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Report Assesses Blame in Hepatitis Cases

By JENNIFER STEINHAUER, The New York Times May 17, 2008

Health care workers at a Las Vegas endoscopy clinic linked to more than 80 cases of hepatitis C routinely mishandled injection equipment and medication vials and often failed to perform basic hand hygiene, according to a report from the Centers for Disease Control and Prevention released Friday.

The Endoscopy Center of Southern Nevada, one of the largest gastroenterology practices in the area, was closed and fined $500,000 after the Nevada State Health Division discovered several cases of hepatitis C that appeared to stem from the clinic earlier this year. Two of the center’s doctors, including its owner, Depak Desai, have been required to stop practicing medicine.

The hepatitis outbreak, one of the largest in the United States, was first reported by the Southern Nevada Health District to the federal agency in early January, the report said. The first seven cases were publicly revealed in February.

The report, based on state and federal officials’ observations of patient procedures at the clinic, details a host of unsanitary practices, including nurses’ and anesthesiologists’ failing to wear gloves when they administered intravenous medications.

Officials noted that IV stoppers were sometimes not properly wiped, that syringes and vials were reused and disinfectant cleaning baths for equipment were used for two endoscopic procedures rather than one as recommended. Health officials believe the hepatitis was spread by the clinic’s reuse of anesthesia syringes among patients.

The health district has notified 40,000 patients who had visited the clinic that they might have been at risk for infection with the hepatitis B and C viruses or H.I.V. and asked them to be tested.

Since February, 85 cases of hepatitis have been revealed — seven clearly contracted at the clinic, one from a sister clinic and 77 that most likely stemmed from the primary clinic as well, Nevada health officials said.

About 50,000 panels of blood from patients have been tested in laboratories around the region, and more cases are expected to appear over time, said Brian Labus, a senior epidemiologist with the health district. The federal report “underscores that we have obvious problems at the clinic that exposed thousands of people,” Mr. Labus said.

The outbreak piqued the interest of law enforcement authorities, including the Nevada attorney general, who are investigating possible fraud connected to the clinic.