Syringes reused on multiple patients.
Single-dose medication vials used on more than one patient.
Such dangerous medical practices by an anesthesiologist were detailed in a state health inspectors' report on the Gastrointestinal Diagnostic Clinic on Maryland Parkway. The report, obtained Monday by the Review-Journal, outlines procedures similar to those followed at the Endoscopy Center of Southern Nevada, which health officials have linked to six cases of hepatitis C.
The difference is that the Shadow Lane facility was not found to have reused syringes on multiple patients. And yet, because of that facility's practice, 40,000 people were notified to be tested for blood-borne diseases.
Why hasn't such a notice been sent to patients of the Maryland Parkway clinic?
"So far, we haven't traced any disease to that center," said Brian Labus, senior epidemiologist with the Southern Nevada Health District. "But that practice will eventually lead to the spread of blood-borne diseases. It could be luck that we haven't had any cases from there, or maybe some just haven't been reported yet."
Attempts Monday to reach the clinic's administrator, Dr. Nourollah Ghahreman, were unsuccessful.
On Friday, Clark County licensing authorities instructed the facility that no surgical or diagnostic testing will be allowed at the location, near Sunrise Hospital.
The 23-page report issued by the state's Bureau of Licensure and Certification recounts the results of an inspection of the facility from Feb. 13 to Feb 15, 12 days before the public disclosure of what investigators learned at the Shadow Lane facility.
Inspectors observed an anesthesiologist working on four patients.
"The anesthesiologist was asked what the process was when he went from a used Propofol (anesthesia) vial to a new patient," the report said. "The anesthesiologist states that he would change the needle and reuse the same syringe."
According to the report, the anesthesiologist "was never observed opening new syringes."
The report also disclosed how the anesthetic was reused: "The anesthesiologist was observed drawing up Propofol from the same vial that he had used on Patient 3 to inject Patient 4."
The report did not name the anesthesiologist, nor did it say how long the practice might have been ongoing.
Labus said transmission of a blood-borne disease could occur from the reuse of syringes on patients as well as through vials contaminated by syringes.
At the Endoscopy Center of Southern Nevada, health officials found that syringes were reused on the same patient, a procedure that would contaminate vials and transmit disease to other patients.
Although Labus said what occurred at the Maryland Parkway clinic might appear to have a greater potential for risk, he was not prepared to say that.
"Blood from one person can be transmitted to another in both cases, and that shouldn't happen," he said.
Of the Maryland Parkway clinic, health inspectors wrote in the report: "The facility lacked documented evidence to verify the center implemented a program for identifying and preventing infections, (maintained) a sanitary environment and reported the results to appropriate authorities."
Inspectors also found that a registered nurse was not in attendance with recovering patients.
In addition, there was no record that an employee hired in 1992, who had tested positive for tuberculosis in 1972, was now free of the communicable disease.
A search of the state Board of Medical Examiners' Web site showed no record of disciplinary action against the Gastrointestinal Diagnostic Clinic.
The release of the report came a day before the federal Centers for Disease Control and Prevention was to send infection control and epidemiology experts to Nevada to team up with local Bureau of Licensure and Certification surveyors.
Jack Cheevers, a spokesman for the Centers for Medicare and Medicaid Services, said the federal agency "might possibly" send one or two inspectors as well to help Nevada with the surveys of the ambulatory surgery centers.
As of Monday, 23 of 50 Nevada outpatient surgery clinics had been inspected, he said.
Cheevers said federal officials also have requested neighboring states to help Nevada.
"We have asked them to send inspectors to help Nevada,'' he said. "I don't know what the status is at this time.''
Assemblywoman Susan Gerhardt, D-Henderson, and other legislators said clinics where violations have occurred should be closed until the state and clinic operators agree on a corrective plan.
"We have to know the corrective action plan will be followed," she said.
"A minor infraction is one thing; spreading infectious, life-threatening disease is another," said Assemblywoman Sheila Leslie, D-Reno.
"If the inspectors have evidence of practices that could spread infectious diseases, I believe they should act immediately to remedy the situation and if necessary, shut the business until public safety is ensured."
But neither Leslie nor Assembly Speaker Barbara Buckley, D-Las Vegas, would say conclusively that the state should close the Maryland Parkway clinic immediately.
"It is our position if the investigation shows they deliberately reused syringes and put lives at risk, then they should be closed," Buckley said. "The rules should be the same."
Her views were echoed by Sen. Randolph Townsend, R-Reno.
"It doesn't matter if they are in the rurals, Washoe or Clark, if they are breaking protocol and allowing these things to happen, then they should be closed down immediately, or the state should be sure they have changed and are following proper procedures."
Mike Willden, director of the state Department of Health and Human Services, said there is no lag time between when an inappropriate practice is identified during an inspection and when the practice is corrected.
At a news conference with Gov. Jim Gibbons on Monday, Willden said inspectors do not leave a facility until corrective actions are taken.
"The protocol with the surveyors is if they find a deficiency, they correct it on site before they leave," he said.
That was the practice with the inspection at the Endoscopy Center of Southern Nevada and with the inspections now under way at the other ambulatory surgery centers, Willden said.
Review-Journal writers Sean Whaley, Annette Wells and Ed Vogel contributed to this report. Contact reporter Paul Harasim at firstname.lastname@example.org or (702) 387-2908.