Health Officials Say Trust Suffered

July 14, 2008 Las Vegas Review-Journal By ANNETTE WELLS

Days after health officials announced their theories behind how six people contracted hepatitis C at a Las Vegas endoscopy center, Nevadans turned to their health care providers and asked: "Do you reuse syringes and needles?"

Some patients didn't bother to go that far. They simply canceled appointments or optional surgical procedures. Even nurses at Southern Nevada Health District immunization clinics found themselves trying to reassure parents no harm would come to their children while receiving vaccines.

Over the past four months, health officials have worked to restore the public's trust in medical care.

Some health care providers are taking unusual approaches. At Steinberg Diagnostic Medical Imaging Centers, patients are handed cards that inform them the facility "never reuses needles or syringes." Other providers explain to patients how medical equipment works and is sterilized.

"The loss of confidence is large, and we've tried to be responsive at all the various levels necessary to restore confidence,'' said Larry Matheis, head of the Nevada State Medical Association.

"People are really nervous," said Dawn Hughes, director of surgical services at Sunrise Hospital. "They say, 'I know what happened.' We just try to reassure them that won't happen here.''

Hughes said patients are asking a lot of questions. In most cases, hospital staff will walk patients through procedures and offer to show them equipment that will be used. Patients also want to see packaging of syringes, she said.

Though that was the practice of Sunrise Health hospitals in the past, staff has been more diligent since news of the hepatitis C outbreak, Hughes said.

"One of the greatest strides we've made over the last 10 years is to get people to do screening for colonoscopies,'' Hughes said. "We sure don't want people avoiding them because of something like this.''

Stephanie Bethel, a health district spokeswoman, said nurses must explain to parents that syringes and needles are not being reused.

The health district uses a particular syringe, VanishPoint, in which the needle retracts into the syringe's barrel after use.

"We have been showing patients how that works,'' Bethel said.

Matheis said physicians must take a "please ask me" approach. In other words, "We want to encourage doctors not to wait for a patient to ask questions but to assume the patient has questions.''

Matheis said physicians must be comfortable with their own infection control standards and procedures before they can offer reassurance to patients.

"We've encouraged physicians to address this as they feel most comfortable,'' Matheis said. "That's led to some innovative efforts like those at Steinberg. ... The hardest thing for many physicians is the growing number of patients who are concerned about referrals to certain specialists.''

Matheis said most patients are referred to specialists such as gastroenterologists by primary care physicians. He said primary care physicians are taking the lead on educating the public about health care safety issues and what questions to ask specialists about procedures and equipment being used.

The Centers for Disease Control and Prevention and health district investigators believe hepatitis C was spread to patients at the Endoscopy Center of Southern Nevada, 700 Shadow Lane, after nurse anesthetists reused syringes and single dose vials of anesthesia.

Initially, health officials notified 40,000 former patients of the endoscopy center they should be tested for blood borne diseases. That increased to just over 50,000 as health officials acquired more accurate patient records.

Eight hepatitis C cases have been linked to two clinics affiliated with the endoscopy center. Another 77 have tested positive for hepatitis C, and their disease may be linked to the Shadow Lane facility as well, health officials say. Several investigations are under way.

Dr. Jerry Jones, a Las Vegas OB-GYN and president of the Clark County Medical Society, said the organization has started a column in its monthly newsletter on medical safety to aid physicians. The group also plans to publish about a dozen articles on the issue.

The state's medical association is working with HONOReform -- a national advocacy group for patients who become infected with hepatitis in health care facilities -- and the Centers for Disease Control and Prevention Foundation to develop a national campaign to ensure injection safety in health care settings nationwide.

Matheis said Nevada's physicians will be the first to pilot a national campaign on injection safety by developing fliers, posters, patient information sheets and creating educational programs for doctors. The campaign is expected to begin nationally by early next year.

"This is probably the first full-blown campaign on this issue since the start of the HIV and AIDS epidemic. A lot of information has changed, and a lot of technology.''

The medical association is also working with the Nevada Center for Ethics and Health Policy to hold a professional ethics summit this fall addressing issues raised by the public, lawmakers and the medical community as a result of the hepatitis C outbreak.

Sally Hardwick, the center's project coordinator, said the forum would look at how to restore the public's trust as well as the quality of care in Nevada.

"We want to build a health care community that really endorses high ethical standards,'' she said. "We really need the public to know that we're all concerned and we're working hard to restore their trust.''

EDITORIAL: The Bureaucratic Shuffle

July 11, 2008 Las Vegas Review-Journal

Medical board bungling -- not money -- the real problem

Throughout the public health crisis surrounding Dr. Dipak Desai's gastroenterology empire, the State Board of Medical Examiners has displayed an alarming lack of urgency in responding to reckless practices at his clinics.

Now we know its plodding, protective oversight of Dr. Desai goes back long before February, when health investigators announced a hepatitis C outbreak and urged tens of thousands of his patients to immediately undergo testing for blood-borne diseases. An in-depth report by the Review-Journal's Paul Harasim, published Sunday, reveals that Dr. Desai's standards were first brought to attention of the Board of Medical Examiners almost 20 years ago.

Medical technician Judy Witman reported Dr. Desai to the board in 1989 after resigning from one of his clinics. Ms. Witman, who now lives in Pennsylvania, said "he wouldn't allow us to properly clean the scopes (used in colonoscopies) because he was in a hurry to get patients through to make more money. He was so cheap. There was always blood and stool on them" after they were washed, she told Mr. Harasim. "It was disgusting."

