Las Vegans who underwent medical procedures at a local clinic that reused syringes reacted angrily to news that they should seek testing for hepatitis strains and HIV, calling Thursday for the Shadow Lane facility to be shut down.
But that won't happen, state officials said, even as they revealed that an affiliated center that performs colonoscopies has been operating with "similar deficiencies."
The unspecified deficiencies, noted at Desert Shadow Endoscopy Center at 4275 Burnham Ave., near Flamingo Road, were discovered in recent weeks by the state's Bureau of Licensure and Certification. They do not rise to the level of the health risk that caused officials to send out 40,000 letters to Las Vegans about the practices of the Endoscopy Center of Southern Nevada at 700 Shadow Lane.
The Burnham Avenue facility has until Monday to turn in a corrective plan of action.
The Southern Nevada Health District is urging patients who underwent procedures at the Shadow Lane facility between March 2004 and Jan. 11 to get tested for HIV and hepatitis B and C.
The health district was flooded with calls Thursday from patients asking about testing. Local doctors' offices were busy answering patient queries too.
Some patients went a step further.
Marco Cuevas, a 42-year-old construction worker, showed up at the doorstep of the Shadow Lane facility at 7:30 a.m.
"These people have to be shut down. What they've done to people is disgusting and horrendous. I've got a wife and three kids, and I'm so worried that I'm going to pass something on to them," he said.
Cuevas, who thinks the clinic should pay for his testing, also directed harsh comments to the doctor who is a majority owner of the facility, Dipak Desai.
"He is a coward, a man without guts," said Cuevas, who had a colonoscopy at the facility in 2006. "He hires a public relations firm to try and make things look good while I have to worry whether I have HIV. How is this place allowed to stay open?"
Desai has not spoken publicly about the incident. The facility on Wednesday expressed concern for its patients and said corrective action had been taken.
Lisa Jones, chief of the licensure bureau, said the community should not expect either center to close. She said the Shadow Lane facility would receive a sanction, which will be disclosed later.
Jones said the agency is confident that both centers will follow corrective plans.
A third Desai-owned ambulatory surgery center, which recently opened, has been inspected too. It did not have any deficiencies.
A Centers for Disease Control and Prevention investigator said Thursday that he did not expect good news out of Las Vegas anytime soon.
"We're waiting for the next wave of cases from this particular clinic," Scott Holmberg said of the Shadow Lane facility. Holmberg has communicated with local health authorities, and the CDC is performing lab work in the case.
Other developments Thursday included the following:
• Rep. Shelley Berkley, D-Nev., called for a congressional hearing on tainted medical clinics, but she did not single out the Las Vegas facility.
• The first lawsuit was filed in District Court by two former Endoscopy Center patients.
• Las Vegas Mayor Oscar Goodman called for the clinic to be shut down.
• The state's Board of Medical Examiners disclosed an investigation of physicians involved in the Shadow Lane cases.
• Attorney general spokeswoman Nicole Moon said the office is reviewing the incident to determine whether it has jurisdiction to investigate.
On Wednesday, District Attorney David Roger said his office "will look at all the facts and circumstances of the Health District investigation" before deciding whether criminal charges are warranted.
The health district announced the large-scale notification on Wednesday after an investigation into how six people were infected with hepatitis C after undergoing procedures at the Shadow Lane facility between June and September 2007. Five of the individuals had undergone procedures at the center on the same day.
After an investigation, health officials learned that the patients might have been exposed to the disease when staff reused syringes to administer medications.
The Endoscopy Center, across from Valley Hospital Medical Center, is a high-volume gastrointestinal practice where colonoscopies are frequently performed.
The reuse of syringes at the facility was a "common practice" undertaken by everyone from doctors to technicians, health officials said Wednesday.
The business also was found to have engaged in other unsafe practices such as not properly cleaning endoscopic equipment used in colonoscopies and upper gastrointestinal procedures.
The CDC's Holmberg said French scientists have found that poorly cleaned endoscopic equipment can cause an infection producing hepatitis. But he said that risk is much less than that caused by reusing syringes.
He emphasized that everyone notified should practice safe sex and use condoms.
The medical facility was open for business Thursday.
Lawyers for the facility will have to go to work also.
