Doctor testifies in Desai trial, says he can’t believe hepatitis C spread through injections

A doctor who worked closely with Dr. Dipak Desai testified Monday that he still struggles to believe that the hepatitis C outbreak that spread through Desai’s clinics stemmed from unsafe anesthetic injections.

Dr. Vishvinder Sharma said he never witnessed nurse anesthetists reuse vials of propofol, adding that the procedure room was dark and he was focused on the monitor while performing upper endoscopies or colonoscopies.

Sharma was the second gastroenterologist to testify in the trial of Desai, 63, and nurse anesthetist Ronald Lakeman, 65, who face more than two dozen charges, including second-degree murder, criminal neglect of patients, theft and insurance fraud.

Prosecutors claim that Desai was so money hungry, he forced nurse anesthetists to reuse vials of propofol between patients instead of throwing them away. They said propofol was injected into a patient infected with hepatitis C, then reused on an uninfected patient, which spread the disease.

The hepatitis C outbreak infected seven patients, including one who died.

Sharma, who worked at Desai’s clinics between 1994 and 2008, said Desai operated his endoscopy clinics in a frugal manner but did not patient safety at risk.

Prosecutors are attempting to show that unsafe injections were possible because of the pace in Desai’s facilities. They claim his waiting rooms were full of patients, and doctors were rushed to maximize his profits.

Unlike other witnesses, Sharma did not discuss crowded clinics or Desai’s penchant to brag about his quick procedures. He instead described Desai’s managing style.

“Dr. Desai is a very frugal person,” Sharma said. “He is a fiscally very conservative person. He liked to micromanage the practice.”

Defense lawyers are attempting to show that Desai was not being cheap with his directive on the use of propofol and that physicians simply were unaware it was a single-use medication. Like Dr. Clifford Carrol, a physician at Desai’s clinics, Sharma testified Monday that although the injection of propofol was the anesthetists’ responsibility, he did not know it was dangerous to use the same vial twice. Like Carrol, he believes the outbreak could be blamed on the reuse of saline bottles in the pre-operation or post-operation rooms.

Sharma said the anesthetists were cautious and doubted they would put a patient’s life in danger because of an order from Desai.

“They were very well-trained, very experienced,” Sharma said. “They were not the type of people who would succumb to any pressure.”

In 2007 the Center for Disease Control and the Southern Nevada Health District descended on Desai’s Shadow Lane clinic and witnessed nurse anesthetists use unsafe injection practices.

Carrol, who returned to the stand for cross-examination Monday, explained that following the outbreak, he examined patient records and determined that the theory that hepatitis C spread through propofol didn’t make sense.

He noted that the virus was passed to one patient followed by five patients who did not get infected. He also found it strange that the virus had jumped from one procedure room to the next. Carrol and Sharma said that the nurse anesthetists never left the room during a procedure.

Chief Deputy District Attorney Michael Staudaher asked if it was possible that a nurse anesthetist left an open vial of propofol on the counter and another picked it up. Carrol said he had never seen that happen.

“I still don’t know how it skips so many people,” Carrol said.

He also told Staudaher that even though 70 patients were filtered through the clinic’s two procedure rooms each day, he never believed anybody to be in danger.

“I thought it was safe,” Carrol said. “I never rushed to go through a patient just because there were other patients waiting.”

Each procedure room got its share of propofol each morning and the vials were never taken to the other room, he said.