There is no public record of Ms. Witman's allegations because, conveniently, the state board, a body of appointed physicians charged with licensing and disciplining their own, doesn't keep records of complaints that receive no action.

Dr. Charles Cohan filed three complaints with the board against Dr. Desai in 1996. The last of those three warned that Dr. Desai was "seeing patients with a five-minute face-to-face encounter, barely examining the patients, and then setting them up for procedures," Dr. Cohan wrote in a report of his concerns to Assemblywoman Sheila Leslie, chairwoman of the Legislative Committee on Health Care.

Dr. Cohan, who now lives in Pennsylvania, informed the assemblywoman that he "submitted to the state board bills from two patients charged for comprehensive examinations that would have taken around an hour each, yet they swore to him they were seen for about five minutes," Mr. Harasim reported.

But Dr. Desai was a member of the board from 1993 to 2001, at one point serving on the investigative committee, screening the complaints filed against him. The only action the board took against Dr. Desai was a $2,500 fine for false advertising.

Dr. Ivan Goldsmith said Dr. Desai used his position on the investigative committee for personal benefit as well. "He told me he could go after my license if he wanted to. But he said if I started referring my patients to him instead of (Dr. Julian) Lopez, he'd forget about it. I had no choice but to start referring my patients to him. I'd call that blackmail."

Yes, Dr. Desai was on the board's radar -- just not in a way that protected public health and safety or the integrity of the medical profession.

So even though authorities had already pinpointed the source and the cause of this year's hepatitis C outbreak -- personnel at the Endoscopy Center of Southern Nevada had been observed reusing syringes and contaminating vials of medication, and the employees told authorities they routinely put patients at serious risk of infection under orders from Dr. Desai and his administrators -- the Board of Medical Examiners did not use the findings of the investigative report to immediately suspend Dr. Desai.

While municipal regulators were stripping clinics of their business licenses, board members insisted on operating at their own pace and openly doubted whether Dr. Desai put patients at risk. The board's crowning achievement in this debacle was, amid a tsunami of public outrage, persuading Dr. Desai to surrender his medical license.

Sunday's report shows that, contrary to what some legislators are claiming, this catastrophe did not result from a lack of resources in the state's vast regulatory structure. No, when licensed professionals are allowed to oversee their friends, colleagues and competitors, the public rarely benefits. Complaints that might be perfectly valid are lost -- or hidden -- within the bureaucracy.

The Board of Medical Examiners is just another protectionist, good-old-boy racket that exists primarily to raise the profile of its members. It is wholly impotent in its primary mission of rooting out bad doctors. It can begin the process of rebuilding the public's confidence in its function by storing every complaint that comes through its doors, regardless of whether action is taken on them. These are public records that must be maintained.

Dr. Cohen told the Review-Journal that Dr. Dipak Desai's previous immunity from accountability gives residents a "sense of the corruption in Nevada." Unfortunately, they're already all too familiar with it.

Endoscopy Center Patients Told How to Get Records

By Mary Manning · July 10, 2008

Metro Police has hired Chart 1, a private firm, to finish organizing about 120,000 endoscopy patient records after a cluster of hepatitis C cases were discovered at a local clinic.

Southern Nevada Health District, and state and federal health officials discovered in January a cluster of eight acute hepatitis C patients at the Endoscopy Center of Southern Nevada.

That cluster prompted an investigation that is ongoing. More than 50,000 people have been notified -- in the largest notification in the nation's history -- to get tested for hepatitis B and C, and HIV as a result of procedures at several local clinics that did not follow standard medical practices.

Here is how patients may obtain records:

Patients treated at the Gastroenterology Center of Southern Nevada, Endoscopy Center of Southern Nevada, Desert Shadow Endoscopy Center and the Gastroenterology Center of Nevada between January 2006 and March 2008 may submit requests to Chart 1 to receive copies of their records.

These written requests must include the medical release request form, which can be downloaded from the Metro Police Web site at www.lvmpd.com. Patients also can pick up the release request forms at any Metro Police area command center.

The request form must include a copy of photo identification, along with the mailing address that patients wish to have their records sent.

All requests should be sent to Chart 1, P.O. Box 95546, Las Vegas, NV, 89119-5546.

Patients who have not received their records within one week may call 828-0170 to check the status of their request. The phone line is a message recording service where patients can leave their name, phone number, birth date and last four digits of their Social Security number.

Patients will receive a return phone call within 24 hours.

Patients treated at the clinics before 2006 who want to obtain their records must send their requests to Gastro Center, P.O. Box 35140, Las Vegas, NV 89133.

Doctors', Technicians' Complaints About Dipak Desai Were Ignored

July 10, 2008 Las Vegas Review-Journal by JANE ANN MORRISON

Many wondered why no whistle-blowers notified authorities about issues with Dr. Dipak Desai. The Las Vegas Review-Journal's Paul Harasim answered that question Sunday in his in-depth report.

There were whistle-blowers.

At least two people, and possibly more, turned to the Nevada Board of Medical Examiners and complained about Desai. A medical technician reported her concerns about cleanliness. A competing gastroenterologist alleged Desai engaged in false advertising and overbilled patients.

Since Desai became the hub of the hepatitis outbreak in February, two other doctors, one a former member of the medical board, have alleged Desai exploited his position on the medical board to extort other doctors, promising protection in exchange for patient referrals. They said nothing to authorities at the time; so they don't qualify as whistle-blowers, just complainers.

