The residual effects of a July stroke would make it difficult for Dr. Dipak Desai, whose endoscopy centers are linked to a hepatitis outbreak, to assist his attorney in defending himself against malpractice charges, according to a report filed Wednesday with the Nevada Board of Medical Examiners.
The report, filed by hearing officer Patrick Dolan, is based on the results of a battery of tests by Thomas K. Kinsora, a Las Vegas clinical neuropsychologist.
Dolan ordered the independent exam in February because medical records submitted by Desai's legal team dating to September continued to show his condition had not improved, repeatedly delaying board action on the malpractice claim.
Kinsora, who is not a medical doctor, recommended additional medical testing, including brain imaging and speech evaluation, Dolan said in his report. Kinsora said he also needed to access and evaluate additional medical records.
Additional testing was recommended "to assist in confirming the extent of any impairment ... and to provide a course of treatment and time table for when -- if ever -- (Desai) could be anticipated to overcome such impairment."
In the report, Dolan ordered that the testing be carried out and that a July 14 status conference be held on Desai's diagnosis and prognosis as it relates to his ability to participate in his malpractice defense.
Attempts to reach Dolan and Kinsora for comment Wednesday were unsuccessful.
Kinsora's findings conflict with those of a medical expert who, according to Deputy District Attorney Scott Mitchell, examined the 58-year-old Desai's medical records. Those records included brain scans from UCLA, where Desai was initially treated.
Though unavailable for comment Wednesday, Mitchell told the Review-Journal in January that the medical expert who examined Desai's records for law enforcement did not find evidence of effects from the stroke that would make Desai unable to participate in his defense in a criminal proceeding.
Las Vegas police, the FBI, the IRS and the state attorney general have investigations under way involving Desai.
Mitchell has not named the physician who examined Desai's medical records.
In July, attorneys for Desai told the medical board that after the stroke, the physician couldn't recognize a wristwatch. Mitchell downplayed such talk: "When it comes to the wristwatch, I'd say he might not have been able to recognize it one minute after the stroke, but an hour later that would have been different."
A stroke occurs when a blood vessel bringing oxygen and blood to the brain ruptures or gets blocked so brain cells don't get the flow they need. Paralysis can occur.
District Attorney David Roger, whose office had planned to start criminal proceedings against Desai this summer, declined to comment Wednesday on Dolan's report. Richard Wright, Desai's attorney, also declined to comment.
Will Kemp, an attorney for several people who have civil lawsuits against Desai and other members of his medical team, said it is too early to know how the latest finding could affect legal action.
Kemp said, however, that it is unlikely Dolan's report would stop any criminal action.
"I don't know too many indictments that are stopped by a doctor's note," he said.
Louis Ling, executive director for the medical board, did not know how Dolan chose Kinsora for the exam.
A clinical neuropsychologist is a licensed psychologist with expertise in how behavior and skills are related to brain structures and systems. Neuropsychological tests examine several cognitive abilities, including language, memory, attention and speed of information processing.
Dolan's latest order for more tests on Desai comes more than a year after the Southern Nevada Health District sent notification to more than 50,000 former patients of the Endoscopy Center of Southern Nevada urging them to be tested for hepatitis and HIV because of unsafe injection practices spanning a four-year period. Nine people contracted hepatitis at the clinics, health officials said. More than 100 other cases have been characterized as possibly linked.
Desai and two other doctors have been hit with medical malpractice complaints relating to the care they provided.
While the disciplinary hearings for Drs. Eladio Carrera and Clifford Carrol are scheduled for this summer, the scheduling of Desai's hearing has hinged on his ability to participate in his defense.
Desai and Carrera have both had their licenses suspended pending the outcome of disciplinary hearings; Carrol is still allowed to practice medicine.
Assemblywoman Sheila Leslie, D-Reno, isn't sure that the board and its hearing officer handled this exam of Desai "in a manner that will sit well with the people of Las Vegas."
Leslie said Kinsora may be a fine clinician, but she thinks it would have been better to select someone to conduct the testing who lives far away from Southern Nevada with no knowledge of Desai.
"People know of the incestuous nature of the medical board in the past," said Leslie, who has held hearings on the hepatitis outbreaks. "You would think they would want to be beyond reproach."
But Ling said Wednesday he is sure that Dolan would not have picked Kinsora for the evaluation if he was a friend of Desai or worked with him.
Leslie said it appears that the medical evaluation of Desai has taken too much time.
"I want the experts to do everything they can in finding out if there is something wrong with him," she said. "But this appears to be another stalling technique."
Dolan didn't order a medical evaluation of Desai until eight months after his stroke.
A member of the Hindu Temple in Summerlin attended by Desai said Wednesday that Desai "shows up at least once a week and seems fine."
"He talks and participates," said the member, who spoke on condition of anonymity.
Review-Journal writer David Kihara contributed to this report. Contact reporter Paul Harasim at firstname.lastname@example.org or 702-387-2908.