Bills spurred by outbreak considered

Gwendolyn Martin has hepatitis C.

Her case was genetically linked to a patient who had underwent a procedure before her on Sept. 21, 2007, at the Endoscopy Center of Southern Nevada.

Martin attended a special joint meeting of the Assembly Committee on Health and Human Services and Senate Committee on Health and Education on Saturday, where lawmakers discussed four bills intended to fill gaps in Nevada’s health care system that they say put Martin and other Southern Nevadans at risk for contracting the disease.

"We understand that the public health system in this state depends upon public trust, and the public trust was seriously eroded by this public crisis,” said Assemblywoman Sheila Leslie, D-Reno, who sits on the Assembly committee.

The bills would prevent retaliation against nurses who report breaches in patient safety, strengthen health authorities’ power during disease investigations and require annual inspections of ambulatory surgery centers and certain physician offices where conscious, general and deep levels of sedation are used.

Though the bills were generally welcomed, there were concerns raised.

Members of the Nevada State Medical Association urged lawmakers to consider exempting physician offices that use conscious sedation during procedures from Assembly Bill 123.

The bill would require these physician offices to undergo annual inspections and obtain a permit to provide sedation, which would cost thousands of dollars depending on the number of procedures that occur at the office. Senate Bill 70 has similar aims.

"For us, the thousands of dollars in yearly licensing and accreditation fees may force us, in the face of increased costs and declining reimbursements, to discontinue the use of conscious sedation,” said Dr. Ronald Kline, a pediatric hematology oncologist. "If physicians choose not to administer conscious sedation in their offices, then a more expensive alternative would be to perform these procedures in hospitals."

Lawmakers asked Kline to work with legislative staff to reach a compromise.

Health officials have said that when nurse anesthetists reused syringes in a manner that contaminated vials of Propofol it led to eight people contracting hepatitis C at the Shadow Lane clinic. Six of those cases, including Martin’s, are believed to have been contracted on Sept. 21, 2007. A total of nine cases have been linked to two clinics and health officials have listed an additional 105 cases as "possibly related."

Some nurse anesthetists and other staff members of the now-closed facility have told health officials that they were instructed to reuse syringes and medication vials when administering sedation to patients during a nearly four-year span.

Those nurses did not report that information to the appropriate regulatory agencies out of fear of retaliation, especially loss of employment, officials said.

Assembly Bill 10, if passed, would prohibit retaliation or discrimination against registered nurses, licensed practical nurses and nursing assistants who report information relating to the safety of patients to regulatory agencies.

Assembly Bill 206, also discussed Saturday, gives the Nevada State Health Division the power to immediately issue a cease-and-desist order on a facility where patient safety is in question until after an investigation.

Contact reporter Annette Wells at awells @reviewjournal.com or 702-383-0283.