It's possible more people tried to report unsafe and unsanitary practices before health authorities identified a cluster of hepatitis cases in February and linked them to Desai's Endoscopy Center of Southern Nevada. Amazingly, the medical board doesn't keep a file of complaints that aren't acted upon; they just toss them. Presumably there could be other complaints that were filed against Desai that no one knows about.

The first whistle-blower is Judy Witman, one of the medical technicians who worked for Desai in 1989. She said she quit after a few months and notified the board of medical examiners. Witman said Desai was so cheap, he rushed the technicians and didn't give them enough time to completely clean the scopes used in colonoscopies. "There was always blood and stool on them," she told Harasim.

Result of her complaint: Case dismissed.

In 1996, Dr. Charles Cohan, a competing gastroenterologist who had opened his practice in Las Vegas two years earlier, filed three complaints with the medical board. The first two alleged false advertising, the third alleged Desai overbilled two patients.

Surprise, surprise, Cohan's first false advertising complaint went nowhere. Desai was on the board and chaired the committee that investigated complaints.

When the new phone book came out six months later and Desai was still falsely advertising all his doctors were board-certified, Cohan filed again, presenting all the documents proving Desai's ads were false. This time, Desai was fined $2,500, and one of his doctors was fined $5,000.

Cohan's third complaint involved billing. Cohan said he submitted bills from two patients who were charged by Desai for exams that should have taken an hour, and the patients said they saw Desai for five minutes. Case dismissed.

So he sent the information to the FBI. Nothing happened.

In 1998, Cohan sent 400 pages of information on false advertising and overbilling to the office of Attorney General Frankie Sue Del Papa. The AG couldn't substantiate the allegations. Result: Unable to substantiate. Case dismissed.

In 1999, Cohan gave up, leaving town after an anonymous caller threatened his family.

Dr. Ivan Goldsmith, an internist, never filed a complaint but said around 1995 or 1996, when Desai was on the medical board, the gastroenterologist threatened disciplinary action if Goldsmith didn't refer patients to him.

Goldsmith said he hired a physician's assistant to work in his office who had passed the tests but wasn't yet licensed. "He (Desai) told me he could go after my license if he wanted to. But he said if I started referring my patients to him ... he'd forget about it. I had no choice but to start referring patients to him. I'd call that blackmail," Goldsmith told Harasim.

Another board member at the time said other doctors said Desai contacted them and said they wouldn't be disciplined by the board if they referred patients to him. The board member said the doctors didn't file complaints because they had no proof, so there was nothing he could do.

Of course, they were supposedly being protected from discipline. Or maybe they thought it was pointless to speak out. For whatever reason, those doctors, including the board member, apparently did nothing to stop Desai's alleged extortion when he was on the medical board between 1993 until 2001.

Wonder how those doctors feel about keeping quiet about Desai, now that 50,000 patients are being tested for hepatitis and AIDS. Any pangs about joining the conspiracy of silence?

Patients' Lawyers Blast Doctors for Clinic Inspection

By BRIAN HAYNES REVIEW-JOURNAL

Two of the state's most influential doctors came under fire Tuesday when lawyers for patients suing the medical clinic linked to a hepatitis C outbreak questioned their inspection of the clinic.

Patti Wise, a lawyer with Bernstein and Associates, said Drs. Javaid Anwar and Ikram Khan should have put a stop to staffers using unsafe injection practices when they inspected the Endoscopy Center of Southern Nevada and reported their findings to health officials.

"It's almost impossible to believe these medical professionals would go into this facility and see this happening and turn a blind eye," Wise said during a hearing on whether to dismiss Quality Care Consultants as a defendant in a pending class action lawsuit.

The Endoscopy Center hired Quality Care Consultants, which is owned by Anwar and Khan, to review its policies and procedures and make recommendations to meet national standards.

Public health officials who inspected the clinic in January observed nurse anesthetists reusing syringes and single-use vials of medication during procedures, which officials think led to the hepatitis C outbreak and potentially exposed 50,000 patients to blood-borne diseases.

Until recently Anwar was president of the Nevada State Board of Medical Examiners. He remains on the board, which licenses and disciplines the state's doctors, but has recused himself from matters related to the Endoscopy Center.

John Bailey, lawyer for Quality Care Consultants, argued that the company should be dismissed from the pending class action lawsuit by non-infected patients because it served only as a consultant to the Endoscopy Center of Southern Nevada and played no part in conducting medical procedures or changing clinic practices.

"Mere consultants are not liable for giving advice," he said.

The patients' lawyers disagreed.

Gerald Gillock said the company assumed responsibility for the clinic's practices when it took payment for the inspection and ongoing monitoring.

Attorney Ed Bernstein said he was skeptical about the true nature of the relationship between Quality Care Consultants and the Endoscopy Center, which is owned by a group of doctors including Dr. Dipak Desai.

"My gut is telling me it wasn't an inspection entity at all, and there was some other purpose for these monies," Bernstein said, noting the influential doctors involved. "I don't know exactly what it was, but we're going to find out."

After the hearing, Bernstein said he had seen three checks of $12,500 from the Endoscopy Center to Quality Care Consultants. The first two checks were written six months apart. The third check was written a few months after the second, he said.

Bailey strongly defended his clients and called the other lawyers' statements "reckless."

"It's analogous to McCarthyism to stand up and say there must be something wrong because two people know each other," Bailey said. "Don't make accusations you have absolutely no facts to support."

