The Biggest Malpractice Suit Ever?

This story broke last week, but I’m just starting to catch up on it now: in Las Vegas, more than 100 people have tested positive for Hepatitis C and HIV after being treated at the Endoscopy Center of Southern Nevada. Apparently, investigators have found that anesthesia needles were re-used on different patients without adequate cleaning, and in some cases, portions of the same dose of anesthesia was injected into multiple patients.

The person who founded the Center, who has also been its majority owner, is a doctor named Dipak Desai. Three class action lawsuits have been filed against the center, with more than 100 plaintiffs total. Doctor friends tell me it might be the biggest medical malpractice case in recent history (I have not been able to directly confirm this… any docs in the house?).

I haven’t come across anyone saying that Desai himself gave the order to use the syringes this way, though I gather that the anesthetists employed at the Endoscopy center were nurses rather than doctors (might be a little corner cutting there). Since the investigations started, the nurses employed at Desai’s clinics have given up their nursing licenses. As of now Desai has not given up his own medical license, though he has voluntarily agreed to not practice medicine until the investigations are complete. My own inclination is to “wait and see” before piling on against Desai: he ran several clinics, and employed many other doctors, nurses, and technicians. This particular policy, which has caused so much harm to so many people, may not have come from him.

Before this mess started, Desai was a very well-respected doctor in the state of Nevada; he had a $1 million contract with the University Medical Center, where he directed the gastroenterology department; and the governor had appointed him to the State Board of Medical Examiners. All of that is not to excuse him; rather, it helps give us some sense of the scope of this case. Incidentally, when two doctors working at his clinics had earlier complained about unsafe hygiene with syringes, the claims weren’t investigated.

I’m curious to know what people think about this case. Obviously, it doesn’t reflect the practices of Indian doctors more broadly (and I come from a medical family, so I’m quite proud of the contributions Indian-Americans have made in medicine in the U.S.). But it does seem like a terrible tragedy, and for the employees of this particular Endoscopy Center, a huge mess.

77 thoughts on “The Biggest Malpractice Suit Ever?

  1. “At the heart of the problem is the self-perception of the medical community as the next best thing to sliced bread.”

    This is a tremendously antiquated view of the medical profession. If you think that physicians fail to appreciate the problems with our medical system, then you have little understanding of the business of medicine.

    “As Ennis previously mentioned, the medical profession functions similarly to a medieval guild, in fact doctors are really the last remnant of an Artisan class that has all but disappeared in the post industrial world. “

    Modern medical training and practice has little resemblance to a pre-industrial Artisan class. Physician groups and hospitals are no different from any other modern business model. They are concerned with revenues and costs.

    “To make medical care affordable and better, medical care needs to be totally transformed into a market commodity. I’m thinking a mix of McDonalds, Wal-Mart, and Six Sigma.”

    Modern healthcare is orders of magnitude more complex. Certain aspects of health care should be treated as a commodity. Access to preventative services should be available at every turn. The proliferation of outpatient clinics in suburban malls is an obvious example of how this has already occurred. Access to the Web is another example of how certain aspects of health care information can be considered commodities. The difficulty is when medical care demands hospital resources and technology. Complex medical or surgical conditions can not be made commodities purely based on the resources that go into diagnosis and treatment.

    “The industrialization and standardization of medicine will both reduce costs, increase quality standards, allow for wider availability, and better troubleshooting of problems.”

    Medicine is industrialized and standardized. The problems with cost in the United States boils down to a simple fact.. Do as I say, Not as I do. Talking about reducing costs is all well and good until it’s your wife, mother or baby that is at stake… then it’s… “do whatever it takes, doc.” It more complex then saying let’s just make it more efficient like Intel does with microprocessor production.

    “The ultimate goal would be that going to the doctor would be no more of a hassle than shopping for a cell phone.”

    This is a beautiful comment because it underlines the depth of misunderstanding of our medical system. The problems with healthcare have little to do with the interaction between a healthy patient and their primary care doctor. Although primary care physicians have been unfairly squeezed when it comes to reimbursement, they are not resposible for the problems with health care that center on our inflationary health care spending. WE ARE RESPONSIBLE. A public that demands high tech procedures and expensive medications simply because we can’t draw boundaries. As a society, we can’t eat healthy and exercize. As a society, we can’t say “it’s ok to let my 65 year old mother with metastatic cancer go to hospice care.”

    Don’t trivialize the problem.

  2. Speaking of checklists, there was a really nice article by Gawande in the New Yorker on how dramatically helpful they are, and how much they reduced the rate of infection when they were adopted, despite tremendous initial opposition from doctors to using them.

  3. I am an anesthesiologist who practices in an outpatient surgicenter. I have also been a medical director of a surgicenter. Let me run some numbers. They did approximately 40,000 GI endoscopic procedures in four years. That is roughly 10,000 per year. They had two rooms. That is 5,000 procedures per room. Let us say they worked 50 weeks of the year. That is 100 cases per week per room. So on an average day they did 20 cases per room. In an eight hour day that is twent four minutes per case. This does not include the time it took to take one patient out and bring the next patient in. Let alone review history and prepare the room for the next case.

    That endoscopy center was basically a production line. It is not possible to give good care to patients when you look at these numbers.

    A few rotten apples reflect badly on the vast majority of desi doctors who work hard and give good care.

    Desai was the medical director and majority owner. A surgicenter that does that kind of volume generates huge profits. Millions of dollars went into his pocket. It will be a malpractice goldmine for the lawyers.

    I truly feel sorry for the patients.

