Autopsy in Philippines showed hepatitis evidence

A Las Vegas police officer and a county medical examiner traveled to the Philippines in April to witness the autopsy of Rodolfo Meana, a hepatitis C outbreak victim, grand jury transcripts reveal.

The officer, Maynard Bagang, who speaks Tagalog, one of the major languages of the Philippines, testified Aug. 10 that detectives conducting the criminal investigation into the 2007 outbreak had asked him to make the trip with the medical examiner, Alane Olson.

Olson testified that her mission was to bring back and examine blood and tissue samples from Meana's body for police and Clark County prosecutors pursuing a murder charge against Dr. Dipak Desai, the central figure in the outbreak, and two of his nurse anesthetists.

The autopsy in Manila found that Meana died of complications from hepatitis C, and Olson told the grand jury she shared that conclusion, according to the transcripts obtained by the Review-Journal.

Bagang and Olson were the only two witnesses who testified before the panel on Aug. 10 as it charged Desai, 62, and two nurses, Keith Mathahs, 76, and Ronald Lakeman, 65, with second-degree murder. All three defendants are free on bail.

Meana, 77, had flown to the Philippines in late March to spend his remaining days in his native country. He died on April 27.

His hepatitis C infection was among seven the Southern Nevada Health District genetically linked to Desai's main clinic, the Endoscopy Center of Southern Nevada on Shadow Lane. Health officials definitively linked two other cases to Desai's facilities and described 106 more cases as "possibly linked."

Health officials concluded Meana and five other patients contracted hepatitis C through unsafe injection practices on Sept. 21, 2007, health officials concluded. Another patient was infected on July 25, 2007.

The murder indictment accuses Desai, Mathahs and Lakeman of "introducing the hepatitis C virus" into Meana's body while he underwent a 2007 colonoscopy.

Bagang told the grand jury he learned of Meana's death the morning of April 27 and that by 11 p.m. both he and Olson had boarded a flight for Manila.

Olson testified that the autopsy took place on April 30 and that she and the officer were allowed to observe.

At the end of the autopsy, she said, the pathologist provided her with the blood and tissue samples she needed to determine that Desai died of cirrhosis of the liver caused by the hepatitis C virus.

Olson said she kept the samples locked in a safe in her hotel room the rest of her stay in Manila and brought them on the return flight to Las Vegas in a carry-on bag that never left her control.

Olson also testified that she and Bagang made special arrangements with airport security in the Philippines and the United States to get through the screening process with the blood and tissue samples.

When Olson arrived in Las Vegas, she went straight to the coroner's office with the samples, she said.

Later, while examining the tissues under a microscope, Olson testified, she found that Meana had extensive scarring in his liver, a sign of cirrhosis.

"Do you have an opinion as to what was the cause of death in this particular case?" Chief Deputy District Attorney Mike Staudaher asked Olson.

"Yes," Olson responded.

"What is that opinion?" Staudaher asked.

"My opinion is that he ultimately died as a result of chronic active hepatitis associated with hepatitis C infection," Olson responded.

Prosecutors allege Desai, a gastro­enterologist who has since given up his medical license, performed Meana's colonoscopy and some of the medical procedures linked to infections at the Endoscopy Center of Southern Nevada.

Mathahs and Lakeman administered the sedative propofol to the infected patients under the questionable injection practices, prosecutors allege.

Only Mathahs injected Meana with the sedative, but prosecutors also were able to charge Lakeman in Meana's death under the theory of the murder charge, which alleges that all three defendants were part of the conspiracy that en­dangered the lives of Desai's patients.

The case follows a 28-count indictment from June 2010 against Desai and the two nurses on an array of other criminal charges stemming from the outbreak.

They are to stand trial Oct. 22 before District Judge Valerie Adair on those charges, which include racketeering, patient neglect, insurance fraud and obtaining money under false pretenses.

The same grand jurors who heard that case were brought back on Aug. 10 to consider the murder charges tied to Meana's death. They received their oaths that day from the judge who oversees grand jury matters.

After listening to Bagang and Olson, the panel members deliberated a few minutes and then voted to return a murder indictment, the transcripts show.

No trial date has been set for the murder case, but District Judge Stefany Miley, who has been assigned the case, suggested in court last week that the trial likely would occur next year.

Miley scheduled a hearing Sept. 19 to come up with a date.

Desai also faces a Nov. 20 trial on federal conspiracy and health care fraud charges in the hepatitis outbreak.

Contact Jeff German at jgerman@reviewjournal.com or 702-380-8135.