District Judge Allan Earl said he was skeptical of the link between Quality Care Consultants and the hepatitis outbreak but rejected the dismissal motion. He allowed the lawyer to refile the motion with more details about Quality Care Consultants' work and responsibilities at the Endoscopy Center.

"We will be back," Bailey said.

Contact reporter Brian Haynes at bhaynes@reviewjournal.com

Hepatitis Records Ready For Release

LAS VEGAS -- Former patients of the Endoscopy Center of Southern Nevada will now be able to retrieve their medical records, four months after being seized by police.

According to the Review-Journal, the company Metro hired to alphabetize the records has completed the task, saying the files are ready for release.

Metro has set up a hot line for records request and will release the number to the public next week.

More than 50,000 former patients were exposed to blood-borne pathogens by unhealthy medical practices at the facility, health officials said. Between March 2004 and January 2008, the staff at the facility reused medical vials and syringes on multiple patients, leading to cross contamination, officials said.

Eight cases of acute hepatitis C have been linked to center, with another 80 hepatitis B, C and HIV cases being tied to the unsafe practice, officials said.

State health officials recommend that former patients of the center be tested for hepatitis B, C and HIV.

DR. DESAI'S RISE AND FALL: Scandal engulfs physician who escaped 'hell on earth,' rose to prominence in LV

By PAUL HARASIM REVIEW-JOURNAL

A dozen palm trees sway gently in the breeze behind the Red Rock Country Club home of Dr. Dipak Desai. Tiny ripples move across the pond that sparkles even as the June sun begins to drop behind the mountains.

Two golfers, preparing to tee off on the 14th hole of the private course designed by the legendary Arnold Palmer, are clearly visible from the huge back window that dominates the physician's $3.4 million, 8,700-square-foot house on a hill.

But it's not a scene that the 58-year-old Desai would particularly relish, according to a longtime acquaintance.

"He doesn't like golf," said Kanti Patel, a 70-year-old retired engineer who has known Desai for 28 years. "He thinks it's a waste of time. I've never seen him play it or watch it. Basically all he's interested in is making money. He just lives on a golf course for the status.

"He's not that hard to figure out."

Until six months ago, few people outside the medical community cared what makes Desai tick. A man who examines polyps and hemorrhoids for a living generally doesn't generate much news.

That all changed in February, however, when health authorities advised thousands of patients of the gastroenterologist's Shadow Lane clinic to undergo testing for hepatitis and HIV. Authorities investigating a cluster of hepatitis C cases had observed clinic nurses reusing syringes in a manner that contaminated vials of medication and, they believe, infected patients. This dangerous practice, according to city investigators, was done at the direction of Desai and other administrators.

Desai's medical license has been suspended as authorities continue to investigate eight hepatitis C cases linked to his Shadow Lane and Burnham Avenue clinics.

Who is the man known in medical circles simply as "D?"

For this story, the Review-Journal spoke with dozens of Desai's associates. Most requested anonymity, saying they feared either retaliation or jeopardizing professional relationships with him.

Their assessments tend toward extremes.

Some believe him to be a dedicated physician, a decidedly spiritual man whose chief desire is to heal. They know him as a strict vegetarian who travels to his native India on religious pilgrimages where he joins millions of other Hindus in washing earthly sins away in the Ganges River.

Others see him as a blackmailer and a strong-arm tactician.

Little insight comes from Desai himself. Since February, he has refused media requests for interviews.

Phone calls go to voice mail. Knocks on the door are met with silence.

Richard Wright, Desai's criminal defense attorney and country club neighbor, says his client won't speak to reporters because he feels as though he's been "burned" by the media. How Desai has been "burned" Wright will not say.

ESCAPING 'HELL ON EARTH'

Desai's background did not assure the material success he has had in Las Vegas. He has told associates he came here with practically nothing, but now has a net worth of about $200 million.

"You do have to remember that he came from a city in India, Ahmedabad, that is hell on earth," recalled a California real estate investor who said he attended college and medical school there at the same time as Desai. "Students studied hard to get the hell out of there so they could leave and make their fortune."

The businessman, an Indian who grew up in Africa, said when he and Desai attended Gujarat University in the late 1960s and early 1970s, there was no escaping the unsanitary conditions and corruption.

"You squatted over a hole in the ground when you had to go. There was no tissue so you used a wet hand to clean yourself," he said. "It was disgusting. In a 115-degree heat, you couldn't get away from the smell of human waste."

Bribery was a way of life.

"Just to get on the bus you had to bribe the conductor with extra rupees," he said. "There were always so many people waiting. It got so I'd climb in a window in the back to get on. ... You had to pay someone to get a job."

Desai has a formidable intelligence, his former classmate said. Raised in the Gujarati tongue of his native Indian state of Gujarat, Desai had to grasp scientific concepts at the same time he was learning the English language used at medical school.

Students there "really had to cram" if they wanted to immigrate and practice in the country they knew from Hollywood. "The medical students loved movies that showed America," he said.

Now a metropolitan area of almost 6 million, Ahmedabad was already teeming with 2 million people 40 years ago. Then, as now, it was the largest city in Gujarat. For most of the time that Desai was at the university, the city was also the state capital.

Nearly a quarter of the population, according to United Nations reports, lived in slums so filthy that people washed in streams where excrement and garbage were visible. There was no air-conditioning. Meanwhile, heavy industries and thousands of kerosene-fueled rickshaws belched black smoke into the air, the classmate said.

And without an infrastructure in place to deal with heavy rains, monsoons regularly left water four feet deep in much of the city.

