Las Vegas police and county prosecutors opened a preliminary criminal investigation Monday into the Las Vegas clinic accused of shoddy medical practices that exposed patients to potentially deadly infections.
The investigation joins inquiries by the FBI and the Nevada attorney general's office into practices at the Endoscopy Center of Southern Nevada, which health officials have said put people at risk of contracting HIV, hepatitis strains B and C and other blood-borne diseases.
"This will be a broad-based investigation. We will be looking at every aspect which may involve criminal wrongdoing," District Attorney David Roger said.
Detectives will meet with health officials and review their findings before deciding whether to pursue a full-fledged criminal investigation, Deputy Chief Kathy Suey said.
"Right now we're looking at everything," she said.
Meanwhile, Nicole Moon of the attorney general's office said the agency's insurance fraud and Medicaid fraud units have been reviewing the case. And Lisa Jones, chief of the Nevada State Board of Licensure and Certification, said Monday that FBI agents contacted her department about its investigative report detailing problems at the clinic.
Also on Monday, Nevada lawmakers called for wide-ranging state investigations and for funding to help patients pay for the blood testing being recommended by the Southern Nevada Health District.
Sen. Randolph Townsend, chairman of the Legislative Commission, sent letters to Gov. Jim Gibbons and several state boards and agencies seeking a broad inquiry into the problems discovered at the Endoscopy Center of Southern Nevada, at 700 Shadow Lane.
In the letters, the Reno Republican asked for an immediate investigation into "the facts surrounding this outrage," which "may well be the largest breach of public trust in the history of the state."
Townsend said the agencies and boards should use all of their statutory and regulatory authority, including subpoena power, to get to the bottom of how the problems occurred.
An investigation made public Wednesday clinic found that staff reused syringes, contaminating vials of medication, which risked spreading disease.
Clinic staff told health investigators they were ordered by administrators, principally majority owner Dr. Dipak Desai, to reuse supplies and medications to save money, according to a letter by Las Vegas Business Services Manager Jim DiFiore, who suspended the clinic's business license Friday.
Health officials have confirmed that six patients who contracted hepatitis C at the clinic. The investigation was ongoing, and officials have urged blood testing for 40,000 patients who visited the clinic between March 2004 and Jan. 11 of this year.
Assembly Speaker Barbara Buckley, D-Las Vegas, said state lawmakers want to ensure testing for people regardless of whether they have insurance or can afford it. The clinic should pay those costs, but a plan is needed immediately to ensure testing is available, she said.
The Legislature might be able to help with those costs, with the Southern Nevada Health District and others, Buckley said.
Assemblywoman Sheila Leslie, chairwoman of the Legislative Committee on Health Care, said Monday she was "beyond appalled" by what happened at the clinic. Her committee will meet 9 a.m. Thursday at the Sawyer Building to discuss how to prevent such a scenario from reoccurring.
"We want to know what licensing boards are going to do," the Democrat from Reno said. "If the medical staff did this knowingly, they should lose their licenses and be pursued criminally."
Leslie said the maximum fine that can be issued the state Board of Licensure and Certification -- $1,000 per violation -- is "woefully inadequate."
"I want to see if our laws are substandard on a national level," she said. "We need more teeth in our regulations."
Larry Matheis, executive director of the Nevada State Medical Association, said it's probably easier to shut down a restaurant for health code violations than temporarily suspend the medical or nursing licenses of the health care workers responsible for the hepatitis C outbreak.
The "law is on their side," Matheis said.
Under Nevada's law, regulatory agencies must provide evidence that a medical care provider is a threat to the public.
Fred Olmsted, counsel for the Nevada State Board of Nursing, said his office had received a complaint about nurses at the Shadow Lane facility, but as of Monday, there was no evidence that they posed an "immediate threat'' to the public.
"If the board finds that there is immediate danger to the public, we can summarily suspend someone's license,'' he said. "However, since such a suspension would be in violation of (the nurses') constitutional rights, we have to have a hearing promptly so that they may tell their side of the story.''
An emergency meeting would have to be held within 30 days of the complaint, but no such hearings had been scheduled as of Monday.
"People are presumed not guilty until proven guilty,'' Olmsted said.
Dr. Javaid Anwar, president of the Nevada Board of Medical Examiners, said his agency needs evidence that a doctor is a threat to the public before suspending a medical license.
He said the board had not received information from its investigators identifying any violations by the doctors who ran the Endoscopy Center of Southern Nevada.
"Are those physicians posing potential harm to our patients at the center? We don't have the information from our investigators to make that determination,'' Anwar said.
Anwar said the medical board, nursing board and licensure bureau each have to finish investigations.
"We need to let them come up with what exactly is the problem. In the meantime, that place is closed.''
Review-Journal writer Paul Harasim contributed to this report. Contact reporter Brian Haynes at firstname.lastname@example.org or (702) 383-0281. Contact reporter Annette Wells at email@example.com or (702) 383-0283. Contact reporter Sean Whaley at firstname.lastname@example.org or (775) 687-3900.