Deficiencies found at Nevada ambulatory surgical centers

A state health division investigation undertaken after tens of thousands of patients were advised last year to be tested for possible exposure to hepatitis C at two Las Vegas ambulatory surgical centers found that more than half of 49 other such facilities in Nevada had “infection control type deficiencies.”

According to a draft report issued Friday on the state’s ambulatory surgical centers, inappropriate use of single-use items such as syringes amounted to nearly a third of the infection control deficiencies at 25 of the centers in fiscal year 2008, while sterilization and disinfection issues accounted for almost half.

“It concerns me when what is on the books (regulations) aren’t followed,” said Marla McDade Williams, chief of the state’s bureau of health care quality and compliance.

While the report doesn’t spell out which surgical centers not connected to the hepatitis outbreak investigation had deficiencies, Nevada Health Division spokeswoman Martha Framsted said that by summer, all surveys done by the division will be posted on a Web site for the public to examine.

What will help ensure that regulations are followed in the future is more frequent inspections by staff surveyors, Williams said. Eleven new surveyors have been requested by the division, Williams noted, which would allow all 1,100 state-licensed facilities — including nursing homes and group homes — to be inspected every 18 months. She now has 34 surveyors and 14 supervisors who do inspections.

Currently, guidelines set down by the federal Centers for Medicare and Medicaid allow for seven years to lapse between surveys of ambulatory surgical centers, she said.

“We want them (ambulatory surgical centers) to know far more frequently that there are state standards that they must adhere to,” Williams said.

In February of last year health officials revealed that authorities investigating a cluster of hepatitis C cases had observed nurses at the Endoscopy Center’s Shadow Lane clinic reusing syringes in a manner that contaminated vials of medication and, they believe, infected patients.

A total of nine cases have been linked to two clinics owned by Dr. Dipak Desai, and health officials have listed an additional 105 cases as “possibly related.”

As a result of the outbreak, more than 50,000 people were told to get tested for hepatitis and HIV, the virus that causes AIDS.

The public health crisis has already spawned several bills by Nevada legislators, including Senate Bill 70 and Assembly Bill 123, which call for annual inspections of ambulatory surgery centers and certain physician offices where surgical procedures require conscious, general and deep levels of sedation.

Williams said that if the Legislature believes an annual, rather than every 18-month, inspection of ambulatory surgical centers should be done, she isn’t sure what number of additional surveyors will be needed on top of what she has already asked for.

She did say, however, that since her agency is “fee funded,” the money for more surveyors will come from increased licensing fees charged to facilities that include nursing homes, ambulatory surgery clinics, group homes and hospitals.

Williams said that in the past, state surveyors spent 70 percent of their time inspecting the third of state facilities that CMS pays Nevada to certify and inspect more frequently, such as nursing homes.

“I don’t know why that was done,” she said. “The priorities were wrong.”

She echoed what Richard Whitley, administrator of the health division, wrote in the executive summary of his agency’s 35-page report:

“While the health division was responsible for meeting its CMS contractual obligations for Medicare initial certification surveys and recertification surveys, the CMS surveys were not balanced with state needs. Despite what happened in Nevada and is happening elsewhere in the U.S., CMS has not changed its priorities to reflect more frequent surveys of ambulatory surgical centers.”

Contact reporter Paul Harasim at or 702-387-2908.