"You had to wade through the water to get where you were going," the former classmate said. "You'd go to school with wet clothes. There would be snakes all over the place. The frogs would croak so loud you had a hard time studying."

What Desai's early life was like in Ahmedabad is unclear. The businessman said that he and Desai, who was a year ahead of him in school, spoke only a couple of times and never about Desai's personal life.

Patel, who grew up in another city in Gujarat and never knew Desai in India, said Desai seldom talked about his life there.

"He said his dad died early of a heart attack, at 44, I believe," Patel said. "That couldn't have been easy."

Patel said Desai, who was born in November 1949, did share that his family was of the Vaisya, or business and trader caste.

Though formally outlawed by the Indian government, the inherited class or caste structure that was long part of Hindu traditional society still lingers in the minds of some Indians, governing certain marriages and life opportunities, Patel said.

"I think he said his father was a businessman, but I don't know in what field," Patel said.

Desai was able to live at home rather than in college dorms, his former classmate said. He stressed that even if Desai lived in an area where sanitary conditions were the norm rather than the exception, Desai wouldn't have been able to escape the primitive side of Ahmedabad.

"Bugs literally became part of your meals," he said. "Cockroaches and flies were baked into your food. There was no way to avoid it. The government did nothing to kill them."

Although the businessman said the medical school was clean and academically rigorous, he said he has often wondered since the health care scandal erupted whether Desai ever escaped the filth and dishonesty of Ahmedabad.

"You may take the man out of Ahmedabad, but can you take all the Ahmedabad out of the man?" he said. "I didn't finish medical school because I couldn't stand the corruption (in the city) and lack of hygiene there."

OPPORTUNITY IN AMERICA

In the mid-1970s, Desai passed exams that allowed him to embark on a career in medicine in the United States.

After his arrival in the United States, he worked as a resident at Catholic Medical Center in New York.

In New York, according to Patel, Desai met his wife, also a native of India. Kusum Desai, a pulmonologist with whom Desai has three daughters, refused repeated requests for interviews.

Records show that during his time in New York, Desai obtained licenses allowing him to practice both there and in Maine.

By 1980, he was headed for Las Vegas.

"In his research, D saw that Las Vegas didn't have a lot of gastroenterologists," said Dr. Ivan Goldsmith, a Las Vegas internist who met Desai shortly after the Indian immigrant's arrival. "D's always been a good businessman. He would ask me to refer him patients."

If Desai and his wife had banked any money in New York, it wasn't evident upon their arrival in Las Vegas.

It was at the low-rent Sombrero Motel just south of Tropicana Avenue on Las Vegas Boulevard that Patel first met Desai. The doctor steered his Chrysler to the motel office through a parking lot dotted with beer cans.

Patel used the motel as temporary housing on weekends while working at the Nevada Test Site during the week. It wasn't unusual, he said, for management to call the cops to deal with rowdy patrons.

He said initially he was thrilled to be in the company of another immigrant from South Asia, particularly one who hailed from his home state of Gujarat. Yet Desai's boasts about his future wealth wore thin.

"Our conversations would always get around to how much money he was going to make in Las Vegas," Patel recalled. "Money, money, money. It was the most important thing to him."

Patel said the proprietor of the motel, Babu Naik, a man of Indian descent, didn't charge Indians to stay at the Sombrero, which was renamed the Pollyanna before being demolished five years ago.

"There was a kind of pipeline where Indians helped Indians who were coming to the United States," Patel said.

Naik, who now runs the Roulette Motel on Fremont Street, said he is proud that Desai became successful in Las Vegas.

He said once investigations into the hepatitis crisis are concluded, he's sure people will see that Desai's only intention is to help people.

"That's all he's ever wanted to do," Naik said, noting he still sees Desai at religious gatherings at the Hindu temple in Summerlin. "He's a very good man."

The Desais lived only a few weeks at the motel before moving into an apartment, Patel said.

According to Patel, a South Asian doctor steered Desai to 700 Shadow Lane, a medical building near Valley Hospital. That building would remain at the core of Desai's practice until February of this year.

His Gastroenterology Center of Nevada, a consulting practice with 14 physicians, was there until authorities shut it down. So was the Endoscopy Center of Southern Nevada, the busy clinic where the outbreak was discovered.

IMMIGRANT DOCTOR ON THE RISE

Soon after Desai's arrival in 1980 he became tight with Dr. Elias Ghanem, Goldsmith said. Ghanem was a Lebanese immigrant whose career had taken off in Las Vegas a decade earlier when he treated Elvis Presley.

Ghanem, who died in 2001, also treated Liberace and Michael Jackson, earning the moniker "physician to the stars." Among his other patients: then-Gov. Bob Miller and President Clinton's mother, Virginia Kelly.

"D figured out how to get close to the right people," Goldsmith said.

Ghanem's lucrative medical clinics, the Las Vegas Medical Centers, catered to Culinary union workers in the hotel-casinos.

"Ghanem became extremely powerful in the medical community because he was the man referring all those Culinary patients to specialists," Goldsmith said. "He had a huge impact on the livelihoods of physicians."

Ghanem, an active fundraiser for politicians on both sides of the aisle, began to refer patients who needed gastroenterological services to Desai, according to Goldsmith.

With his medical practice taking off, Desai became a homeowner and took his first turn as a land speculator.

Records show that his first home, a 3,200-square-foot house near Rancho Drive and Sahara Avenue, was purchased for just over $127,000 in 1981.

