Mandatory accreditation urged

Accreditation soon might be more than an option for ambulatory surgery centers. It might be a requirement.

Several Nevada lawmakers plan to introduce legislation that would require ambulatory surgery centers to be accredited or inspected by an organization other than the state's licensing bureau.

Still, that might not solve problems with the centers that have come to light following an outbreak of hepatitis C in Southern Nevada.

"The centers that had the most egregious problems, some were accredited and some were not," Mike Willden, director of the state Department of Health and Human Services, said during a meeting Wednesday of the Legislative Commission.

At the very least, Willden said, the state needs to "look at our relationship with the national accrediting organizations."

Currently, the accreditation of ambulatory surgery centers is voluntary. Of the 50 ambulatory surgery centers in Nevada, 32 are accredited by one of three organizations, the American Association for Accreditation of Ambulatory Surgery Facilities, the Accreditation Association for Ambulatory Health Care, and the Joint Commission.

Representatives of the organizations will testify on Monday before the Legislative Committee on Health Care. The meeting, which will be held at the Sawyer Building, is dedicated to examining the hepatitis C outbreak.

Assemblyman Joe Hardy, R-Boulder City, said he, along with state Sen. Joe Heck, R-Henderson, and Assemblywoman Heidi Gansert, R-Reno, plan to introduce legislation that would either require ambulatory surgery centers to be accredited or inspected by an organization other than the state's Bureau of Licensure and Certification.

"With respect to inspections, the state's licensing bureau has had to work from behind because it is understaffed," Hardy said. "The bottom line is inspections did not take place through no fault of the people, and because of our budget crisis it is probably time to look at something outside the budget.''

The state's licensing bureau licenses ambulatory surgery centers and, under an agreement with the federal Centers for Medicare and Medicaid Services, conducts inspections and complaint investigations of the facilities.

Hardy said Tuesday's announcement by the licensing bureau -- ordering the Lake Tahoe Surgery Center at Round Hill cease patient care procedures after an inspection revealed unsafe infection-control practices -- is another reminder that Nevada still faces "challenges" ensuring patients are safe while undergoing procedures at those facilities.

It was the second inspection of the Northern Nevada facility in a month during which unsafe practices were documented.

Since learning of unsafe injection practices at two Las Vegas endoscopy centers, Hardy said, the three lawmakers have had ongoing discussions, primarily through e-mail because Heck is in Iraq, about possible legislation.

Nearly seven weeks ago, 40,000 letters were sent to former patients of the Endoscopy Center of Southern Nevada on Shadow Lane by health care authorities after they discovered unsafe injection practices at the clinic. The patients were urged to be tested for blood-borne diseases, including hepatitis C, an incurable, potentially fatal condition that attacks the liver.

Six cases of acute hepatitis C have been traced to that clinic, and a seventh is linked to the Desert Shadow sister clinic on Burnham.

"If I owned an ambulatory surgery center, I would want somebody looking over my shoulder. And, as that owner, I would want to pay for those inspections," Hardy said. "I would want the public to know that my facility has been inspected by an experienced accrediting agency."

Those inspections are typically done by highly trained medical professionals.

According to the state Health Division's Web site, the Endoscopy Center of Southern Nevada was not accredited.

Jeff Pearcy, executive director for the American Association for Accreditation of Ambulatory Surgery Facilities, said his recommendation when he testifies on Monday will be that the state go a step beyond ambulatory surgery centers and require accreditation of physician's offices where outpatient surgical procedures are also taking place.

"This was a terrible adverse event. Everybody knows that. But Nevada is in a really great position to make strides in patient safety," said Pearcy, whose organization uses surgeons to inspect surgery centers.

Willden mentioned on Wednesday several other issues related to the hepatitis C outbreak that need to be addressed during the upcoming legislative session, including:

• Reorganizing the state's Bureau of Licensure and Certification.

• Setting steeper fines and penalties for ambulatory surgery centers found to have deficiencies.

• Creating better channels of communication among the state's regulatory agencies.

Willden said there was a lag getting information to various boards because some require that information be delivered in writing. Some require written notification to be notarized.

"We need to streamline the notification process, particularly from professional to professional," Willden said. "It needs to be instantaneous."

Tony Clark, executive director of the state's Board of Medical Examiners, said he supports Willden's efforts to streamline communications among the regulatory boards.

When the licensing bureau learned of problems at the Lake Tahoe clinic, Clark said, "they notified us immediately."

He said the medical board has "opened an investigation for a potential investigation," into the Lake Tahoe facility.

Clark's wording seemed to irritate Sen. Randolph Townsend, R-Reno.

"Don't look into looking into it," Townsend said. "The thing that irritated me about Southern Nevada is, while everybody was pointing fingers, nobody said, 'Round up all the people we're concerned with and get them tested.' You've got to protect the people you serve, not your licensees. And you got to learn to work together."

Debra Scott, executive director of the state's nursing board, also testified Wednesday, saying the regulatory board has received more than 30 complaints about the practices of registered nurses related to the outbreak.

Scott said six nurses have voluntarily relinquished their licenses.

Contact reporter Annette Wells at awells@reviewjournal.com or 702-383-0283.