A lawsuit filed on behalf of Michael Cordero and Richard Taylor seeks compensation to cover the cost of blood testing and cash damages for mental anxiety while having to "wait around and wonder if your life is going to end," said their attorney, Will Kemp.
The lawsuit names the Endoscopy Center of Southern Nevada as the only defendant and is intended only for patients who were not infected, he said.
"Everybody's really distressed and dismayed," Kemp said. "The general reaction is, 'How could this happen in the United States?' This is Third World medical practice."
Dr. Sidney Wolfe, a physician with Public Citizen, the advocacy group begun by Ralph Nader, said Thursday that the clinic "should pay for all the blood tests people need to have because it caused the problem."
"We are talking about gross negligence on the part of this clinic," he said. "Why should people pay out of pocket or have their insurance pay for this? If this clinic is truly concerned about detecting diseases caused by its negligence, one of the best ways to show that is to pay for every test and urge people to get it done in the next week."
Wolfe also said the Board of Medical Examiners should either suspend the licenses of the center's physicians or place them on probation, under which they could work only under the supervision of state-sanctioned medical professionals.
"These doctors have done something that is a breach of any kind of medical practice," he said.
Tony Clark, executive director of the Nevada Board of Medical Examiners, said the fact the center on Shadow Lane already has corrected deficiencies might mean the board cannot summarily suspend physicians.
Clark said the board needs "hard evidence" to suspend a physician's license or place a doctor on probation.
He said investigators will comb through the report issued by the state board of health for violations by doctors. He added that the board has subpoenaed the medical records of the six patients who contracted hepatitis C.
The normal complaint process that can lead to a physician having his license suspended often takes months, Clark said.
"We have to determine which doctors did what to whom," he said.
Clark continued: "If there is not sufficient evidence to indicate a present danger by a doctor continuing to practice, then we probably will not go the summary suspension route.''
During his weekly news conference at City Hall, Goodman called the situation a "horror show" and "unforgiveable.''
Asked if he wanted the clinic shut down, Goodman said, "I do."
"I have to find out if I have the authority to do it,'' he said. "If I have the authority to do it, I'm going to bring an order to show cause."
Inspections of medical facilities such as the Endoscopy Center are required once every six years under federal guidelines, a state official said Thursday.
And such inspections, performed by the licensure bureau under contract for the Centers for Medicare and Medicaid Services, would not normally turn up inappropriate medical practices such as those used at the Las Vegas facility, said Steve George, a spokesman for the state Department of Health and Human Services.
The state inspections, which are unannounced, focus on interviews with staff on how they perform procedures, George said. They do not involve observing the delivery of medical care, he said.
Inspections can occur more often than every six years, and they can be initiated if a complaint is received about a facility, he said.
Jack Cheevers, a San Francisco-based spokesman for Medicare and Medicaid in Nevada, said the plan of correction filed by the Endoscopy Center has been accepted. A follow-up surprise inspection will occur to ensure the plan is being followed, he said.
At that point, the federal agency will decide what, if any, sanctions will be imposed, Cheevers said. Those sanctions could include a loss of federal funding for Medicaid and Medicare patients, he said.
Physicians' offices were busy Thursday receiving calls from their patients about where they could get testing and what the risks were.
Dr. Constantine George, a Las Vegas internal medicine physician, said that by early afternoon, six people had come to his office requesting information.
"They were nervous, anxious, upset and aggravated,'' he said. "We reiterated to them what the health district has said, that 'look, you may have been exposed. Now you need to be calm and get tested.'''
George said his patients will be tested within the next day or so either at LabCorp or Quest Diagnostics. Neither of the testing centers returned repeated phone calls Thursday.
Shelli Miller, 54, a registered nurse suffering from breast cancer, could not get in for a blood test Thursday. But she hopes to do so today.
"I'm pretty aggravated right now. This place should have been closed years ago,'' she said about the clinic, where she had a colonoscopy in recent years.
Review-Journal writers Sean Whaley, Brian Haynes and Alan Choate contributed to this report. Contact reporter Paul Harasim at firstname.lastname@example.org or (702) 387-2908. Contact reporter Annette Wells at email@example.com or (702) 383-0283.