In his 24 years practicing medicine, Dr. Frank Nemec has never had to tell his patients that he doesn't reuse syringes.
The gastroenterologist hasn't had to look them in the eye and tell them he never has done it, and he never will.
But that has changed.
Nemec's office has been flooded with new patients since investigators found the Endoscopy Center of Southern Nevada reused syringes on infected patients and contaminated vials of medicine that were shared among patients. Six of the center's former patients have tested positive for hepatitis C.
Nemec's new patients, their trust in the medical system shaken, want to know how he does business.
Events of the past two weeks have taken a toll on the reputation of Nevada's medical community.
In addition to the massive health alert that accompanied the Endoscopy Center of Southern Nevada investigation, Dr. Harriston Bass Jr. was found guilty of second-degree murder in the death of a patient.
And a federal trial is under way in which attorney Noel Gage is accused of conspiring with doctors to jack up medical costs, protect physicians from malpractice suits and share kickbacks.
"As physicians, we're all kind of demoralized," said Dr. Mark Barry, a pediatric orthopedic surgeon. "Our reputation is collectively tarnished by these scandals."
Some doctors fear patients might forgo getting medical care or leave the state for treatment. Others wonder what lasting impact the scandals will have on the reputation of the local medical community.
"The reputation of the medical care in this community has not been very highly regarded around the nation," gastroenterologist Dr. Julian Lopez said. "Now this is just proof positive of the medical care in Las Vegas."
Dr. James Tate, a trauma surgeon and Association of Black Physicians president, said the problems at the Endoscopy Center of Southern Nevada "puts a real black eye on the state of Nevada."
Doctors said a common concern they're hearing from patients is that there has been a deep violation of trust.
Lopez said some of his patients brought their own syringes with them to his office. He spent 40 minutes talking to one patient, easing her fears.
Duke Breuer, who was treated at the Endoscopy Center of Southern Nevada in December, said he'll think twice before getting a procedure from a local doctor.
"I'll probably think about going to Mexico before I get anything done here," he said.
Dr. Ron Kline, a pediatric oncologist and former head of the Clark County Medical Society, said he's been insulated from such remarks because his patients are children.
But, Kline said, for the average person, going to the doctor is like taking your car to a mechanic. At the end of the day, they have to trust the expert is doing safe and honest work, Kline said.
"I think most definitely that this is viewed as a violation of trust by people, and they have a right to feel that way."
Assemblyman Joe Hardy, R-Boulder City, a family practitioner, said the medical community is "going to soul search" about their practices and habits in light of the Endoscopy Center's problems.
"This is huge in the ramifications, (including) overcoming the feeling of betrayal people will have toward their trusted physicians," Hardy said.
While some doctors avoided commenting about the physicians who worked at the Endoscopy Center of Southern Nevada, others expressed outrage at reports that the clinic reused syringes and didn't properly clean equipment.
"I thought it was an inexcusable, appalling breach of aseptic technique" to control contamination, said Dr. Don Havins, Clark County Medical Society president and an oncologist.
Some doctors wondered about the role of greed in the crisis. Dr. Dale Carrison, chairman of emergency medicine at University Medical Center, said endangering patients in order to save money is akin to "selling your soul."
"You already make $3 million dollars a year," Carrison said of Dr. Dipak Desai, the majority owner of the Endoscopy Center of Southern Nevada. "Why in God's name do you need more money?"
Dr. Maurizio Trevisan, chief of the University of Nevada Health Sciences System, said what happened at the clinic was "completely unacceptable."
"It's disheartening to think somebody might take a gamble on patients just for a financial savings," Trevisan said.
Lopez said Desai and the other doctors who operated out of the company's six clinics should never be allowed to practice again.
At the request of the Nevada Board of Medical Examiners, Desai agreed Friday "to voluntarily cease the practice of medicine" until the board completes its investigation of the clinic.
"This goes to the very core of who you are as a human being," Lopez said. "They didn't value the lives of the patients who entrusted their lives to them. Now they want to get off with an apology?"
Some patients are demanding that doctors now explain their procedures. If there is a silver lining, Carrison said, it is that patients and doctors might become more educated and mindful of the practice of medicine.
But the profession will need to regain the trust of patients.
"People are kind of second-guessing the practice of medicine here," Barry said. "But they shouldn't."
Medical care here is good and continues to improve, he said.
Nemec said his first feeling was that the hepatitis C cases linked to the clinic were just bad luck, that doctors he knew couldn't have intentionally reused syringes and vials.
"I guess part of me still wants to believe that this was just some sort of mistake and not done with any intent," Nemec said.
"I've known some of the doctors who practiced there for many years, and some of them are just outstanding doctors. It's hard for me to believe that they knew about this," he said.
Contact reporter Lawrence Mower at firstname.lastname@example.org or (702) 383-0440.