CDC warns of safety problems at clinics
WASHINGTON (AP) - March 4, 2008 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.