The City of Las Vegas shut down a clinic last week after health officials traced several cases of hepatitis C to the endoscopy centre.
According to an Associated Press report, city mayor Oscar Goodman said the clinic’s licence has been suspended while health officials try to trace patients who were treated at the centre over the last four years and test them for hepatitis C.
Health officials have traced six reported cases of hepatitis C to the Endoscopy Center of Southern Nevada, and alleged the centre put patient safety at risk by reusing syringes and vials, said the AP report in the New York Times yesterday.
The head of the US Centers for Disease Control and Prevention (CDC), Dr Julie Gerberding, said in a media conference call that the the agency was concerned this could be “the tip of an iceberg” in improper practice across the whole country, reported the Washington Post.
Health officials in Nevada are trying to contact around 40,000 patients who were treated at the clinic between March 2004 and mid January 2008, and had received anesthesia by injection. The patients should be tested for hepatitis C, hepatitis B and HIV. The announcement on the Nevada state health department website says:
“Patients who had procedures requiring injected anesthesia at the Endoscopy Center of Southern Nevada, located at 700 Shadow Lane, Las Vegas will begin to receive letters this week.”
Geberding said this kind of breach to patient safety:
“Should never happen in contemporary health care organizations.”
Unfortunately, although this is the largest number of patients to be recalled for a “blood exposure”, the CDC has seen similar practices in other large scale situations that have led to equivalent breaches of patient safety, she told the media.
This could be the tip of an iceberg and “we need to be much more aggressive about alerting clinicians about how improper this practice is,” urged Geberding.
An emergency spending bill seeking to give the CDC more resources is coming before Congress in April, said the Washington Post.
Several lawsuits have been filed against the clinic and there is also an investigation under way by the Clark County district attorney, said the paper.
Five of the six cases traced to the clinic were treated on the same day and the connection was confirmed using genetic testing, head epidemiologist of the Southern Nevada Health District, Brian Labus, told the Post.
It is highly likely that as the 40,000 patients are traced and tested, more cases of hepatitis C will be found. But it is going to be very difficult to establish if they contracted the virus at the endoscopy centre because the prevalence in the general population is 4 per cent, said Labus.
Dr Dipak Desai, who heads the clinic took out space in the Las Vegas Review-Journal on Sunday to write a letter of regret where he expressed “deepest sympathy” for patients and their families, but there were no words of apology, just an offer to set up a fund to pay for the tests and a defence of practices at the clinic.
According to the Post, Desai wrote:
“The evidence does not support that syringes or needles were ever reused from patient to patient at the center.”
Hepatitis C is a liver disease with an initial acute phase lasting about 6 months where most people show no symptoms, but some feel like they have the flu, feel tired and nauseous and become jaundiced. It is often misdiagnosed, unless a specific test is taken.
The acute phase is followed by a chronic infection phase that results in long term cirrhosis (scarring) of the liver. The disease progresses at different rates in different people.
About one in four people with hepatitis C get rid of the virus naturally, but the other 75 per cent will develop chronic infection, which in most cases will not shorten their lives. However, around one in five chronically infected people will develop severe cirrhosis which can lead to liver cancer or damage that is so bad they will need a transplant.
Hepatitis B is a similarly serious disease caused by a virus that also attacks the liver and can lead to lifelong infection, cirrhosis of the liver, liver cancer, liver failure, and death. However, most adults will recover and develop immunity.
According to the Washington Post, Nevada state health officials are investigating a second clinic that is believed to have re-used anesthetic vials but not syringes.
A hotline has been set up for anyone concerned or who needs further information on the investigation.
Sources: Washington Post, Associated Press, CDC, Southern Nevada Health District.
Written by: Catharine Paddock, PhD