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

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)