We can’t have it both ways on public health

Public health agencies carry out their work of communicable disease investigation and control almost undercover to protect patient privacy. But late last month, the Southern Nevada Health District called a news conference to announce that six hepatitis C infections were identified in January when usually only two such infections are reported annually.

Investigators interviewed each of the infected persons to determine the source of their infection and found that each, prior to their symptoms of hepatitis, had undergone a colonoscopy with intravenous lines for anesthesia at the same Las Vegas clinic.

One reason the health district called the news conference: The investigation also revealed that unsafe practices may have been going on for four years, putting 40,000 patients at risk. The news conference was one way to inform patients in a timely manner that they need to be tested for hepatitis B, hepatitis C and HIV.

So many questions arise. How long were these unsafe practices going on? Are 10,000 colonoscopies a year a reasonable number for quality medical care given the size of the facility? Who has the authority to close a medical facility and under what circumstances? Does the health district have the resources to complete the notification of patients in a timely manner? If not, how can resources be provided?

The magnitude of this crisis both from the sheer number of persons at risk and the gravity of the diseases should spur our leaders to action. Hepatitis B, hepatitis C and HIV infection can be deadly. It is frightening that a large proportion of persons with such infections may not have symptoms for many years and are unaware that they are infected. But they are infectious and may unknowingly transmit these infections through sexual intercourse to their partners.

What should be done? In the short term, it is imperative to provide the health district with resources necessary to notify every at-risk patient as soon as possible. Is one month a reasonable time frame? Let us ask the leaders who have acted in the public's interest what they need to complete the notification and refer all infected persons to the appropriate care. We should work with commercial laboratories to provide a discounted package of the three blood tests needed at no cost to the patient or reimbursed by the state or county from additional resources provided for such emergencies. The state should find the additional funds necessary to complete the notification, testing and referral process.

Then we need to convene a task force of public health and health care leaders to examine our system, identify how it worked and where it failed. It needs to make recommendations to the governor and Legislature to prevent such incidents.

Nevadans traditionally do not like government -- the less government, the better. However, during this emergency, I have heard repeated calls for the government to take responsibility.

We can't have it both ways. Public health law is a delicate balance between individual rights and the public good. It is never easy to enact regulatory statutes. It goes against the grain of Western libertarian philosophy.

We have to hold our leaders accountable, but we also have to support those who vote for the necessary funds to improve the public health system instead of driving them out of office.

If we don't do this, we can only blame ourselves for not valuing our health enough.

In the future, if we have the terrible misfortune of being notified that we have been exposed to a potentially life-threatening infection because of improper infection control practices by our health care provider, we will know who to hold accountable.

Mary Guinan, M.D., Ph.D., is dean of the UNLV School of Public Health.