Doctor details push for quick procedures, cost savings at endoscopy clinics

Of all the physicians snared in the federal hepatitis C outbreak investigation, Dr. Eladio Carrera had worked for Dr. Dipak Desai the longest.

Yet Carrera testified Wednesday that he was an outsider who wasn’t treated kindly by his boss.

While other physician partners received generous bonuses from Desai several times a year, Carrera said he only received one. And Carrera’s slow-paced colonoscopies were often the subject of Desai’s staff meetings.

“He berated me about that on multiple occasions,” testified Carrera, who began working with Desai in 1988. “He went to the point of presenting at group meetings. He was always harping on the fact it took me very long to do procedures, in his estimation.”

Carrera, who signed an immunity agreement with the government, said it typically took him about 20 minutes to complete a colonoscopy and 10 minutes to do an upper endoscopy procedure. Fellow physicians, technicians and nurses have testified that Desai wrapped up a colonoscopy in as little as five minutes.

Desai, 63, and co-defender, nurse anesthetist Ronald Lakeman, 65, face more than two dozen charges — including second-degree murder, criminal neglect of patients, theft and insurance fraud – in relation to a 2007 hepatitis C outbreak that infected six patients. A seventh contaminated patient died.

The prosecution contends that Desai was greedy and grew his profits by rushing as many patients as possible through procedures and saving money by skimping on medical supplies and medicine.

According to the government, Desai forfeited patient safety and comfort during the process. And, in 2007, prosecutors claim his irresponsible behavior led to an outbreak when the anesthetic drug propofol was injected into a hepatitis C-positive patient and then used again on other patients.

Carrera stood before the media during a March 2008 press conference announcing the outbreak and made a statement on behalf of Desai’s clinics. He said it was not his choice to read the statement; it was Desai’s.

Just before the press conference, he said Desai backed out.

“He said he had a cardiac problem and his treating doctor advised him not to give the statement himself,” Carrera said. “At the very last moment he said he wasn’t feel well and he wouldn’t be attending.”

Out of the presence of the jury, Desai attorney Richard Wright objected to prosecutors suggesting that Desai backed out because he was cognizant of criminal behavior. Wright also unsuccessfully bid for a mistrial after prosecutors revealed that Desai met with criminal defense attorneys days after the press conference, a violation of attorney-client privacy laws.

Wright said he advised Desai not to speak at the press conference.

Earlier in the morning, Carrera said that Desai treated him differently. Desai reduced his hours and therefore his ownership shares in his endoscopy clinics.

He also described how Desai was cheap when it came to equipment and anesthesia.

During one procedure, Carrera noticed that the patient appeared to be growing uncomfortable. He asked Lakeman if it was safe to administer additional propofol and Lakeman said that Desai had directed nurse anesthetists not to use more than 20 ccs of propofol.

“I said ‘Ron, that doesn’t matter, if a patient needs more medicine, they need more medicine,’” Carrera said, adding that Lakeman did oblige.

Desai also nagged Carrera about the use of protective masks, saying he should use one per day, Carrera testified.

“He commented to me that I used too much lubricant on scopes and he suggested I put a small amount on a gauze pad and limit my use to that,” Carrera said. “He commented I used too much personal protective gear such as masks and coats. I told him if they were visibly soiled I was going to change them out, that’s just how it was.”

Three patients were alleged to have been infected with hepatitis C during procedures performed by Carrera. His medical license was suspended for a year and a half during the investigation but has since been fully reinstated.