CDC Warns of Safety Problems at Clinics

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CDC Warns of Safety Problems at Clinics

By ERICA WERNER – 4 days ago

WASHINGTON (AP) — An outbreak of hepatitis C at a Nevada clinic may represent "the tip of an iceberg" of safety problems at clinics around the country, according to the head of the Centers for Disease Control and Prevention.

The city of Las Vegas shut down the Endoscopy Center of Southern Nevada last Friday after state health officials determined that six patients had contracted hepatitis C because of unsafe practices including clinic staff reusing syringes and vials. Nevada health officials are trying to contact about 40,000 patients who received anesthesia by injection at the clinic between March 2004 and Jan. 11 to urge them to get tested for hepatitis C, hepatitis B and HIV.

Senate Majority Leader Harry Reid, D-Nev., met Monday with CDC head Dr. Julie Gerberding, and on a media conference call after their meeting both strongly condemned practices at the clinic.

Health care accreditors "would consider this a patient safety error that falls into the category of a 'never event,' meaning this should never happen in contemporary health care organizations," said Gerberding.

"This is the largest number of patients that have ever been contacted for a blood exposure in a health-care setting. But unfortunately we have seen other large-scale situations where similar practices have led to patient exposures," Gerberding said.

"Our concern is that this could represent the tip of an iceberg and we need to be much more aggressive about alerting clinicians about how improper this practice is," she said, "but also continuing to invest in our ability to detect these needles in a haystack at the state level so we recognize when there has been a bad practice and patients can be alerted and tested."

Reid said he would work with Gerberding to try to get the CDC more resources in an emergency spending bill Congress is to take up in April.

State health officials said they weren't sure how many of the 40,000 patients they'd been able to contact since making the risk public last Wednesday. At least initially they didn't have correct addresses for 1,400, officials said.

The head of the clinic, Dr. Dipak Desai, purchased space for an open letter in the Las Vegas Review-Journal on Sunday in which he expressed "my deepest sympathy to all our patients and their families for the fear and uncertainty that naturally arises from this situation."

Desai offered no apology but said a foundation was being set up to cover testing costs. He also defended practices at his clinic, which performs colonoscopies.

"The evidence does not support that syringes or needles were ever reused from patient to patient at the center," Desai wrote.

A spokeswoman, Nancy Katz, declined Monday to comment further.

The Clark County district attorney is investigating, as are various health agencies, including the Nevada State Board of Nursing. Several lawsuits already have been filed and a hearing is scheduled for Thursday before a Nevada legislative committee.

It may never be known how many people contracted hepatitis C because of unsafe practices at the endoscopy center, state health officials said. Brian Labus, head epidemiologist of the Southern Nevada Health District, said that because 4 percent of the population has hepatitis C, he expects to get numerous positive results after the at-risk clinic patients are tested and it may be impossible to determine which of those were infected at the clinic.

Of the six cases that health officials did trace to the clinic, five of them happened on the same day and genetic testing was used to make the connection, Labus said.

Hepatitis C can cause fatal liver disease as well jaundice and fatigue, but 80 percent of people infected show no symptoms. Hepatitis B is a more rare and serious disease that attacks the liver.

Meanwhile, state health officials are still looking at a second clinic with connections to the first, called Desert Shadow Endoscopy Center. At Desert Shadow, officials had been found to reuse anesthetic vials but not syringes and so far no patients have been notified of potential risk. That determination could still be made, said Lisa Jones, head of the Nevada State Health Division's bureau of licensure and certification.

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More Nevada Surgery Clinics to Be Cited

By KATHLEEN HENNESSEY – 18 hours ago

LAS VEGAS (AP) — A statewide inspection of outpatient surgery centers like the one believed to have spread hepatitis C to its patients has uncovered dangerous practices at four other clinics, a health official said Friday.

The state swore to quickly inspect all 50 Nevada outpatient surgery centers after it was discovered the Endoscopy Center of Southern Nevada spread the blood-borne virus to at least six patients by reusing syringes and sharing vials of medication.

Of the 18 clinics inspected by Friday, three in northern Nevada and one in Las Vegas will be cited and fined for improper disease prevention techniques, state health division chief Mike Willden said.

Willden said there was no evidence that the clinics were responsible for any outbreaks of disease.

The Gastrointestinal Diagnostic Center in Las Vegas will be cited for repeatedly reusing syringes, he said. Willden could not say whether the center also reused medication vials. Clark County pulled the center's business license, shutting it down shortly after the announcement.

Willden said the Digestive Health Center in Reno had problems with sterilization of equipment, but he did not elaborate.

The center did not immediately return a call for comment.

Dr. Dennis Yamamoto, a partner at the Digestive Health Center, said the infractions found at his clinic were "not even close" to those discovered at the Endoscopy Center.

"We have every confidence that we didn't do anything wrong in the sense of putting any patient's health at risk," he said, adding that the practice in question had been stopped. "They said don't do it, so we don't do it."

At St. Mary's Surgery Center at Galena, inspectors found problems "with the lack of high-level disinfection or sterilization of instruments used between patients," Willden said.

"There have been no known cases of infection from any of our patients, but we encourage anyone who is concerned about their treatment to contact their doctor for appropriate follow-up care or treatment," St. Mary's Center said in a statement.

A staff member at the Sierra Center for Foot Surgery in Carson City reported reuse of syringes. The clinic did not respond immediately to a request for comment.

The FBI is investigating possible Medicare fraud at the Endoscopy Center of Southern Nevada, Rep. Jon Porter's spokesman, Matt Leffingwell, said.

The FBI does not comment on open investigations. The Southern Nevada Health District said it would not confirm the conversation between the congressman and its chief, Dr. Lawrence Sands, for the same reason.

At issue is whether the surgical center may have billed the federal Medicare program for 30-minute appointments that did not last that long, Leffingwell said.

A spokeswoman for Nevada Attorney General Catherine Cortez Masto said the state is also investigating whether the practices may have resulted in insurance or state Medicaid fraud.

"We're looking at whether they billed for two vials and only used one," spokeswoman Nicole Moon said.

Six cases of acute hepatitis, a potentially deadly virus that attacks the liver, have been traced to the Endoscopy Center. Nearly 40,000 patients have been notified that they are at risk and should be tested for hepatitis B and C and HIV.

The clinic has been temporarily closed and fined $3,000.

Health officials believe the virus was spread when clinic nurses used the same syringe twice to administer anesthesia, contaminating the vial. The staff also was found treating multiple patients with vials of medication intended for a single patient only.

Five of the six people infected received treatment at the clinic on the same day.

The owner of the clinic, prominent gastroenterologist Dipak Desai, has refused to answer questions about the outbreak.

Unlike some nurses at the clinic, Desai has not surrendered his medical license. He agreed to "voluntarily cease the practice of medicine" until the state Board of Medical Examiners completes its investigation, the board said Friday.

The state regulatory agency in charge of inspections at outpatient clinics has been criticized for falling behind on its inspection schedule. The Endoscopy Center had not received a full inspection since December 2001, despite a bureau policy of inspecting ambulatory surgical centers every three years.
On the Net:

    * Nevada State Health Division: http://health.nv.gov/
    * Southern Nevada Health District: http://www.southernnevadahealthdistrict.org/

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