That same year, documents reveal, Desai and his wife joined with Dr. V.A. Ram and his wife to buy a 121/2-acre plot for $322,850 at Rancho and Lone Mountain Road. That parcel, plus an adjacent 11-acre parcel the foursome bought later for $1 million, would earn more than $4 million in profits by the time the last piece was sold in 2004.

A physician who invested in land deals with Desai said the Indian immigrant told him that since 1981, he had also purchased land in Arizona, California and on the East Coast.

"He has gotten many physicians in land deals with him," the doctor said. "Desai told me the land deals have helped his personal worth go over $200 million. Other physicians appreciate his reaching out to them. He has a tremendous mind for business. He's not only helped physicians that way, but he's also helped set up their practices. The only thing he asks in return is that they refer patients to him.

"That makes sense."

All of his wheeling and dealing might have taken a toll. In the mid-1980s, Desai -- seemingly the picture of good health at a slim and trim 5 foot 6 and 150 pounds -- had a heart attack, Patel said.

"He almost died," he said.

The first hint of trouble in Desai's medical practice also surfaced in the 1980s. Judy Witman, one of his medical technicians, said she became concerned about the physician's work, even as his reputation grew and his practice became busier and busier.

"Everybody thought he was this great physician," she said in a phone interview from her Pennsylvania home. "But he wouldn't allow us to properly clean the scopes (used in colonoscopies) because he was in a hurry to get patients through to make more money. He was so cheap. There was always blood and stool on them" after they were washed. "It was disgusting."

Witman, who now works for a Pennsylvania hospital, said she quit her job at Desai's clinic after a few months and notified the Nevada State Board of Medical Examiners about Desai's behavior in 1989.

She said she never received a return call.

"This terrible thing that happened might not have if they had listened to me," she said.

There is no record of the complaint. Tony Clark, executive director of the medical board, said the board keeps no record of complaints that aren't acted upon.

Two years later, registered nurse Wendy McMurray, who headed the endoscopy center at Valley Hospital, became concerned about Desai for a different reason.

Desai tried to get Dr. Julian Lopez "thrown off the staff," McMurray recalled. "He wanted me to say that the new guy was incompetent. He didn't want the competition. I couldn't do that. Lopez was a much better doctor than Desai."

The misgivings that Witman and McMurray had about Desai never reached Gov. Miller, who would appoint Desai to the Nevada State Board of Medical Examiners.

"I only heard good things about him," Miller said. "He seemed so professional."

Miller said he met Desai after becoming governor in 1989, but he can't remember exactly when.

The Democratic governor had been referred to Desai by Ghanem, the governor's personal physician.

That referral would radically change Desai's life.

Desai's removal of a polyp for Miller, a routine procedure, impressed the governor.

"He (Desai) was so charismatic and caring," Miller said. "There certainly was no indication of his being anything other than a good physician. His practice was growing dramatically."

In 1992, Desai followed Ghanem's lead and provided free medical care to striking Frontier Hotel workers who had no medical insurance. Ghanem, whose managed care company had a contract to provide medical care to 85,000 Culinary and Bartenders union members and their dependents, said it was important for union members to know the medical community supported them.

"I wasn't born rich, and sometimes you have to give something back to the society in which you live," Desai told the Review-Journal at the time.

Desai, one of 700 specialists who received referrals from Ghanem's company, acknowledged in the Review-Journal interview there was a business component to the free care.

In 1993, Miller appointed Desai to the medical board.

Miller stressed that he talked to other physicians about Desai's suitability for the board.

He said he can't remember, however, who the doctors were.

But Lopez, a physician who admits to an extreme dislike for Desai, said the appointment had to be "strictly political."

"He (Desai) was always bragging about doing two-minute colonoscopies, procedures that bring in money but are bad for patients," Lopez said. "Other doctors knew there was no way you can detect problems patients may have in two-minute scopes. It wouldn't be wrong to say it takes at least 10 times that long."

TAKING CHARGE ON THE BOARD

No one, according to longtime Nevada physicians, has ever taken better advantage of an appointment to the medical board than Desai. Reappointed by Miller in 1997, Desai didn't leave the board until 2001.

"It gave him the opportunity to do basically what he wanted to enrich himself," Lopez said.

He became the medical director for gastroenterology at University Medical Center in 1994 and chief of internal medicine at Lake Mead Hospital (now North Vista Hospital) the same year. He also would become Valley Hospital's director of gastroenterology and get the opportunity to teach at the University of Nevada School of Medicine. He no longer has those positions.

According to Goldsmith, Desai at a party in the late 1990s publicly expressed his gratitude to Ghanem, who survived an FBI investigation into his own clinic's billing practices and accusations that he was one of the doctors who provided drugs that contributed to Elvis' death.

"He stood up and said (to Ghanem), 'Thank you for showing me how to use power,''' Goldsmith recalled. "It was from Ghanem that I'm sure he learned it was smart to both contribute and hold fundraisers for politicians."

Goldsmith said it didn't take long for him to learn how Desai could use the power of his board position.

"I admit, I once let a physician's assistant work in my office before I received the necessary paperwork from the state," Goldsmith said. "It was just a bureaucratic thing. The PA had passed all the necessary tests, but I still shouldn't have done it. Somehow D found out about it. He hadn't liked the fact I was referring patients to Lopez, so he was looking at me.

"He (Desai) was on the investigative committee of the board at the time. He told me he could go after my license if he wanted to. But he said if I started referring my patients to him instead of Lopez, he'd forget about it. I had no choice but to start referring my patients to him. I'd call that blackmail."

