More than a dozen bills aimed at giving health authorities more power during disease investigations will be considered for submission to the Legislature, a direct result of the hepatitis C outbreak that sent tens of thousands of patients flocking to labs to get tested for blood-borne diseases.
"Given what we've seen, we need to raise the bar instead of doing just the minimum,'' said Assemblywoman Susan Gerhardt, D-Henderson, at Tuesday's Legislative Committee on Health Care meeting, where lawmakers and health care professionals decided what their priorities would be for the upcoming session.
Of 47 potential bill drafts, more than a quarter addressed the public health crisis, which arose out of unsafe injection practices linked to a Las Vegas endoscopy center.
Committee members want to better regulate ambulatory surgery centers, monitor the use and sale of anesthesia in Nevada and change how members of professional licensing boards are appointed.
One proposed bill requires the state's Bureau of Licensure and Certification to conduct annual inspections of ambulatory surgery centers. The bill also requires annual inspections of individual physician offices where surgical procedures require conscious, general and deep levels of sedation.
"We certainly don't want to burden every doctor's office, but we have to make sure patients in Nevada, that if you choose to have a surgical procedure done and you are put under a level of sedation ... you need to know that office has been inspected. We're having accidents; we're having problems," Gerhardt said.
"Inspection, education and accreditation,'' said Assemblyman Joe Hardy, R-Boulder City, who is a doctor. "All three processes will have to happen.''
A cautionary note was sounded by Sen. Joe Heck, R-Henderson, who warned that if too many regulations were put into place, Nevada could be deemed a "hostile environment" when trying to recruit physicians from other states.
"We need to be careful so as not to limit access to health care,'' he said.
Despite that concern, the committee accepted bill drafts that directly affect physicians. And one of those was a proposal by Heck that would allow health care professional licensing boards to suspend or revoke the license of physicians who own health care facilities being investigated as a public health threat.
Heck, an emergency room physician, said had this provision been in effect in January, owners of the Endoscopy Center of Southern Nevada might have lost their licenses pending the investigation into unsafe injection practices.
"This would allow the osteopathic or medical boards the authority to suspend a license of someone who has fiduciary interests or oversight of a facility where there has been an immediate threat posed to the public,'' he said. "In the situation with the Endoscopy Center, the medical board didn't feel they had the authority to suspend or revoke the licenses.''
Dr. Dipak Desai owns the 700 Shadow Lane facility, where officials think eight people contracted hepatitis C because of the reuse of syringes and medication vials. Desai also partially owns the Desert Shadow Endoscopy Center on Burnham Avenue, where health officials think a ninth person tested positive for hepatitis C.
Desai himself was a member of the state's medical board from 1993 to 2001 and former chairman of the board's investigative committee.
Though Desai voluntarily stopped practicing medicine in Nevada weeks after the outbreak was announced, the medical board had to seek a court injunction to suspend his license until the investigation is complete.
Also, under a separate bill draft, health care professional licensing boards would be required to keep every complaint filed, including complaints that receive no action, for 10 years.
"Change isn't easy, but change is necessary with these boards,'' said Sen. Steven Horsford, D-Las Vegas.
Gerhardt agreed, saying the state needs to change the perception of "cronyism" among medical licensing boards. Because of their relationships with Desai, three members of the medical board recused themselves during proceedings involving the hepatitis C outbreak.
Another bill draft was submitted by the Nevada State Health Division. The bill addresses six issues, one of which allows the agency to issue a "cease-and-desist" order to health care providers, whether it be on the entire facility or on particular procedures that might be considered unsafe pending an investigation.
The bill also strengthens the authority of local health districts during disease outbreaks, allowing public health officers to shut down a facility when investigators identify practices that might "jeopardize the health of patients during the course of a disease investigation."
When disease investigators from the Southern Nevada Health District and the Centers for Disease Control and Prevention identified unsafe injection practices at the Shadow Lane facility in January, the only authority they had was to tell the facility's staff to stop the unsafe injection practices.
They did not have the authority to close the facility, an action taken nearly two months later by the city of Las Vegas.
The health division's bill draft also imposes steeper penalties on medical care facilities where deficiencies are identified and gives the agency authority to take control of medical records.
The health division's bill draft also requires health facilities to report any preventable adverse event and calls for fines for facilities that do not report.
The committee endorsed a concept by Larry Matheis, executive director of the Nevada State Medical Association, that would consolidate the administrative functions of all 42 professional or occupational licensing boards. They include the 22 health care professional licensing boards such as the osteopathic, nursing and medical boards.
The administrative duties would include accepting and investigating complaints. The goal is to streamline the complaint process and due process.
The committee plans to draft a bill before the Legislature meets, Matheis said. The committee is allowed to submit a total of 10 bills to the Legislature for consideration.
Health officials have said there is a possibility that 77 other people contracted hepatitis C while being treated at the Shadow Lane facility from March 2004 to Jan. 11.
In all, some 400 former patients of the center have tested positive for hepatitis C since March, but officials have said they cannot say the cases are linked to the clinic.
Contact reporter Annette Wells at firstname.lastname@example.org or 702-383-0283.