Though Southern Nevada Health District disease investigators think they have "clear-cut" evidence a patient contracted hepatitis C at a Las Vegas endoscopy center in 2006, they just can't say how.
As a result of the findings, the district is not going forward with a full-blown notification of patients at the now closed Desert Shadow Endoscopy Center at 4275 Burnham Ave.
In a report released Thursday, investigators said they do not have enough information to determine the source of hepatitis C transmission at the facility, which was affiliated with the Endoscopy Center of Southern Nevada on Shadow Lane.
Seven hepatitis C cases were linked to the reuse of syringes and anesthesia vials at that clinic, prompting a massive public health investigation.
No other patients who have tested positive for hepatitis C have been linked to the Burnham facility, and health officials have not been able to document any other unsafe practices that could have led to transmission there, said Brian Labus, the health district's senior epidemiologist.
"We have one case there," Labus said. "The person tested negative (for hepatitis C) two days prior to undergoing a procedure at the facility. That patient then developed acute hepatitis C. It's likely the patient acquired it at the clinic, but how, we can't speculate on because we can't make the same assumptions as were made at the Shadow Lane facility.''
As for 13,000 former patients of the Burnham clinic, Labus said, "it's an unfortunate frustrating situation, but we can't give them a firm recommendation.'' They need to discuss whether to get tested for hepatitis and HIV with their physicians, he said.
"We're not discouraging patients from getting tested. We're just suggesting that they speak with their physicians about their risk,'' Labus said. "We will be sending those patients a letter (saying) here is what we've found and here's what we know."
Unlike observations made at the Shadow Lane facility, state Bureau of Licensure and Certification inspectors did not observe staff reusing syringes at the Burnham facility, which was closed shortly after news of the health crisis broke. But they did find staff there reusing single-dose vials of propofol, according to inspection reports.
The Centers for Disease Control and Prevention and health district officials think the cluster of hepatitis C cases at the Shadow Lane facility resulted from nurse anesthetists contaminating single-dose propofol vials with syringes that had been reused.
Regardless of the health district's announcement, attorneys representing patients in hepatitis C litigation said people should get tested.
"It is extremely important that they make sure they are free from disease,'' Lewis Gazda said.
His firm represents 50 clients who have tested positive for a blood-borne disease and were treated at a facility owned by Dr. Dipak Desai, majority owner of the Shadow Lane and Burnham clinics.
The law firm also represents more than 50 patients who have tested negative.
Dr. Vishvinder Sharma, a gastroenterologist who resigned as a member of the state's Board of Health, managed the Burnham facility.
The health district also announced Thursday that it has started a Hepatitis C exposure registry.
The registry was developed to help in identifying patients who had procedures at the clinics, including those infected by hepatitis C. The registry will include a way for patients to report on possible hepatitis B or HIV infections.
The health district will be mailing enrollment forms to patients of the Burnham and Shadow Lane facilities, including the 40,000 who were initially warned to be tested. The forms are available online at www.southern nevadahealthdistrict.org.
Dr. Lawrence Sands, the health district's chief health officer, said there are many former patients the agency has been unable to locate because clinic records were incomplete. The registry is another way to identify such patients.
Labus said the previous system of calling patients based on positive lab results received by the health district was not working.
"This approach eliminates us trying to make contact with someone who may have moved or changed their telephone number,'' he said.
Officials think 50,000 patients visited the Shadow Lane facility between March 2004 and Jan. 11, the time frame that they said unsafe injection practices took place.
With the seven hepatitis C cases linked to that clinic, a possibility exists that an additional 77 people who have chronic hepatitis C might have contracted the disease there. About 400 people who underwent procedures at the clinic have tested positive for hepatitis C.
Contact reporter Annette Wells at firstname.lastname@example.org or 702-383-0283.