The New Vegas Health Odds

What happens in Vegas, stays in you!

Nearly 40,000 people learned this week that a trip to the doctor may have made them sick. In a type of scandal more often associated with Third World countries, a Las Vegas clinic was found to be reusing syringes and vials of medication for nearly four years. The shoddy practices may have led to an outbreak of the potentially fatal hepatitis C virus and exposed patients to HIV, too. The discovery led to the biggest public health notification operation in U.S. history, brought demands for investigations and caused scores of lawyers to seek out patients at risk for infections.

Thousands of patients are being urged to be tested for multiple viruses. Six acute cases of hepatitis C have been confirmed. The surgical center and five affiliated clinics have been closed.

In letters that began arriving this week, patients who received injected anesthesia at the endoscopy center from March 2004 to mid-January were urged to get tested for hepatitis B and C, and HIV. Because all three viruses are transmitted by blood, they could have been passed from one patient to the next by the unsafe practices at the clinic. The mass notification is the result of a health district investigation that began in January when officials linked an uptick of unusual hepatitis C cases to the clinic.

Health officials say they are most worried about the spread of hepatitis C, which targets the liver but shows no symptoms in as many as 80% of infections. Hepatitis C results in the swelling of the liver and can cause stomach pain, fatigue and jaundice. It may eventually result in liver failure. Even when no symptoms occur, the virus can slowly cause damage to the liver. Officials estimate that 4% of the patients already had the virus when they entered the clinic, compared with 0.5% for hepatitis B and less than 0.5% for HIV. Hepatitis C also is easier to transmit than HIV, they said.

Health inspectors say they observed clinic staff using the same syringe twice to extract anesthesia from a single vial, which was then inappropriately used to treat more than one patient. The practice allows contaminated blood in a used syringe to taint the vial and infect the next patient. Of the six patients so far diagnosed with acute hepatitis C, five received treatment at the clinic on the same day in late September. Since 1999, the CDC counts 14 hepatitis outbreaks in the U.S. linked to bad injection practices.

The largest outbreak occurred in Fremont, Nebraska, where 99 cancer patients were infected at an oncology center from 2001 to 2002. At least one died. The doctor involved in the case acknowledged reusing syringes and settled scores of lawsuit. But he never explained why the syringes were reused.

Unlike hospitals, such centers often do not have employees whose sole responsibility is to monitor and educate staff on best practices. In Las Vegas, clinic staff told inspectors they had been ordered by management to reuse the vials and syringes. The practice was an unwritten, but long-practiced policy. Ah, Sin City, is proper health now a gamble?