Oversight and the medical board
Tony Clark has drawn criticism for not immediately suspending the licenses of doctors whose failure to follow standard aseptic procedures contributed to the hepatitis C outbreak centered at the Endoscopy Center of Southern Nevada.
Mr. Clark will retire as executive director of the Nevada State Board of Medical Examiners next month. The board is scheduled to choose Mr. Clark's replacement from among three applicants in a telephone conference Tuesday.
The three candidates are Louis Ling, legal counsel for the state Board of Pharmacy; Dr. Don Havins, the former executive director of the Clark County Medical Society; and Douglas Cooper, currently the medical board's chief investigator.
All three candidates see their top job as restoring public confidence in the caliber of the board's oversight.
That's an understatement.
Mr. Clark did obtain a restraining order against lead medicos Dr. Dipak Desai and Dr. Eladio Carrera, prohibiting them from practicing medicine in Nevada until after the endoscopy/hepatitis scandal has been resolved.
But the medical board has been wrongly accused of mishandling the investigation, says Mr. Cooper -- defending his own performance. "We cannot take someone's license based on what's in the press," Mr. Cooper explains.
That's true, up to a point. No one should be deprived of his profession or livelihood based on unsubstantiated rumors, or undocumented "he said/she said" reports. Sorting through reams of medical histories and other documents -- and taking testimony from witnesses who may well seek immunity or the advice of counsel -- may be required to afford due process. That can all take time.
But come on. The hepatitis cases are real. The thousands of patients who were put to the expense and emotional strain of seeking hepatitis and HIV tests -- which carry risks both of false negatives and false positives -- are real. No on has advanced a credible alternative theory to contradict the damning coincidence that the cases lead back to the endoscopy centers, where staff members say they were told to take shortcuts in cleaning equipment and to reuse syringes and vials of anaesthetic -- violations of anti-contamination procedures that are taught to both doctors and nurses in the first year of medical training.
Yet the clinics in question were closed down on the initiative of business license regulators -- not thanks to the Board of Medical Examiners.
The public is perfectly justified in asking whether the board was more interested in preserving the careers, cash-flow and reputations of politically well-connected fellow M.D.s -- hoping the public uproar would die down -- than in guaranteeing public safety.
No regulatory agency can have inspectors stationed in every clinic and doctor's office, watching over shoulders on a full-time basis. It would be a useful exercise in humility for the board to acknowledge it has no such all-seeing powers. It can, however, choose a new director who vows to take a firm hand with physicians who are found to violate such a basic trust.
Doctors are human. But if the board's inquiries confirm staff were ordered to engage in a purposeful and systematic violation of basic and well-established safeguards against contamination and contagion, presumably to speed things up and bolster profits, that becomes a criminal matter -- not something to be whitewashed with denial and happy talk.
Meantime, Dr. Havins, the only Southern Nevada candidate for Mr. Clark's chair, said something last week that's hard to argue with: He vowed to press for a branch office in Las Vegas for the medical board, which currently makes do with short-term campouts in a 150-square-foot room in the Southern Nevada office of the State Board of Pharmacy.
A local office would encourage Southern Nevadans to file complaints locally, and give them a chance to meet board members, Dr. Havins said.
Southern Nevada is the most populous part of the state. We have the most doctors here and -- unfortunately -- a matching share of medical problems. It's not too much to ask that the State Board of Medical Examiners spend something approaching more than half their official time here, establishing a presence with staff who can respond promptly to local concerns.
For a change.
