The bureaucratic shuffle

Throughout the public health crisis surrounding Dr. Dipak Desai's gastroenterology empire, the State Board of Medical Examiners has displayed an alarming lack of urgency in responding to reckless practices at his clinics.

Now we know its plodding, protective oversight of Dr. Desai goes back long before February, when health investigators announced a hepatitis C outbreak and urged tens of thousands of his patients to immediately undergo testing for blood-borne diseases. An in-depth report by the Review-Journal's Paul Harasim, published Sunday, reveals that Dr. Desai's standards were first brought to attention of the Board of Medical Examiners almost 20 years ago.

Medical technician Judy Witman reported Dr. Desai to the board in 1989 after resigning from one of his clinics. Ms. Witman, who now lives in Pennsylvania, said "he wouldn't allow us to properly clean the scopes (used in colonoscopies) because he was in a hurry to get patients through to make more money. He was so cheap. There was always blood and stool on them" after they were washed, she told Mr. Harasim. "It was disgusting."

There is no public record of Ms. Witman's allegations because, conveniently, the state board, a body of appointed physicians charged with licensing and disciplining their own, doesn't keep records of complaints that receive no action.

Dr. Charles Cohan filed three complaints with the board against Dr. Desai in 1996. The last of those three warned that Dr. Desai was "seeing patients with a five-minute face-to-face encounter, barely examining the patients, and then setting them up for procedures," Dr. Cohan wrote in a report of his concerns to Assemblywoman Sheila Leslie, chairwoman of the Legislative Committee on Health Care.

Dr. Cohan, who now lives in Pennsylvania, informed the assemblywoman that he "submitted to the state board bills from two patients charged for comprehensive examinations that would have taken around an hour each, yet they swore to him they were seen for about five minutes," Mr. Harasim reported.

But Dr. Desai was a member of the board from 1993 to 2001, at one point serving on the investigative committee, screening the complaints filed against him. The only action the board took against Dr. Desai was a $2,500 fine for false advertising.

Dr. Ivan Goldsmith said Dr. Desai used his position on the investigative committee for personal benefit as well. "He told me he could go after my license if he wanted to. But he said if I started referring my patients to him instead of (Dr. Julian) Lopez, he'd forget about it. I had no choice but to start referring my patients to him. I'd call that blackmail."

Yes, Dr. Desai was on the board's radar -- just not in a way that protected public health and safety or the integrity of the medical profession.

So even though authorities had already pinpointed the source and the cause of this year's hepatitis C outbreak -- personnel at the Endoscopy Center of Southern Nevada had been observed reusing syringes and contaminating vials of medication, and the employees told authorities they routinely put patients at serious risk of infection under orders from Dr. Desai and his administrators -- the Board of Medical Examiners did not use the findings of the investigative report to immediately suspend Dr. Desai.

While municipal regulators were stripping clinics of their business licenses, board members insisted on operating at their own pace and openly doubted whether Dr. Desai put patients at risk. The board's crowning achievement in this debacle was, amid a tsunami of public outrage, persuading Dr. Desai to surrender his medical license.

Sunday's report shows that, contrary to what some legislators are claiming, this catastrophe did not result from a lack of resources in the state's vast regulatory structure. No, when licensed professionals are allowed to oversee their friends, colleagues and competitors, the public rarely benefits. Complaints that might be perfectly valid are lost -- or hidden -- within the bureaucracy.

The Board of Medical Examiners is just another protectionist, good-old-boy racket that exists primarily to raise the profile of its members. It is wholly impotent in its primary mission of rooting out bad doctors. It can begin the process of rebuilding the public's confidence in its function by storing every complaint that comes through its doors, regardless of whether action is taken on them. These are public records that must be maintained.

Dr. Cohen told the Review-Journal that Dr. Dipak Desai's previous immunity from accountability gives residents a "sense of the corruption in Nevada." Unfortunately, they're already all too familiar with it.