A former member of the medical board who served at the same time as Desai now admits he became disturbed with how his colleague appeared to be using his position. Yet he said there was nothing he could do about it.

Desai's former board colleague said he learned from other doctors that they were contacted by Desai and assured that if they referred patients to him they would never have to worry about being the subjects of any disciplinary board action.

"I asked them why they didn't file a complaint, and they said there would be no proof of what he was doing," the physician said. "There was nothing I could do."

Another physician, Dr. Charles Cohan, who now lives in Pennsylvania, also had concerns about Desai in the 1990s. He filed three complaints with state officials regarding what he felt were deceptive advertising practices and billing irregularities.

The complaints went nowhere, he said, which he blames on Desai's influence with regulatory officials. But the last straw for him came in a 1999 phone call from an unidentified caller, a year after he filed a complaint with the attorney general's office.

It was a threatening message directed at his family, he said. Soon afterward, he left the state.

BEFORE THE FALL

The new millennium appeared to have special promise for Desai. Once again he showed his flair for land deals.

In 2000 he bought a 4.8-acre plot of land near U.S. Highway 95 and Kyle Canyon Road for $300,000. Five years later he sold it for $3.2 million.

He was proud that his older daughters were flourishing, an associate said. One is a physician, the other a lawyer.

He was especially pleased with the role he played in the opening of the Hindu Temple in Summerlin in 2001, noted Swadeep Nigam, the Clark County Republican Party treasurer.

"He gave the largest donation ($250,000), and many people are thankful for that, but some people think he tries to determine what happens at the temple," said Nigam, who created a Web site for South Asians called vegasdesi.com. "We even have people who write in about that."

Gopala Krishna, the temple's priest, said Desai is a religious man who tries only to use his medical knowledge to help others, and that his wife is active in children's programs at the temple.

"Dr. Desai cares so much about people," he said recently as he sat in the temple, where his daughter translated for him. "He is a very good man, and the people can't believe the man they know is the man they are reading about in the newspaper and see on TV."

An officer in 17 Nevada-based corporations, Desai was among the founders and organizing board members of the Bank of George. He also became a founding director of the Nevada Mutual Insurance Co., a liability insurer that covered his Endoscopy Center of Southern Nevada. Desai has resigned from both institutions.

His contribution to the Keep Our Doctors in Nevada lobbying effort -- the $25,000 donation was the largest in the state -- paid off as voters agreed with physicians that it should be much more difficult for individuals to sue doctors for malpractice.

Newly elected-Gov. Jim Gibbons named Desai to his transition team, which Nigam described as a nod to Desai's political donations, fundraising expertise and political savvy.

Like Ghanem, his mentor, Desai was respected by lawmakers and he would donate to opponents in the same race.

"Politicians would take his calls," Nigam said.

Desai's Gastroenterology Center of Nevada gave to both Gibbons and failed Democratic candidate Jim Gibson before the last gubernatorial election. He donated to Rep. Shelley Berkley, D-Nev., and Republican Don Chairez when they vied for a congressional seat in 1998.

He enjoyed holding fundraisers and parties.

"He used to seat doctors who didn't like each other at the same table," a physician said. "He enjoyed watching them argue."

In 2004, Desai moved from his home in the Canyon Gate Country Club to his palatial estate at the Red Rock Country Club.

His youngest daughter got a position as an intern in Sen. Harry's Reid's office, a position she resigned from in February.

Desai's gastroenterology practice, already the largest in Southern Nevada with three clinics, was poised to become even larger.

"He planned on opening a clinic in office space near the new Centennial Hills hospital," one physician said.

And positive news even came out of a stroke Desai had recently suffered.

"He bounced back from it so fast," said one physician. "He didn't seem to suffer any aftereffects."

But on Feb. 27, Desai's seemingly endless rise came to a halt.

Public health officials announced that more than 40,000 of Desai's patients had to be tested for blood-borne diseases, the largest notification of its kind in U.S. history.

Desai and his medical team became the subject of local, state and federal criminal investigations.

Lawyers representing thousands of former patients filed civil lawsuits, which could tie up the courts for years. Associates of Desai say that almost immediately, he began to spend considerable time with his own attorneys planning a defense strategy, a practice he continues today.

The story of a doctor allegedly putting profits before patient safety drew international attention, with the Times of India referring to Desai as "Dr. Greed."

In an effort to try to turn his fortunes around, Desai engaged in the Hindu religious rite of yagna on at least three occasions, according to two of his associates. During that ritual worship, in which a priest invokes various gods as he chants mantras for hours, the individual before him prays for help and makes offerings into a sacred fire.

More publicly, Desai responded to the uproar in Southern Nevada by publishing a full-page open letter in the Review-Journal.

He expressed sympathy "for the fear and uncertainty that naturally arises from the situation."

And he made a promise: "For those who are uninsured, a foundation is being set up to cover the cost associated with the tests. You will learn more about this in the days to come."

More than 100 days have passed. No further word has emerged about the foundation.

Congress Scraps Funding For Hepatitis C Probe

Monday, 30 June 2008

Congress Scraps Funding For Hepatitis C Probe

The federal government won't be helping to fund an investigation into the Las Vegas hepatitis scare. Twenty-six million dollars earmarked for investigation costs and outbreak prevention strategies was left out of an emergency war funding bill approved by Congress. Senate Majority Leader Harry Reid says the money for the Centers for Disease Control and Prevention would have gone for studying genetic mapping of hepatitis cases in Southern Nevada. The Southern Nevada Health District has redirected funds from grants and other sources toward the investigation, and Reid says he has earmarked funding in a separate federal bill that could be approved later this year. At least cases of acute hepatitis C have been linked to alleged unsafe practices at the now-closed "Endoscopy Center of Southern Nevada," and another 50,000 patients at the clinic were put at risk.

