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No promises on medical safety

Michael Willden wishes it were possible.

But the director of the state Department of Health & Human Services says there is no way he can promise Nevadans that newly passed public health legislation can prevent a situation similar to the recent hepatitis C outbreak.

"I think the laws that have been passed to protect the public are absolutely a huge improvement," Willden said last week. "It is far less likely. But I can’t say we’ll never have an infection-control event like that again."

The reason for Willden’s caution, despite new laws on the books dealing with everything from stepped up clinic inspections to easier suspension of medical licenses, isn’t difficult to understand: No one, he noted, can legislate human behavior.

Authorities investigating a cluster of hepatitis C cases had observed nurses at the Endoscopy Center of Southern Nevada reusing syringes in a manner that contaminated vials of medication and, they believe, infected patients.

City officials in a report said the clinic’s owner, Dr. Dipak Desai, ordered that practice, and that city investigators were told this was to save money.

But Willden and a number of legislators and medical officials contacted by the Review- Journal believe the new laws will so heighten attention on proper protocols that it is far less likely that Southern Nevada Health District officials will again have to do what they did in 2008: ask 50,000 patients to be tested for HIV and hepatitis.

Assemblyman Joe Hardy, R-Boulder City, who is a physicain, said passage of Assembly Bill 123 is a big step forward for public health. It requires ambulatory surgical clinics to be the subject of yearly, unannounced inspections rather than inspections every three to six years.

"It is much easier to keep things in line," said Hardy, who believes another aspect of the bill, requiring accreditation by a national regulator in order to do business, is also critically important. "It shows we won’t tolerate bad medicine."

Larry Matheis, head of the Nevada State Medical Association, said the fact that the state health division will now assign a nurse to accompany all inspection teams specifically to observe infection control should also give Nevadans more confidence in the state’s health care system.

"This can assist in immediate corrections," he said. "This may become a new national model."

Hardy said Assembly Bill 10, signed Friday by Gov. Jim Gibbons, puts more teeth in legislative protections for medical whistle-blowers.

"This will help both nurses and doctors and other medical personnel who want to do the right thing," Hardy said.

Debra Scott, executive director of the Nevada State Board of Nursing, said Thursday that some nurses were afraid to step forward in the outbreak case for fear they would lose their jobs.

Passage of two other Assembly bills, 112 and 206, look to bridge potential gaps in communication during a public health crisis.

The governor is now required to determine if a public or health emergency needs a coordinated response by a team of state officials.

"We now will have everyone on the same page in an emergency," said Assemblywoman Debbie Smith, D-Sparks, who chairs the Assembly Health and Human Services Committee. "We had problems with coordinating what different offices were doing."

Assemblywoman Sheila Leslie, D-Reno, whose interim health care committee held hearings on the outbreak last year, said it is now clear through legislation that the state health division has the power to have a facility shut down in a crisis.

"That was a problem we didn’t need to have, " she said.

Leslie said last year that she believed existing law gave the state the right to shut down Desai’s clinic, an action that the city’s business license division took when health authorities did not act to close the clinic.

Another bill that Leslie said "clarified existing law" was state Senate Bill 362, which states that a health care professional’s license can be suspended if the facility they own is investigated or disciplined for misconduct.

Last year, Leslie repeatedly said she believed that the Board of Medical Examiners had the right to suspend Desai’s license.

The board’s then-executive director, Tony Clark, had long said the board didn’t have the power to issue a summary suspension.

Clark later said the board did have that power, but that there wasn’t enough evidence to summarily suspend Desai’s license.

Michael Washington, one of nine people whose hepatitis C case was linked to Las Vegas clinics where Desai was the majority owner, has been closely watching the work of the Legislature.

Washington was supposed to testify on behalf of Assembly Bill 495, which would remove a $350,000 cap on pain and suffering damages, a key element of the 2004 medical reform initiative. But the Assembly-approved bill died in the state Senate in apparent retaliation for an Assembly committee chairman’s decision to sit on two Senate-passed construction defect bills.

"I want to believe that the legislators care about what’s happened with this hepatitis C tragedy," Washington said.

"But I don’t understand what construction bills had to do with a bill that would allow people to be justly compensated when doctors are doing something wrong."

Contact reporter Paul Harasim at pharasim @reviewjournal.com or 702-387-2908.

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