Closing arguments in hepatitis C trial expected Thursday

It took prosecutors almost eight weeks and 70 witnesses to present their criminal case against Dr. Dipak Desai and nurse anesthetist Ronald Lakeman.

The defense took less than eight hours.

Both sides rested their cases Tuesday in the high-profile trial stemming from the hepatitis C outbreak at two of Desai’s clinics.

The defense presented only two witnesses Tuesday, and neither Desai or Lakeman took the stand.

District Judge Valerie Adair gave the jury Wednesday off so attorneys could hammer out instructions for the panel’s deliberations, which are planned after closing arguments Thursday.

The drawn-out and sometimes emotional trial began with jury selection April 22.

Among the witnesses who testified for prosecutors were former patients infected with hepatitis C, physicians and nurse anesthetists who worked with Desai and federal and county health officials who conducted the unprecedented public health investigation into the outbreak.

The criminal investigation -- launched in March 2008 after health officials disclosed the outbreak and urged some 64,000 patients to get tested for blood-borne viruses -- was one of the largest and most complicated undertaken by Las Vegas police.

Health officials concluded unsafe injection practices of the sedative propofol caused the outbreak. Double-dipping syringes into propofol bottles used on multiple patients spread the virus from patients infected with hepatitis C on two different dates in 2007, officials contended.

Desai, 63, and Lakeman, 66, are facing more than two-dozen charges, including second-degree murder, criminal neglect of patients, theft and insurance fraud.

Before the lunch break Tuesday outside the presence of the jury, Adair asked Desai to stand up at the defense table so she could question him about his right to testify in his own defense.

But when she asked him if he understood that right, he turned to his lead attorney, Richard Wright, in apparent confusion and did not answer the judge.

Adair suggested his posture was different than what she was accustomed to seeing, and said she didn’t understand why he couldn’t look at her.

“I just hope there’s not some exaggeration going on,” she said.

Wright later said during the break that the defense was not planning to call Desai.

Before the trial had gotten under way, Wright argued Desai was not competent to assist in his own defense because of the effects of several strokes. Desai, who gave up his medical license, has largely sat motionless with a blank expression on his face throughout the weeks of testimony, refusing to look at witnesses.

Despite Wright’s contention, a judge found Desai competent to stand trial. Prosecutors have previously argued Desai was exaggerating his physical impairments in a ploy to escape a heavy prison sentence if convicted.

The criminal charges focus on the cases of seven patients infected with hepatitis C that health officials linked to Desai’s Endoscopy Center of Southern Nevada on Shadow Lane.

One of the patients, 77-year-old Rodolfo Meana, died last year in his native Philippines.

The prosecution’s final witness, county medical examiner Alane Olson, testified Monday that she shared the opinion of an autopsy done on Meana in the Philippines that concluded he died of complications, primarily liver failure, from hepatitis C.

But a defense medical expert, Columbia University’s Dr. Howard Worman, didn’t share that opinion Tuesday.

Worman, a liver specialist who practices medicine and teaches in New York City, testified it was “extremely unlikely” Meana died as a result of the virus.

Worman said Meana had a series of other “underlying” health problems, including structural damage to his kidneys.

Last week, Chief Deputy District Attorneys Mike Staudaher and Pam Weckerly played a videotaped deposition of Meana explaining how his health declined after he had a colonoscopy at the Shadow Lane clinic and was diagnosed with hepatitis C. The deposition was taken in Las Vegas several weeks before Meana flew to the Philippines to spend his remaining days.

Two of the prosecution’s key witnesses early in the trial were Desai’s former clinic partners, Dr. Clifford Carrol and Eladio Carrera. They testified under grants of limited immunity and were not charged in the case.

Also testifying were Desai’s former clinic manager, Tonya Rushing, and former nurse anesthetist Keith Mathahs, who pleaded guilty in the massive criminal case.

Rushing was not charged, but is facing federal conspiracy and health care fraud charges with Desai.

On Tuesday, Dorothy Sims, a state health care inspector who participated in the investigation, testified for the defense.

Sims said she saw a nurse anesthetist at the now-closed endoscopy center reuse syringes in January 2008, but did not tell the nurse it was considered an improper practice that could put patients at risk.

Sims, who works for the state Bureau of Health Care Quality and Compliance, said she later cited the endoscopy center for failing to develop a written policy banning the multi-dose use of propofol bottles.

She testified that she considered the clinic’s procedures safe, but not the “best practice.”

Prosecutors contend a Desai-created work environment that placed profit above the well-being of patients led to unsafe injection practices and the outbreak.

Contact Jeff German at jgerman@reviewjournal.com or 702-380-8135. Follow @JGermanRJ on Twitter.