthetists already have voluntarily surrendered their licenses pending the outcome of the board’s investigation.
• State Board of Osteopathic Medicine: It also has launched an inquiry but has not disclosed the nature of that investigation.
• University Medical Center: The county-run hospital canceled its contract with Desai for gastroenterology services.
• Nevada State Medical Association: The association, which represents doctors, has expressed a willingness to work with the Legislature on initiatives that could arise from the Endoscopy Center case.
• Quest Diagnostics Inc. and LabCorp: They are the two major laboratories doing the bulk of testing on as many as 40,000 former Endoscopy Center patients for hepatitis B and C and HIV.
• Health care insurers: The companies have said they are providing coverage for insured members who have been advised to undergo testing for hepatitis B and C and HIV.
• Nevada Licensure and Certification Bureau: This health division bureau, which has authority over the Endoscopy Center’s state health clinic license, investigated the facility in January and fined it $3,000 for three deficiencies. The bureau presented the clinic with a plan for corrective action, but allowed it to remain open until it was shut down indefinitely by Las Vegas.
• Other Nevada health division offices and bureaus: The Office of Epidemiology; the Nursing Program; the Health Planning and Statistics Bureau’s Public Health Preparedness; and the Community Health Bureau’s Communicable Disease, Immunization and Chronic Disease programs have provided technical assistance.
• Clark County Business License Department: The county department, following the city’s action, initially suspended indefinitely the business licenses of three other clinics — the Desert Shadow Endoscopy Center, the Gastroenterology Center of Nevada and the Spanish Hills Surgical Center — owned by the medical group that runs the Endoscopy Center of Southern Nevada. The suspension was later revised so the medical group could perform administrative and consulting work but not invasive procedures.
• Las Vegas Finance and Business Services: This agency and its Business Services Division participated in the license suspension action.
• Las Vegas panel: A three-member panel consisting of City Manager Doug Selby, Finance and Business Services Director Mark Vincent and Business Services Division Manager Jim DiFiore voted to indefinitely suspend the Endoscopy Center’s business license.
• Las Vegas city attorney’s office: It provided legal advice on the city’s decision to indefinitely suspend the Endoscopy Center’s business license at 700 Shadow Lane.
• Henderson city attorney’s office: It provided legal advice on the city’s decision to suspend the business license of a Desai-owned clinic.
• Henderson Finance Department: The department and its Business License Division initially suspended the business license of the Gastroenteroloy Center of Nevada before Desai voluntarily surrendered the license.
• North Las Vegas city attorney’s office: It provided legal advice that led to a cease-and-desist order issued for Desai’s clinic in that city, the Gastroenterology Center of Nevada. The city ultimately allowed the business to do administrative work and consultations but not injections or other invasive procedures.
• North Las Vegas Finance Department: The department and its Business License Division participated in the city’s cease-and-desist order.
• North Las Vegas city manager’s office: It served in a consulting capacity.