Hepatitis C in Nevada Could Be "Tip of the Iceberg"

By Mike Grippi

Originally published on Advocate.com March 05 2008 12:00 AM ET

An outbreak of
hepatitis C at a clinic in Nevada might represent ''the
tip of an iceberg'' of safety problems at clinics around the
country, says the head of the Centers for Disease
Control and Prevention.

The city of Las
Vegas shut down the Endoscopy Center of Southern Nevada
last Friday after state health officials determined that six
patients had contracted hepatitis C because of unsafe
practices, including clinic staff reusing syringes and
vials. Nevada health officials are trying to contact
about 40,000 patients who received anesthesia by injection
at the clinic between March 2004 and January 11,
2008, to urge them to be tested for hepatitis C,
hepatitis B, and HIV.

In Washington,
D.C., Senate majority leader Harry Reid met Monday with
CDC director Julie Gerberding, and the Democratic leader
shared a media conference call with her after their
meeting. Both strongly condemned practices at the
clinic.

Health care
accreditors ''would consider this a patient safety error
that falls into the category of a 'never event,'
meaning this should never happen in contemporary
health care organizations,'' said Gerberding.

''This is the
largest number of patients that have ever been contacted
for a blood exposure in a health care setting. But
unfortunately, we have seen other large-scale
situations where similar practices have led to patient
exposures,'' Gerberding said.

''Our concern is
that this could represent the tip of an iceberg, and we
need to be much more aggressive about alerting clinicians
about how improper this practice is,'' she said. At
the same time, she said, inspectors also should
continue ''to invest in our ability to detect these
needles in a haystack at the state level, so we recognize
when there has been a bad practice and patients can be
alerted and tested.''

Reid said he
would work with Gerberding to try to get the CDC more
resources in an emergency spending bill Congress is to take
up in April.

State health
officials said they were unsure how many of the 40,000
patients they had been able to contact since making the risk
public last Wednesday. At least initially, they did
not have correct addresses for 1,400, officials said.

The clinic's
head, Dipak Desai, MD, bought space in the newspaper the
Las Vegas Review-Journal on Sunday in which he
expressed ''my deepest sympathy to all our patients and
their families for the fear and uncertainty that
naturally arises from this situation.''

Desai offered no
apology but said a foundation was being set up to cover
testing costs. He also defended practices at his clinic,
which performs colonoscopies.

''The evidence
does not support that syringes or needles were ever reused
from patient to patient at the center,'' Desai wrote.

A spokeswoman,
Nancy Katz, declined Monday to comment further.

The Clark County
district attorney is investigating, as are various
health agencies, including the Nevada State Board of
Nursing. Several lawsuits already have been filed, and
a hearing is scheduled Thursday before a Nevada
legislative committee.

It may never be
known how many people contracted hepatitis C because of
unsafe practices at the endoscopy center, state health
officials said. Brian Labus, head epidemiologist of
the Southern Nevada Health District, said that because
4% of the population has hepatitis C, he expects to get
numerous positive results after the at-risk clinic patients
are tested, and that it may be impossible to
determine which of those were infected at the clinic.

Of the six cases
that health officials traced to the clinic, five
happened on the same day, and genetic testing was used to
make the connection, Labus said.

Hepatitis C can
cause fatal liver disease as well jaundice and fatigue,
but 80% of people infected show no symptoms. Hepatitis B is
a more rare and serious disease that attacks the
liver. (AP)