Physician fired for missteps

June Likourinou, director of nursing at the Maryland Parkway gastroenterology clinic shut down by the county Friday, said she doesn't believe allegations of unsafe practices by Dr. Scott Young reflect how he usually did his job.

"I've seen him in action before, and he never did that," she said Tuesday of reports that Young reused syringes and vials on multiple patients. "His father has cancer, and I just believe he wasn't thinking."

Nevertheless, health investigators will begin interviewing administrators at hospitals to determine whether Young put other Southern Nevada hospital patients at risk for the same kind of blood-borne diseases that forced authorities to request 40,000 people be tested for hepatitis and HIV.

"This is very complicated," said Brian Labus, senior epidemiologist with the Southern Nevada Health District. "He worked at many places, including hospitals, and we have to try and determine what was done."

Though Likourinou doesn't believe what Young did in front of state investigators was the norm for him, "We had to fire him for it. It can't be tolerated."

Young's actions at the Gastrointestinal Diagnostic Clinic, referenced in a state report, are similar to those found at the Endoscopy Center of Southern Nevada, which health officials have linked to six cases of hepatitis C.

Health officials believe disease transmission at that clinic's Shadow Lane facility occurred when nurse anesthetists reused syringes on infected patients, contaminating vials of medication that were shared among multiple patients.

Labus said his staff must also determine whether anesthesiologists at the group Young works for, PBS Anesthesia, are reusing syringes and vials.

"We don't know how far the investigation must go at this point," Labus said.

PBS, one of the area's largest anesthesiology groups, has at least three dozen anesthesiologists, according to a 2006 medical directory. Their physicians practice at hospitals and clinics throughout Southern Nevada.

PBS did not return repeated phone calls Tuesday seeking comment. Neither did Young, who was fired from the clinic at 3196 S. Maryland Parkway after the state's site inspection from Feb. 13 to Feb. 15.

Likourinou said when investigators arrived, she was busy retrieving paperwork for state officials.

She said if she had seen him engaging in unsafe practices, "I would immediately have said something. I've got a big mouth."

Likourinou, a nursing veteran of 21 years, said she has worked at other large hospitals.

"Physicians were often trying to do that," she said of syringe and vial reuse. "I had to speak up, or it would have been done. They all did it. Let me tell you, it's out there."

She said there was no financial incentive for Young to deviate from accepted medical protocol. It just comes down to busy doctors "not taking the extra step," she said.

NO OFFICIAL COMPLAINT FILED

Early Tuesday, an administrator for the Nevada State Board of Osteopathic Medicine said the regulatory board received a complaint against Young on Feb. 26. The official would not say who had made the complaint, described as "extremely serious," nor whether it was related to the state's Licensure and Certification Bureau inspection of the Maryland Parkway facility.

But later in the day, Dr. Larry Tarno, executive director of the osteopathic board, said it had not received an "official" complaint against Young.

"Technically, we don't have a formal complaint in the form we normally receive it, and so it is not something we can go forward with,'' he said Tuesday afternoon. "I have received information from two sources, including one from Northern Nevada. I have requested that these individuals contact me and provide me with additional information.''

Tarno said if a formal complaint is brought against Young, or any other osteopathic physician involved in the hepatitis C or unsafe practice investigation, he would move forward.

"We don't want to lose the trust of the public,'' he said.

350 LICENSED IN NEVADA

Known as DOs, doctors of osteopathic medicine complete the same training as medical doctors and are certified in different specialties such as anesthesiology.

Young is a DO, one of 350 licensed by the osteopathic board in Nevada.

Tarno, a retired family care physician, said complaints are brought to his attention first, then he designates a board member to review and investigate the complaint.

"The remainder of the board has no knowledge of the complaint because they function as the judge and jury during hearings,'' he said. "The attorney general's office also gets involved if we go to hearings because it functions as the board's attorney.''

Charlene Herst, spokeswoman for the Nevada State Board of Health, said her agency will await the outcome of the health district's inquiries into Young before deciding whether to add hospitals to the emergency inspections now underway. As of Tuesday, 23 of 50 ambulatory surgery clinics had been inspected statewide.

Patients who had Young as an anesthesiologist should take action, she said.

"They should be tested," Herst said.

But Labus said it's is too early to determine that. So far, no disease has been traced to the Maryland Parkway center.

Dr. Neil Swissman, past president of the American Society of Anesthesiologists and president of Summit Anesthesia in Las Vegas, said during Young's time with his group he was unaware that he ever engaged in risky medical practices. Young worked with Summit from Dec. 1, 1997, through Nov. 1, 2002.

"I can't conceive of anybody reusing syringes on multiple patients," he said. "There's just no reason. Everyone knows you can't do that."

Although Young no longer has privileges at the Maryland Parkway gastrointestinal center, he is an active member of the anesthesiology staffs at most Southern Nevada hospitals.

Young has privileges at all three of the St. Rose Dominican and Sunrise Health hospitals and at University Medical Center.

Representatives from the Valley Health System, which operates five hospitals in the Las Vegas Valley, did not respond to questions about Young.

Andy North, a spokesman for St. Rose Dominican Hospitals, declined to say whether any action by the hospital would be taken, such as suspending Young's privileges.

"We're not taking a stance right now,'' he said "This is a process that is being looked at by the health district and legal.''

REUSE OF ITEMS FORBIDDEN

Regarding syringe reuse, North said, the policy of St. Rose Dominican Hospitals is to follow the guidelines of the Joint Commission, Centers for Disease Control and Prevention, the Occupational Safety and Health Administration and the Association for Professionals in Infection Control.

"Our policies are not to reuse equipment that has been contaminated or been in contact with another person,'' North said. "All physicians and staff that practice medicine in our hospitals must follow those guidelines.''

Ashlee Seymour, a spokeswoman for Sunrise Health, made similar comments.

She also said that because anesthesia medication is a controlled substance, vial disposal is to be witnessed by two licensed staff members. Each patient receiving anesthesia or any other medication has their own individual tray with a new syringe and a new single-dose medication vial. That syringe is used once, then discarded. The vial, even if its contents are not fully used, is thrown away after medication is drawn for the patient.

"We have a strict standard of care and practice guidelines, and it is our expectation that physicians on our campus follow those guidelines,'' Seymour said.

All staffers at the hospital are encouraged to communicate with a physician or immediate manager if they are uncomfortable with a particular practice.

UMC'S WHISTLE-BLOWER HOT LINE

Rick Plummer, a spokesman for UMC, said any staff at the hospital who witnesses a physician or other health care professional doing something that makes them uncomfortable may call its "whistle-blower hot line.''

As of Tuesday, Plummer said he didn't know whether the hospital had initiated an internal investigation regarding Young. Should such an investigation occur, it would be initiated by the hospital's Medical Executive Committee, which is made up of physicians.

Also Tuesday, Bill Welch, president and CEO of the Nevada Hospital Association, said doctors and other health professionals at hospitals have been sent a document to sign acknowledging they're aware of proper hygienic practices.

He said conference calls have been ongoing with hospitals to make sure unsafe practices are not allowed.

"If it is determined that any doctor has not been following hospital practices, their privileges will be suspended," he said.

Contact reporter Paul Harasim at pharasim@reviewjournal.com or (702) 387-2908. Contact reporter Annette Wells at awells@reviewjournal.com or (702) 383-0283