Two and a half weeks after a Las Vegas clinic was first found to be using unsafe medical practices, Gov. Jim Gibbons on Monday announced it is time for the state to take aggressive action to restore public trust in the medical system.
"Action is needed," Gibbons said on a Monday afternoon conference call with journalists. He added, "I am focused today like a laser on our health care system. I intend to take aggressive steps to restore public confidence in our health care system."
That aggressive posture was the latest in a vacillating series of public stances Gibbons has taken on the crisis, which began with revelations Feb. 27 that the Endoscopy Center of Southern Nevada was the source of six cases of Hepatitis C. Authorities said the clinic's practice of reusing syringes on patients, in turn contaminating vials of medication, violated medical standards. Notices were sent to 40,000 patients, urging testing for hepatitis and HIV.
As the scope of the crisis has expanded, the governor has seemed to delegate responsibility and to downplay the seriousness of the problem, leading to questions about his leadership.
Gibbons on Monday denied he had come late to the problem.
"I don't think we waited long," he said. "Additional information was coming in daily. When I received additional information after Saturday, it became very clear that we needed to take action, and that's what we're doing today."
In response to the very next question, however, the governor said, "We cannot wait. We cannot linger until all the information is in while we are under this crisis of confidence in our public health care system. We have to take action."
Gibbons declared states of emergency within a day of January's flooding in Fernley and of last month's earthquake in Wells. He has yet to publicly tour Southern Nevada medical facilities or otherwise officially address the health crisis in the place where it originated.
The day after health officials brought the medical procedures at the Endoscopy Center to light, Rep. Shelley Berkley, D-Nev., called for a congressional investigation. Two days after the crisis broke, Las Vegas Mayor Oscar Goodman, frustrated that state and county bureaucracies were allowing the center to remain open, went to the clinic to shut it down personally by suspending its city business license.
Clark County, Henderson and North Las Vegas soon followed his lead, suspending the licenses of affiliated clinics as the probe, whose scope still is not fully known, continued to widen.
Gibbons' first official response to the massive health alert came on March 6. In a news release, the governor announced he was instructing the state Department of Health and Human Services to use all available resources to address what he called a "public health emergency," including tapping the state Disaster Relief Fund.
"With the health of so many Nevadans seemingly at risk, as governor, I feel it is imperative that we act swiftly and decisively to help restore public trust and to ensure that unsafe medical practices are halted immediately," he said in the press release.
Two days after that, on March 8, a fellow Republican, state Sen. Joe Heck, a physician, implicitly rebuked Gibbons for not doing more. From his posting at a combat hospital in Iraq, the Army colonel called on Gibbons to convene the Nevada Academy of Health, saying in a news release, "Nevadans deserve much better than this, and they are looking to their elected leaders and the medical community for a swift, thorough and decisive response to this crisis in order to regain their trust and confidence."
On March 10, Gibbons held a news conference on the issue in Carson City to answer media questions and to underscore the seriousness with which he regarded the problem. He said criminal action should be considered if clinic workers knowingly endangered people.
But he shrunk from suggestions that clinics needed more oversight. Comparing the situation to speeders on a highway, he said, "We could inspect (surgical centers) annually and then pretty soon, have we done overkill?"
On Saturday, Gibbons went further, telling the Reno Gazette-Journal that media "buffoonery" had frightened people unnecessarily and that six cases of hepatitis was a relatively small number.
A Gibbons adviser who spoke on condition of anonymity said the governor meant to express concern that people might not be seeking needed tests out of fear of the medical system, but botched his talking points, to the dismay of advisers and staff.
The adviser has not consulted with Gibbons on the health-care situation and said if he had, he would have urged much quicker and more sweeping action, potentially a removal of the entire medical board.
The shock caused by Gibbons' Saturday comments and growing concern about the many conflicts of interest faced by members of the state Board of Medical Examiners led to emergency meetings late Sunday where Gibbons and staffers drafted a new, more aggressive stance.
Gibbons announced Sunday night that he was asking three members of the medical board to step down, as well as the board's executive director and the head of the Bureau of Licensure and Certification. He also apologized for the "buffoonery" comment.
On Monday, Gibbons followed up with his strong calls for action and the announcement that an adviser linked to the clinic's owner, Dr. Dipak Desai, was resigning.
It was too little, too late for critics of Gibbons.
"That should have been done immediately," said Assemblywoman Susan Gerhardt, D-Henderson. "He certainly knew what the relationships (between doctors and board members) were. It's the very least that could have been done."
A former policewoman, Gerhardt likened the situation to that of a dangerous criminal at loose in a community. Once there is probable cause, the criminal should be removed from the streets while an investigation is conducted.
Gerhardt also took issue with Gibbons' remarks on Saturday describing the crisis as media-generated hysteria. People have every right to be concerned, she said.
"People are worried. They're angry about this situation. They need to be heard," she said. "I thought what he said was very patronizing." What was needed, she said, was "a word of support. Some empathy for what people are going through."
University of Nevada, Reno, political scientist Eric Herzik said Gibbons' response to the crisis in policy terms may have been the right one. But in political terms, it has been disastrous.
"It's classic Gibbons: I'm digging in my heels because I think I'm right on the substance," he said. "Gibbons is trying to argue this rational, detached response to what has become a very emotional issue."
Herzik noted that Gibbons' public relations team is in transition, with his longtime press secretary departing late last month and a new one scheduled to start later this week.
The interim press secretary, Daniel Burns, is juggling his simultaneous responsibilities as spokesman for other major state departments. He kicked off Monday's conference call by wryly noting, "This is Dan Burns from the governor's office -- at least for the next three days."
But that transition notwithstanding, "Gibbons has never been able to get out in front of issues," Herzik said. "Gibbons is always reacting to things. There's been a lot of addressing problems after the fact, rather than before."
At a time of crisis, people want to see a governor acting gubernatorial, even if that means taking action that isn't strictly necessary to create the impression of concern, he said.
The public, in such cases, needs reassurance from a leader who is forcefully taking charge, said Eric Dezenhall, CEO of the international crisis-management firm Dezenhall Resources and author of a new book, "Damage Control."
Leaders often don't have all the facts at hand in a developing situation, he said. "That said, when you're dealing with public safety issues, going into virtual lockdown scares the hell out of people."
"Somewhere in between saying nothing and making pretend you know everything about a situation is a middle ground," said Dezenhall, who was speaking about general principles and did not have prior knowledge of the situation in Nevada.
"People are looking for a pathway out of the wilderness. Ideally, you'd be able to say, 'Problem solved.' But in the absence of that, people want to know what your plan is for getting through the uncertain future, and that you're taking a personal interest in seeing it through."
Contact reporter Molly Ball at firstname.lastname@example.org or (702) 387-2919.