"Horrendous." "Unfathomable." "Horrifying." At one point in Thursday's meeting of the Legislative Committee on Health Care, I thought Chairwoman Sheila Leslie and her colleagues might run out of adjectives to describe the awful expanding crisis stemming from the substandard medical practices at the Endoscopy Center of Southern Nevada. I can appreciate their dilemma.
The longer I listened to representatives of the Southern Nevada Health District and state Bureau of Licensure and Certification discuss their findings - or lack of findings, in some cases - the more I couldn't believe my ears. It was infuriating, outrageous, unconscionable, dangerous, and deadly.
We now know such shabby unprofessionalism is common practice in the booming Southern Nevada health care racket, where substandard appears to be the standard of care.
From March 2004 to Jan. 11 of this year, the Endoscopy Center knowingly cut corners that endangered the lives of patients and possibly exposed 40,000 patients to hepatitis C and B and HIV, the virus that causes AIDS. Syringes were used more than once, vials of anesthesia marked "single use" were used for more than one patient, and even the hygienic detergent used to clean the endoscope equipment was reused - all to hustle along the procedure and increase profitability, health district officials learned in their interviews of the center's employees. They were only doing "what they were told to do," Health district senior epidemiologist Brian Labus explained to the legislators.
Did I mention that Labus, one of the unsung heroes in this debacle, acknowledged that the March 2004 start date was somewhat arbitrary and that it's possible the substandard practices might have begun earlier? He did.
He also confirmed my own findings that a number of patients haven't received letters encouraging them to get blood tests. Assemblywoman Susan Gerhardt, D-Henderson, added that, although she and her husband had undergone procedures at the clinic, neither had received letters.
The fact that single-use anesthesia vials were reused in violation of standard health practices should lead police detectives and FBI agents to ask whether patients were properly billed by center management.
Remember, this wasn't just bad medical practice. This was part of a management-approved business plan at the center, which in my opinion makes it all the more scurrilous.
Scurrilous, but not unique.
Of all the jaw-dropping remarks made by Bureau of Licensure and Certification Health Division chief Lisa Jones on Thursday, my favorite was her deadpan delivery of the news that the division's 13 recent inspections of outpatient surgical centers revealed numerous violations similar to those at the Endoscopy Center.
"Sadly, this is not an isolated occurrence," Jones said. "We've got a lot of concerns with a lot of different practices going on."
The concerns may be many, but the answers are few.
The licensure division staff's broad range of responsibilities and substantial employee shortages make more frequent inspections of these centers unlikely. On the job since May, Jones stammered her way through the meeting, offering unsatisfactory and unsettling excuses for the systematic lack of scrutiny.
Assemblywoman Leslie, D-Reno, and Assembly Speaker Barbara Buckley, D-Las Vegas, led the questioning, occasionally interjecting their outrage. At one point, Leslie asked Jones how many more inspectors she needed to do the job properly. No specific answer was given.
Jones is a bureaucrat, not a reformer.
That raised another appalling fact of life. Whether it's the public health or penny stocks, a lack of regulatory oversight is a dead certainty in Nevada.
This isn't a state. It's a storefront operation.
Although some of the center's nurses have already surrendered their licenses, the doctors aren't going anywhere without a fight. Don't expect the state's Board of Medical Examiners, or obviously the board of licensure, to rush to the public's rescue.
Only an outraged public, combined with law enforcement investigation and cooperating insider witnesses, will force change in the system.
On the big screen at the meeting were displayed the words of Dr. Michael Bell of the Centers for Disease Control and Prevention: "There's no excuse for this. It's on the order of driving against traffic on the freeway. It's that reckless."
No, doctor, it's Nevada. Reckless is a way of life around here.
From the sounds of things, the committee will need to invest in a thesaurus before its next meeting.
• John L. Smith's column, reprinted from the Las Vegas Review-Journal, appears on Thursdays on the Appeal's Opinion page. E-mail him at email@example.com or call (702) 383-0295.