‘They are absolutely monstrous’

It's hard to imagine 40,000 people put at risk of exposure to potentially life-ending illnesses just being the tip of the iceberg.

But now that the state Bureau of Licensure and Certification is looking into about 50 ambulatory surgery centers, it seems that the reuse of medicine vials and syringes may be more widespread.

As the granddaughter of a cancer victim, I would never advise healthy people to stay away from testing as they get older to screen for different types of the disease. But as I sat at the Legislative Committee on Health Care meeting Thursday morning, the only thing that crossed my mind was that every one of these centers ought to be closed.

Yet the state continues to operate in the type of bureaucratic bubble that again endangers the public's health.

Lisa Jones, chief of the bureau which licenses hospitals, ambulatory surgical centers and a host of other clinics, defensively explained her agency's inability to see the forest for the trees when it was called in by the Southern Nevada Health District's epidemiology unit to examine acute cases of hepatitis C.

When her investigators first went to the dirty scope mill down on Shadow Lane, Jones said they were only observing practices and had yet to prove the cases stemmed from the center's reuse of syringes from infected patients to healthy ones.

Given that mind-set, she said, when investigators noticed deficiencies, they simply asked the center to take corrective action.

That's one of the options in the bureaucratic protocols for investigations. But as Assembly Speaker Barbara Buckley, D-Las Vegas, aptly noted, state law gives three specific examples of when a license can be suspended immediately.

"It seems to me we probably met all three," Buckley said. "Your job is to get out there right away and stop the process."

Buckley also pointed out the state can fine the guilty party $1,000 a day, stretching back to March 4, 2004, and possibly beyond to meet the scope of the problem. The bureau has fined the clinic $3,000.

"If you give a $3,000 fine for killing people, then what kind of message are you sending to the community?" Buckley asked Jones.

A moment later, Buckley left the room. Committee Chairwoman Sheila Leslie, D-Reno, asked Jones for an update on the ongoing investigations into the other centers. "We can't be naive to the fact that these types of practices are happening in other places," Jones said.

Investigators are finding varying degrees of problems, she added, from medicine vials being re-used to syringes being re-used.

"Sadly, it's not an isolated occurrence," Jones added.

And sadly, Jones still doesn't understand she not only has the authority, but a duty, to shut these disgusting mills down.

How many more healthy people is the state willing to put at risk?

Jones didn't suggest any suspensions of licenses. Instead, she actually told lawmakers she was probably going to seek a waiver from federal requirements to inspect nursing homes so her teams could concentrate on the surgical centers.

We already know what happens when places aren't inspected. Ask construction workers up and down the Strip about the last time they saw a proactive OSHA inspection.

The state had not inspected the Endoscopy Center of Southern Nevada since 2001. It was supposed to give a look in 2007, but no docucmentation of such an inspection can be found.

Finally, late Thursday, the governor woke up to the crisis and issued a statement encouraging his Department of Health and Human Resources to throw every available resource at the issue.

Glad to have you on board, governor. It only took a week to pry him from family meetings to address a public health crisis.

When the story first broke, the Internet was full of student doctors and practitioners saying, essentially, that this kind of horrific case could only happen in Sin City, where morals are cast away easier than a pair of dice.

But Jones' nonchalant blockbuster that these practices are routine throughout Las Vegas makes you wonder if they might not be routine in Peoria, too.

Even after receiving new technical specifications from the state's top doc and after a full week of daily news coverage into the issue, other clinics were still found to be re-using syringes and medicine vials.

Assemblywoman Susan Gerhardt, D-Henderson, said she struggled with whether to disclose the fact that she and her husband had been patients at the center during the time in which bad practices were occurring.

"They are absolutely monstrous," Gerhardt said. "They cannot claim that they cannot know the consequences for their actions."

Dr. Lawrence Sands, the medical director of the health district, said it was important to reassure the public that the health system is safe.

Gerhardt and her husband still haven't gotten letters informing them they might have been exposed. And those who were patients at the center before 2004, when it still had the same management, didn't get letters, either.

There's no way to reassure the public about the cases we know about -- an estimated 40,000 from one center.

What about the other 13 the state has investigated? And just how much faith will we have in the system after they finally get around to all 50?

Contact Erin Neff at (702) 387-2906, or by e-mail at eneff@reviewjournal.com.