Registered nurse Maggie Martin and her colleagues feared patients at Dr. Dipak Desai’s Shadow Lane endoscopy clinic would be seriously harmed because of the speed in which they were processed through upper endoscopy and colonoscopy procedures.
She raised her concerns with Desai, but they consistently fell on deaf ears, Martin, formerly known as Maggie Murphy, told jurors Thursday.
“We as staff members had no idea that something to this magnitude was going to happen,” said Martin, who worked with Desai between 2002 and 2007. “We thought maybe the scope might perforate the colon. That’s what we thought.”
The “something” that Murphy referred to was a hepatitis C outbreak that infected six patients and killed a seventh.
Desai, 63, and co-defendant, 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.
Prosecutors claim that Desai sought to maximize profit margins by overloading the endoscopy clinic and performing as many procedures as possible with little consideration for patients’ safety. That greed combined with his stinginess ultimately led to the outbreak of the deadly virus, according to the state.
While Desai’s defense attorney Richard Wright has intimated that his client simply did not like to see staff standing around or materials wasted, Martin, who testified in District Judge Valerie Adair’s courtroom at the Regional Justice Center, described scenarios that appeared to go beyond that of a cautious business owner.
Martin recalled a special dinner held one year to celebrate a milestone: 1,000 procedures performed in a single month.
Despite only two procedure rooms and one or two physicians on duty, the clinic performed exams on 65 patients or more per day, Martin testified.
Desai was the quickest, she said, and he bragged about that “quite often.” He would conduct a colonoscopy in five minutes and an upper endoscopy in two or three minutes, Martin said. Other physicians took about 15 minutes or longer to perform a colonoscopy.
As other nurses testified earlier this week, Martin witnessed Desai starting colonoscopies before the patient was fully sedated or even given anesthesia two or three times per week.
“For the most part, the anesthesiologist made sure the people were sleeping,” Martin said. “When they were doing these mass amounts of patients, bring them in, bring them out, bring them in, bring them out; there were times that the patient wasn’t quite asleep yet and the procedure would start.”
More frequently, she said Desai would stop the nurse anesthetist from giving patients additional anesthesia when they began moving around and “moaning.”
“He would say, ‘I’m almost done, don’t give them any more,’” Martin testified.
Investigators with the Centers for Disease Control and prosecutors for the state claim the manner in which the anesthesia was handled led to the outbreak.
The drug propofol, which was used to sedate patients, is intended to be a “single-use” only medication, meaning that once it is injected into one patient, the same vial cannot be used on another – it must be thrown away.
The outbreak is blamed on the use of a vial of propofol on a patient infected with hepatitis C and then on an uninfected patient. The pattern continued on Sept. 21, 2007.
Several physicians have testified they did not know that propofol was not a multi-use drug, but prosecutors claim that it wouldn’t have mattered to Desai, who was constantly searching for ways to pinch pennies and bolster his income.
Martin discussed how nurses were instructed to cut the padding placed underneath patients in half and technicians were told to place only a little lubricant jelly on gauze pads. She said nurses were admonished for attending gowned patients who were chilly.
“They didn’t have blankets for patients,” Martin said. “If we gave patient a sheet to cover up with, we were reprimanded for that. He would say, ‘That costs money.’”
If Desai saw a sheet on a patient, he grabbed it off the patient and folded it up to be used on another patient. She said that Desai would then reprimand the nurse.