Officials Hoped for $5 Million to Cover Hepatitis C Investigation

By STEVE TETREAULT STEPHENS WASHINGTON BUREAU

WASHINGTON -- Southern Nevada health officials may face a financial squeeze after Congress failed to come through with $5 million to defray costs of responding to the hepatitis C health crisis in Las Vegas, officials said Friday.

Money that had been earmarked for the Southern Nevada Health District was stripped from an emergency spending bill before federal lawmakers completed their work on Thursday and sent the bill to the White House.

Also jettisoned was $21 million inserted by Sen. Harry Reid, D-Nev., for outbreak prevention strategies at the Centers for Disease Control and Prevention.

A portion of the CDC money would have been budgeted in Las Vegas, where authorities continue to investigate clinics affiliated with the Endoscopy Center of Southern Nevada.

Health investigators said patients could have been exposed to hepatitis strains or the HIV virus through unsafe practices such as the reuse of syringes and anesthesia vials that were documented at the clinics.

More than 50,000 patients were advised to take blood tests for the diseases, including a number of uninsured or underinsured people whose tests were being conducted at community clinics.

"It would have been very helpful if we did receive the funding, not so much from the perspective of the health district but from the perspective of the public that would have been affected and had their needs met," health district spokeswoman Jennifer Sizemore said Friday.

"What that means is we will have to meet those needs through community resources that are already in place, which are pretty tapped at this point," she said.

"We understood going in that it would be difficult to get the money included in that bill," Sizemore said.

In the meantime, the Southern Nevada Health District has redirected funds from other grants and accessed other sources including fines that were levied against the owners of the Endoscopy Center of Southern Nevada, Sizemore said.

Democrats said they encountered tough resistance from the Bush administration, which had insisted that the emergency bill be limited to $162 billion for continued military operations in Iraq and Afghanistan, and selected foreign assistance.

Over the past several weeks, House Democratic leaders and the White House reached agreement to add $21 billion for domestic programs.

Money was included to improve veterans benefits, extend jobless benefits by 13 weeks, repair Midwest communities hit by floods and rebuild levees damaged by Hurricane Katrina.

But another $10 billion worth of domestic spending was discarded, including money to help poor families pay heating and cooling bills, and community grants for law enforcement. The Nevada funding was in that category.

"Getting anything through this White House is enormously difficult," Reid said in a statement Friday. "The hepatitis C scare in Southern Nevada is a serious issue I will continue to work to address in Congress."

Reid said he has initiated Plan B. He said he has placed money for the hepatitis C investigation in a separate Department of Health and Human Services spending bill that the Senate Appropriations Committee approved this week and that may be completed later in the year.

A Reid aide said that bill contains $550,000 for the Southern Nevada Health District, and $5 million for the Centers for Diseases Control and Prevention.

Separately, Sen. John Ensign, R-Nev., said he has been trying to persuade the Department of Health and Human Services to reprogram unspent funds in other programs towards Las Vegas. He has not reported progress on that effort.

Of the health district's $5 million request to Congress, $3 million was to be spent on blood tests on 15,000 uninsured and underinsured patients, and $1.3 million for followup tests on persons found positive for HIV or hepatitis strains.

Sizemore said much of the federal funding would have been forwarded to community clinics operated by Nevada Health Centers, a nonprofit that has been offering blood tests to patients.

Sizemore said she did not know how the funding situation was affecting ongoing testing. Officials at the Carson City-based Nevada Health Centers had no immediate comment on Friday.

Federal money for hepatitis C outbreak will have to wait another day

By Lisa Mascaro · June 27, 2008

WASHINGTON — Funding for the investigation into the Hepatitis C outbreak in Las Vegas was stripped from the final war supplemental bill passed by the Senate last night, though Senate Majority Leader Harry Reid has tucked the request in a new bill making its way through Congress.

Almost half the Republican senators, including Sen. John Ensign, as well as fiscally conservative Democrats in the House, had balked at extras in the bill last month.

Reid’s request had included $21 million for the Centers for Disease Control and Prevention to investigate the problem nationally and $5 million for the Southern Nevada Health Center to cover unexpected costs.

As many as 50,000 patients of an outpatient clinic in Las Vegas may have been exposed to hepatitis C or HIV after nurses reused syringes, an improper health care practice. Seven patients have been diagnosed with hepatitis C, as has one patient from a related clinic.

The CDC director has said what happened in Nevada may be the “tip of the iceberg” of similar problems nationwide. The CDC wants to conduct a public education campaign, staff training on proper techniques at outpatient and research the development of safer medical devices.

Locally, the health district would have used the funds to test patients and cover costs associated with the scare.

But to strike an agreement on the war funding bill, Congress eliminated much of the domestic spending from the package, which still preserved extended unemployment benefits and expanded education benefits for post-Sept. 11 vets under a new GI Bill.

In voting against the package last month, Ensign questioned whether the Southern Nevada Health Department needed the money. He voted for the bill last night.

Reid has since tucked a smaller funding request in another bill going through Congress. On Thursday, a committee approved $5 million for the CDC and $550,000 for the Nevada health district in the Labor, Health and Human Services bill.

“Reid definitely thinks the money is needed,” his spokesman said. “He’s going to work as hard as he can to get the funding this year.”