Medical malpractice

On Shadow Lane near Valley Hospital and not far from the University Medical Center, the Endoscopy Center of Southern Nevada is a high-volume gastrointestinal practice that performs a lot of colonoscopies. Reuse of syringes and vials at the facility was a “common practice” undertaken by everyone from doctors to technicians, county health officials said Wednesday.

The business was also investigated for other unsafe practices such as not properly cleaning endoscopic equipment used in colonoscopies and upper gastrointestinal procedures.

As a result of the investigation, 40,000 Nevadans soon will receive word that they might have been exposed to HIV and hepatitis strains B and C in what a federal health official called the largest notification of its kind in U.S. history.

A sample letter warns patients that at the facility they were “placed at risk for possible exposure to bloodborne pathogens. As a precaution, and in order to take appropriate steps to protect your health, we recommend you get tested for hepatitis C, hepatitis B, and HIV. … All patients who received injected anesthesia at the center have been placed at increased risk of exposure. … We recommend that you be tested at your own doctor’s office, as he or she will be able to best advise you on what to do if you test positive.”

Those affected must pay for their own testing.

Health officials began investigating the endoscopy center in early January after learning of three patients who had been diagnosed with hepatitis C, a chronic, potentially lethal blood-borne virus that can cause liver cancer and liver failure.

Each of the individuals underwent procedures requiring injected anesthesia at the center between June and September 2007. Five — three other cases were identified later — underwent the procedures on the same day at the facility, said Brian Labus, the health district’s senior epidemiologist.

During the investigation Dr. Labus said doctors, nurses and other medical personnel at the facility were asked whether it was the norm to reuse syringes and vials there. “They admitted, ‘This is what we were told to do,’ ” Dr. Labus said.

Dr. Cheryl Hug-English, associate dean of admissions and student affairs for the University of Nevada School of Medicine, said students are taught from their first year of medical school that what transpired at the Endoscopy Center of Southern Nevada “is not an acceptable practice. … The proper practice is repeated and ingrained that syringes cannot be reused. … We take this very seriously.”

Those who administered the endoscopy center obviously did not.

This outrage does not appear to fall into the categories of ignorance, or a single mistake due to haste, fatigue or assigning a procedure to staff not properly trained.

Both patients and regulatory officials have every right to ask why staff members didn’t step forward and blow the whistle far earlier. This isn’t merely a case of a restaurant owner ordering the help to mix more bread crumbs into the meatballs: Patients may see their lives shortened due to the serious diseases in question, and anyone with any medical training had to know that.

Was it just about saving money? Or cranking more patients per day through the assembly line — which amounts to the same thing? Did reduced Medicare and Medicaid reimbursements create perverse incentives?

Pursuing the less-direct causes is worth some effort. But they don’t excuse the behavior, which may very well cross the line into the criminal.

Right now, the top priority is tracking down every patient who went through that facility in the relevant time period, and making sure they’re fully informed.

So far, there have been no cases of hepatitis B or HIV linked to the center. Here’s hoping that remains true.

But, “Once again, we have an outbreak that involves two common elements — an outpatient clinic and the reuse of medical equipment that is intended to be used only once,” comments Evelyn McKnight, co-founder of Hepatitis Outbreak National Organization for Reform. “When we hold our restaurants to higher standards than our doctors’ offices, that’s a tragedy.”