Outbreak Was Preventable

After a two-year investigation state health officials say a hepatitis C virus outbreak tied to two Las Vegas endoscopy centers was most likely caused by unsterile injection practices and could have been prevented.

The HCV cases were linked the Endoscopy Center of Southern Nevada and Desert Shadow Endoscopy Center, both owned by Dipak Desai. Nine of the cases were genetically linked to the centers, and ECSN patients undergoing procedures on one day -- September 21, 2007 -- were 31 million times more likely to develop an acute HCV infection.

An additional 106 HCV cases were potentially linked to the clinics, according to the 266-page report, though alternative sources of infection might have been to blame. Nonetheless, the U.S. Centers for Disease Control and Prevention, state, and local investigators ruled out the possibility that practices such as unclean endoscopes or a reuse of bite blocks caused the infections. Through interviews and observations, investigators identified unsafe injection practices at the clinics, including reusing syringes on a single patient and reusing vials of anesthetic between patients.

"We can never prove that it was done that way, but we looked at every possible alternative," says Brian Labus, the Southern Nevada Health District's senior epidemiologist.

Some nurse anesthetists told investigators they were instructed to perform the unsafe injection techniques, the report notes.

The district investigation of the outbreak cost $828,369. The $13.8 million spent on testing plus future medical treatment could push the cost of the nation's largest health care related HCV outbreak to between $16 million and $21 million, according to the report.