CARSON CITY -- The state agency responsible for inspecting 50 surgery centers in Nevada did not perform those reviews as often as required, including at two Southern Nevada facilities where problems with reusing syringes and other unsafe practices have recently been uncovered.
Of the 50 ambulatory surgery centers now being inspected by the state Bureau of Licensure and Certification for unsafe practices, 22 have not had a recertification survey within the six-year time frame required. Some of them have not been inspected for 12 years.
Information posted on the state Health Division's Web site shows that the Endoscopy Center of Southern Nevada, which has been linked to an outbreak of hepatitis C in six patients, last saw a routine inspection in December 2001, just over six years ago.
The Gastrointestinal Diagnostic Clinic on South Maryland Parkway, where inspectors last month discovered the reuse of syringes but no infectious outbreak, had last been inspected in September 1996.
Federal requirements set by the U.S. Department of Medicare and Medicaid Services recommend that inspections occur every six years.
The state lists a three-year inspection rule for ambulatory surgical centers, but the federal requirements trump the state's rules if there's a conflict, said Steve George, spokesman for the Department of Health and Human Services.
Regardless, there are no penalties for not meeting the guidelines.
Jack Cheevers, a spokesman for the federal agency, would not comment on the apparent inspection lapses.
George acknowledged inspections have not been conducted as often as recommended.
"Yes, there are some big holes on there," he said of the inspection dates posted on the Web site.
The Web page listing the centers and inspection dates was removed late Wednesday from the site. It is expected to be back online today.
Part of the reason for the lapses is a shortage of staff due to vacancies, and the fact that other types of facilities overseen by the bureau are required to be inspected more often, George said.
Intermediate care facilities for the mentally retarded and skilled nursing centers, for example, must be inspected every year by the same pool of surveyors who also look at the surgery centers, he said.
There are federal penalties for not completing those surveys in a timely fashion.
When the Endoscopy Center's Shadow Lane clinic was given a full Medicare inspection in 2001, deficiencies focused on construction and safety aspects of the building.
Exit doors were not quite wide enough, ceiling tiles and flooring did not comply with regulations, and some rooms were not equipped with emergency lighting.
The facility failed to ensure it was conducting fire drills, according to the survey.
In 2004, the licensure bureau conducted an inspection at the center based on a complaint from someone regarding the manner in which sedated patients were being released to drivers.
The inspection report does not reveal who made the complaint.
On Jan. 30, 2004, state investigators reviewed the medical records of six patients and interviewed staff. Investigators determined the facility did not ensure that patients were discharged in the company of a "responsible adult."
A plan of correction was issued by the clinic, and accepted by the state.
Dr. Lawrence Sands, chief health officer for the Southern Nevada Health District, said inspections only offer one level of assurance.
Ambulatory surgery centers in Nevada probably need to be accredited at the same level as hospitals, he said.
To operate in Nevada, hospitals must be accredited by The Joint Commission, an independent nonprofit organization and the nation's largest and oldest standard-setting health care accrediting body.
Ambulatory surgery centers, under Medicare, also must be accredited but not at the same level.
Sands said approved accrediting agencies offer another layer of oversight and allow more frequent inspections.
"Inspections are just one piece of the puzzle,'' Sands said. "What's the correct frequency of inspections? Certainly we've talked about this with our legislators."
Assemblywoman Sheila Leslie, D-Reno, who held a hearing on the health alert last week as chairwoman of the Legislative Committee on Health Care, said the news "just keeps getting worse. I've run out of adjectives to describe this situation.
"We need to vastly improve our ability to inspect these facilities more frequently and more comprehensively," she said.
The Health Committee will be focusing its attention on improved state oversight, including better and more frequent inspections, an aggressive recruitment and retention plan for health inspectors and creating a culture of safety in regards to medical care, Leslie said.
"We know inspections can save lives, and we need to do whatever it takes to ensure the public's health is not jeopardized," she said.
The information showing the lapses was posted just days after concerns were raised by Leslie about a decision by Gov. Jim Gibbons to oppose hiring 10 new surveyors for the licensure bureau during the 2007 legislative session.
Gibbons rejected the hirings because of his pledge not to raise taxes or fees.
Ultimately, he and the Legislature agreed to fund six new positions. Funding for the positions comes from federal funds and fees charged to the facilities, not the general fund.
Gibbons on Monday rejected the criticism, saying the number of positions approved in 2007 was not an issue in the ability of the bureau to do its inspections. Rather, it is the ability of the agency to fill vacancies, he said.
Of 50 approved positions, the agency has 14 vacancies due to the difficulties in recruiting and retaining surveyors.
Gibbons also said more frequent inspections would not help.
"You do not have enough money, you do not have enough people, to look at every day, every procedure, conducted on every patient," he said. "We could inspect it annually, and then, pretty soon, have we done overkill?
"I think the important thing is to assure the public we have the right policies, the right procedures, in place," Gibbons said.
As of Wednesday, 25 of the 50 centers have been inspected in response to the discovery of hepatitis C cases, 16 in Northern Nevada and nine in Southern Nevada. Infection control issues have been found in seven of the facilities.
Inspectors from the Centers for Disease Control and Prevention on Wednesday began assisting the state with the survey.
Mike Willden, director of the Department of Health and Human Services, has said the inspections of the 50 centers are focusing on basic health care safety issues, the types of things that health care officials know should not be occurring.
He called the basic practices to prevent the spread of infection as "health care 101 stuff" that inspectors haven't necessarily looked for in the past.
"When they do a survey there is an assumption that you may be not reusing a syringe, an assumption of sterilization," Willden said. "They certainly are going to be looking more closely from here forward."