Health officials say they have "clear-cut" evidence that a second medical clinic is responsible for transmission of hepatitis C in the valley, a development that will send investigators sifting through patient records to determine whether any clusters can be traced to the clinic.
The single new case stems from an endoscopy procedure performed on a patient at Desert Shadow Endoscopy Center, 4275 Burnham Ave., the Southern Nevada Health District said. Six cases of the disease previously had been linked to an affiliated clinic at 700 Shadow Lane.
Health officials gave the date of that patient's visit to Desert Shadow as June 14, 2006, but acknowledged they arrived at that date based on the patient's representation.
Several weeks after the procedure was performed at Desert Shadow, the patient's physician at the time made the diagnosis of infection, the health district said. But it was not reported to the district, as is required by state law, officials said.
Had that report been made promptly, it would have come a year before the transmissions of hepatitis C that officials say occurred July 25 and Sept. 21 at the Endoscopy Center of Southern Nevada on Shadow Lane.
"Had the doctor reported this to us, maybe we would have been able to find it back in 2006 and eliminated any potential for disease transmission," said Brian Labus, chief epidemiologist for the health district.
Labus said the health district is trying to identify the physician who diagnosed the seventh case. The health district did not release identifying details about the patient, including gender.
Neither the physician who diagnosed the patient nor the patient's current physician is linked to any of the endoscopy centers or offices owned by Dr. Dipak Desai, majority owner of the Shadow Lane clinic.
According to state business records, the Desert Shadow clinic is managed by Dr. Vishvinder Sharma and the Hari Om Limited Partnership, which lists as general partners Desai, his wife, Dr. Kusum Desai, and Dilip Patel.
Sharma could not be reached for comment Tuesday afternoon. He resigned as a member of the state's Board of Health earlier this month and after the state Bureau of Licensure and Certification announced deficiencies at the Desert Shadow facility.
Desai, after expressing concern for patients after news of the massive health alert broke on Feb. 27, has refused comment on the crisis.
After health officials revealed that the six Endoscopy Center patients were infected after medication vials -- infected by reused syringes -- were used on multiple patients, notices were sent to 40,000 patients urging them to be tested for hepatitis and HIV, the virus that causes AIDS.
Health officials are not sure whether the new case will cause a new round of notifications. Labus said the health district is at the beginning of its investigation.
As of Tuesday afternoon, the health district did not have access to the June 2006 records of the seventh hepatitis C patient, though more current medical records had been examined.
Over the next few days, disease investigators will review Desert Shadow's patient records to identify individuals who might have been exposed.
Those records are being held by Las Vegas police which, with the FBI, is conducting a criminal investigation into Desai's practices.
"Are we going to see them reusing Profolol vials?'' Labus said about practices at the Burnham Avenue clinic. "We don't know yet.''
Profolol was the anesthetic medication contained in single-dose vials at the Shadow Lane facility that were being reused.
The new hepatitis C case was first mentioned Tuesday during a discussion before the Clark County Commission. Commissioners were trying to determine whether the county should extend the limitations of the clinic's business license.
The ambulatory surgery center's license, with licenses at two other affiliated clinics, was suspended earlier this month as a precaution based on a state health inspection report.
During the Jan. 30 inspection, licensure bureau surveyors observed staff at the clinic improperly using single-dose medication vials on multiple patients.
The deficiency was not considered to rise to the level of seriousness that caused the mass notification. Health inspectors also did not observe Desert Shadow staff reusing syringes.
After the new information was presented, the commission upheld the limited suspensions of business licenses of all three Desai endoscopy centers within the county's jurisdiction. Two of the clinics are on Burnham Avenue and one is on Rainbow Boulevard.
They can be open for administrative purposes only.
"The sense of this board is it's one strike and you're out," Commissioner Rory Reid told the attorney representing owners of the clinics.
Dan Kulin, a Clark County spokesman, said the county plans unannounced visits to the Desert Shadow center to make sure it complies with conditions of the limited suspension business licenses.
Labus said the Desert Shadow patient contacted the agency a few days ago to report the June 2006 visit and subsequent illness. The patient became ill in July 2006, Labus said. Hepatitis C has an incubation period of about six to eight weeks, he said.
After reviewing the patient's medical records, Labus said the only risk factor that could have led to the disease transmission was the Desert Shadow procedure.
"The person had a routine health screening a few days prior to the procedure. That test came back negative for hepatitis C,'' he said. "Several weeks after undergoing the procedure, the person got sick. It is pretty clear-cut that transmission is connected with the clinic in some way.''
Assemblyman Joe Hardy, R-Boulder City, a physician, used similar language to describe the latest development.
He said given what has been revealed about multiple clinics, it shouldn't be too surprising.
"This confirms our suspicions that the practice is more widespread than one isolated day, one isolated place, one isolated person," he said. "It tells us that indeed we have to look at all of the procedures that were being done in each one of these places. This wide net that we're casting is the reasonable and appropriate thing to do."
If the health district finds that a physician or other medical care provider is not reporting diseases, such as hepatitis C, as required, the agency could submit a case to the Clark County district attorney's office.
"If they bring us the case, we will look at it,'' District Attorney David Roger said.
The licensure bureau continues to inspect ambulatory surgical centers in Southern Nevada. Thirteen of the state's such clinics remained to be inspected Tuesday.
State health officials anticipate completing the inspections by Friday.
Review-Journal writers Molly Ball, Scott Wyland and Brian Haynes contributed to this report. Contact reporter Annette Wells at firstname.lastname@example.org or (702) 383-0283.