Gov. Jim Gibbons is meeting resistance in his attempts to remove members of the state Board of Medical Examiners and its director in the wake of the discovery of a cluster of hepatitis C cases that officials linked to the Endoscopy Center of Southern Nevada.
Dr. Daniel McBride said Monday he would not step down from the state medical board and would fight any attempt to remove him. And Tony Clark, the board's executive director, also defied the governor's request to resign.
"I don't work for the governor. I work for the board," Clark said Monday. "I'll do whatever the board wants me to do."
Both McBride and Clark said they had not been contacted by the governor's office and only found out about his demands when they read the Monday morning newspaper.
"I have no intention of resigning," McBride said Monday afternoon about an hour after Gibbons vowed to take action against McBride and two other doctors, board President Javaid Anwar and Vice President Sohail Anjum, if they did not voluntarily step down.
Gibbons said the fact the doctors can't vote on issues affecting the Endoscopy Center's Shadow Lane facility because of friendships and business associations with the clinic's owner, Dr. Dipak Desai, would be grounds for replacing them. He said board members have acknowledged conflicts of interest involving the Shadow Lane clinic, the center of the crisis.
"I am not questioning their integrity," Gibbons said. "They would do the right thing by resigning. I want members who can participate and vote on the issues. I want action from the Board of Medical Examiners to restore public confidence in the health care system."
Gibbons also announced that Dr. Ikram Khan was stepping down from his position as one of his health care advisers. Khan had performed consulting work for Desai last year, judging the quality of physicians Desai employed.
Also Monday, Steve George, a spokesman for the state Department of Health and Human Services, said Lisa Jones has been removed as chief of the Bureau of Licensure and Certification.
Mike Willden, head of the Department of Health and Human services, said he removed Jones shortly after Gibbons' request.
"She's not being fired,'' he said. "She is a classified employee who has been on the job for just five months.'' Jones has two options: take a lower-level position or retire. "She has 29 years with the state,'' he said. "She could retire.''
Jones, who had been criticized for not acting quickly against the Endoscopy Center, could not be reached for comment Monday. Lawmakers felt she had probable cause to shut the facility down and impose hefty fines for infractions dating back to March 2004. Instead, the licensing bureau imposed a $3,000 fine and the city of Las Vegas ended up suspending the clinic's business license.
If a board member refused to resign as requested by Gibbons, Legislative Counsel Bureau Administrator Lorne Malkiewich said, the governor could order a dismissal. If that decision was challenged, the matter could end up in litigation and ultimately would be decided by a judge, he added.
Gibbons said Monday afternoon that none of the three board members had responded to numerous calls made to them by staff members.
McBride said he and the other doctors went far enough by recusing themselves from hearing any case against Desai and the doctors who worked for him. McBride said he recused himself because he has known Desai in the medical community for 25 years and rents office space in the same medical building as the Shadow Lane clinic. But he said he had no financial ties with Desai.
McBride also felt the need for recusal because he underwent a colonoscopy at the center on Jan. 25, and his wife, who had a procedure done there, received a health district letter urging her to get blood testing, he said.
Gibbons' targeting of the medical board doctors threatened to distract the board from its ongoing investigation, he said.
"The governor has made this an unfortunate sideshow to a very serious health matter," McBride said.
Anjum did not return a call for comment, and Anwar's office referred questions to the medical board.
On Feb. 27, officials announced that unsafe health care practices at the Shadow Lane clinic infected six individuals with hepatitis C. Notices were sent to 40,000 patients of the ambulatory surgery center urging them to be tested for blood-borne diseases. Medical personnel were found to have reused syringes on infected patients, which contaminated single-use vials of medicine. The vials were shared between multiple patients, health officials said.
Dr. Benjamin Rodriguez, a Las Vegas plastic surgeon and member of the medical board, said he too doesn't believe the three doctors should resign, noting their voluntary recusals.
Rodriguez also said he wasn't bothered by the fact there was no emergency meeting by the board to discuss whether to suspend the medical licenses of Desai and the other physicians involved in his clinic.
"Do these people represent a threat right now to the public? I would tell you no, based on everything I've ascertained at this point," Rodriguez said.
In an agreement brokered by Anwar and Clark, Desai was allowed to keep his license but agreed not to practice medicine in Nevada while the investigation is ongoing.
Donald Baepler, former president of UNLV and former chancellor of entire education system, thinks Anwar, McBride and Anjum are three of the best members on the board, which consists of six physicians and three members of the public.
"They do their homework, read everything, serve on committees," said Baepler, one of the board's public members.
He said the recusals were premature, and would only be necessary if board members were to vote on a malpractice case.
"They've done business with Desai for years," he said. "There's no problem with that.
"They recused themselves too early," he said. "They should have waited and seen if they were going to bring charges against Dr. Desai."
He also saw no problem with Anwar negotiating with Desai the nonbinding promise not to practice medicine.
"I thought it was a good idea," he said.
He said the board could have summarily suspended Desai's license, but that could have resulted in a lawsuit.
Baepler said he's the last remaining member of the board who served with Desai, who left the board in 2001.
"He was a good board member," Baepler said, noting Desai was very active in meetings.
Another public board member, Jean Stoess, a former Washoe County commissioner, said she was "blind sided" by the recusals.
The board members "should have informed the public right away of their conflicts of interest," she said. "Now they have tainted the entire board. I'm very uncomfortable with what's been done."
Clark said the governor's actions were too harsh. On Friday afternoon, he had sent a proposal to the governor's office to name three temporary board members for this case. The proposal recommends using doctors from Northern Nevada to reduce the possible business and personal conflicts Southern Nevada doctors might have with Desai, Clark said.
Clark said medical board investigators were gathering information as quickly as possible under the law, which requires due process for any accused doctors.
If the public wants faster action against doctors, McBride said, the Legislature needs to change the law, which now allows emergency suspension of medical licenses only if there is an immediate, ongoing threat to the public.
Assemblywoman Sheila Leslie, D-Reno, said she was concerned Gibbons had a "knee jerk reaction" to the developments about the board members' potential conflicts.
"I am leaning toward what he is doing is a good solution," said Leslie, chair of the Legislature's Health Care Committee. "It seems like their conflicts are pretty extensive. But the last thing we need is a long, drawn-out court battle on who gets to be on the medical board."
Leslie added her committee will develop recommendations on changing the structure and appointment process of the medical board. Any recommendations would be considered at the 2007 Legislature.
Leslie was critical of Clark, particularly in light of comments he made at a recent legislative meeting. Clark said he could not attend the meeting because he would be vacationing in Hawaii.
Leslie added she and other legislators were not pleased by Clark's attitude.
"I can understand how people have plans," she said. "But I didn't appreciate how he joked about it. He wasn't taking the situation as seriously as he should. I don't think they (board members) are doing a very good job."
Gibbons said Monday that several physicians already have asked to be appointed to the board and he intends to move swiftly to name replacements.
But Daniel Burns, his acting press secretary, said no specific time has been set for the appointment of replacements.
Review-Journal writers Annette Wells and Paul Harasim contributed to this report. Contract reporter Ed Vogel at firstname.lastname@example.org or (775) 687-3901. Contact reporter Brian Haynes at email@example.com or (702) 383-0281.