Vegas clinic may have sickened thousands

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http://news.yahoo.com/s/ap/20080306/ap_on_re_us/hepatitis_exposure

Vegas clinic may have sickened thousands

By KATHLEEN HENNESSEY, Associated Press Writer

1 hour, 42 minutes ago

LAS VEGAS - Nearly 40,000 people learned this week that a trip to the

doctor may have made them sick. In a type of scandal more often

associated with Third World countries, a Las Vegas clinic was found

to be reusing syringes and vials of medication for nearly four years.

The shoddy practices may have led to an outbreak of the potentially

fatal hepatitis C virus and exposed patients to HIV, too.

The discovery led to the biggest public health notification operation

in U.S. history, brought demands for investigations and caused scores

of lawyers to seek out patients at risk for infections.

Thousands of patients are being urged to be tested for the viruses.

Six acute cases of hepatitis C have been confirmed. The surgical

center and five affiliated clinics have been closed.

" I find it baffling, frankly, that in this day and age anyone would

think it was safe to reuse a syringe, " said Bell, associate

director for infection control at the national Centers for Disease

Control and Prevention.

One of the infected patients is retired airplane mechanic

Washington, 67, who was the first to report his infection. On the

advice of his doctor, he received a routine colon exam in July at the

Endoscopy Center of Southern Nevada.

In September, he started to get sick. He was losing weight fast. His

urine turned dark. His stomach hurt. By January, it was clear what

had happened.

Washington describes his virus as a " creeping death sentence " and

worries that others will hear his story and think twice before

getting preventive care they need.

In letters that began arriving this week, patients who received

injected anesthesia at the endoscopy center from March 2004 to mid-

January were urged to get tested for hepatitis B and C, and HIV.

Because all three viruses are transmitted by blood, they could have

been passed from one patient to the next by the unsafe practices at

the clinic.

The mass notification is the result of a health district

investigation that began in January when officials linked an uptick

of unusual hepatitis C cases to the clinic.

Health officials say they are most worried about the spread of

hepatitis C, which targets the liver but shows no symptoms in as many

as 80 percent of infections.

Hepatitis C results in the swelling of the liver and can cause

stomach pain, fatigue and jaundice. It may eventually result in liver

failure. Even when no symptoms occur, the virus can slowly cause

damage to the liver.

Officials estimate that 4 percent of the patients already had the

virus when they entered the clinic, compared with 0.5 percent for

hepatitis B and less than 0.5 percent for HIV. Hepatitis C also is

easier to transmit than HIV, they said.

" You put the two together and hepatitis C is really our big concern, "

said Labus, senior epidemiologist at the Southern Nevada Health

District.

Health inspectors say they observed clinic staff using the same

syringe twice to extract anesthesia from a single vial, which was

then inappropriately used to treat more than one patient. The

practice allows contaminated blood in a used syringe to taint the

vial and infect the next patient.

Of the six patients so far diagnosed with acute hepatitis C, five

received treatment at the clinic on the same day in late September.

Since 1999, the CDC counts 14 hepatitis outbreaks in the U.S. linked

to bad injection practices.

The largest outbreak occurred in Fremont, Neb., where 99 cancer

patients were infected at an oncology center from 2001 to 2002. At

least one died. The doctor involved in the case acknowledged reusing

syringes and settled scores of lawsuit. But he never explained why

the syringes were reused.

Bell said such improper procedures appear to be more common in

outpatient surgical centers like the endoscopy center. Unlike

hospitals, such centers often do not have employees whose sole

responsibility is to monitor and educate staff on best practices.

In Las Vegas, clinic staff told inspectors they had been ordered by

management to reuse the vials and syringes. Labus described the

practice as an unwritten, but long-practiced policy.

Investigators were told the practice was an attempt to cut costs,

according to a letter of complaint from the city, which revoked the

facility's business license Friday. Five other facilities affiliated

with the Endoscopy Center of Southern Nevada also had their licenses

revoked.

The clinic's majority owner, Dipak Desai, a political contributor and

member of the governor's commission on health care, has refused to

comment on the allegations.

He released a statement expressing concern for the patients and

assuring the public the problems had been corrected. He later took

out a full-page ad in Sunday's edition of the Las Vegas Review-

Journal insisting that needles had not been reused and that the

chances of contracting an infection at the center in most of the last

four years were " extremely low. "

Of the thousands of people who have rushed to be tested, many will

get positive results, Labus said. More than 15,000 people already

have called the health district for information.

But it takes a more sophisticated test, a complete evaluation of risk

factors and a clear pattern of infection to determine whether the

virus was caught at the facility.

Plenty of lawyers are wading into the mess. Television ads

called " health alerts " are soliciting clients. At least a handful of

class-action lawsuits have been filed.

On Tuesday, the office of Las Vegas attorney Ed Bernstein was buzzing

with phone calls — nearly 1,000 a day, he said. Bernstein said he

represents about 1,200 patients at the facility, eight who have

tested positive for hepatitis C.

Washington, the infected airplane mechanic, is one of Bernstein's

clients.

His wife, phine, a registered nurse, wonders how any health care

professional could be so reckless: " To maximize profit? For what?

What are you going to save? "