  4. Ennis, and Rahul: It wasn’t physicians who resisted checklists, but a government agency called the Office for Human Research Protections. They shut it down for bizarre reasons. Most physicians I run into are for this sort of thing, as are hospitals.

    Risk management and prevention is the way to keep medical malpractice away from medicine. This is one iniative, that I suspect will come back in a way to get around the goverment’s concerns.

  5. Ennis, and Rahul: It wasn’t physicians who resisted checklists, but a government agency called the Office for Human Research Protections. They shut it down for bizarre reasons. Most physicians I run into are for this sort of thing, as are hospitals.

    Interesting. Can you elaborate? That’s not what Gawande indicates though in the article:

    After the checklist results, the idea Pronovost truly believed in was that checklists could save enormous numbers of lives. He took his findings on the road, showing his checklists to doctors, nurses, insurers, employers—anyone who would listen. He spoke in an average of seven cities a month while continuing to work full time in Johns Hopkins’s I.C.U.s. But this time he found few takers. There were various reasons. Some physicians were offended by the suggestion that they needed checklists. Others had legitimate doubts about Pronovost’s evidence. So far, he’d shown only that checklists worked in one hospital, Johns Hopkins, where the I.C.U.s have money, plenty of staff, and Peter Pronovost walking the hallways to make sure that the checklists are being used properly. How about in the real world—where I.C.U. nurses and doctors are in short supply, pressed for time, overwhelmed with patients, and hardly receptive to the idea of filling out yet another piece of paper?

    Now, it might be that overwork is the biggest reason for seemingly justifiable corner cutting (although, at least in this case, the evidence seems to indicate otherwise), and that what the community needs is really many more doctors, but the shortage too seems to be a result of conscious efforts by the AMA to keep demand high.

  6. To clarify: What I meant in my previous comment is that the evidence seems to indicate that corner cutting is not justified at least in ICUs. Another example (which I might not be recalling correctly) is how resistant doctors were to follow hand washing guidelines even after there was considerable evidence that it reduced the risk of MRSA.

    Also, I am not saying that these examples are indicative of something fundamentally wrong about the US medical community because I certainly don’t feel that way, but it seems like there is some reluctance to adopt measures that are focused more on diligence and meticulousness, because it is seen as an insult to the inherent skill and talent of doctors.

  7. This desi doctor was greedy as hell and guilty as sin. Indians are at risk of becoming pariahs in America thanks to jerks like him:

    If you want to get a sense of the rushed medical procedures that patients encountered inside the clinic that triggered the unprecedented hepatitis scare, consider Duke Breuer’s experience.

    After undergoing a colonoscopy at the Endoscopy Center of Southern Nevada, Breuer asked a nurse what he should do about the bandage on his right forearm.

    “Take it off when you get home,” the nurse said.

    Later, when the 78-year-old Breuer pulled up the tape, he started gushing blood. The IV needle had been left in his arm and he had accidentally yanked it out.

    Blood spurted with each beat of his heart — “Poom! Poom! Poom!” is how Breuer describes it. The darkest blood he’d ever seen, covering his pants and ruining his beloved Chinese silk rug.

    So Breuer was none too happy when he returned to the facility a few days later for a second procedure.

    “I ought to sue you for ruining my rug,” he told a nurse.

    Her response stunned him.

    “You ought to sue us for a lot of other things that go on here,” Breuer says the nurse replied. “You don’t know what goes on here. I hate my boss.” He dismissed her as a disgruntled employee.

    Then, 10 days ago, the Southern Nevada Health District announced that 40,000 people might have been infected with hepatitis B, hepatitis C or HIV because of dangerous injection practices at the downtown endoscopy center.

    Never, it seems, has the community been so collectively outraged as now, with the news that patients were put at risk of being infected with fatal diseases because of a doctor’s drumbeat to save money.

    According to investigators, the nurses claimed that Dr. Dipak Desai, one of the state’s most powerful physicians and owner of the clinic, had ordered the dangerous practices. When patients needed more anesthetic, the nurses were using the same syringe to dip back into the vial. That tainted the medicine. Then, even though the vials were intended for single use, the nurses would reuse them on other patients. That passed along infection. Little money would be saved by reusing syringes, but reusing the medicine could save $5 to $10 per procedure, experts estimated.

    Six people contracted acute hepatitis C because of the dangerous injection practices, health officials said, and now thousands more await the results of blood tests.

    The clinic has been closed by the city.

    Why did Desai apparently ignore established, fundamental medical safety?

    Medicine is business. And in an era of rising health care costs and dropping insurance reimbursement rates, physicians balance the pursuit of profit with patient care. But those who know Desai and worked with him say his downfall was greed. Desai proudly proclaimed that he ran the most cost-effective clinic in the entire country.

    A nurse who worked for Desai said his business plan called for extreme cost-cutting measures. A doctor who has worked with Desai said he was proud of churning through procedures at an impossibly fast pace. He said he witnessed Desai perform in a few minutes a colonoscopy that should have taken 15 minutes. And then brag about it.

    “He’d say, ‘I’m the fastest endoscopist, the best endoscopist, in town,’ ” recalled the doctor, who like others asked for anonymity for fear of reprisals. “That was his pride and joy.” By many measures Desai is a success. He attended medical school in India and completed his residency and an internship in New York before he and his wife, Dr. Kusum Desai, a pulmonary specialist, were licensed to practice medicine in Nevada in 1980.

    Desai has been chief of gastroenterology at University Medical Center and Valley Hospital & Medical Center, and a professor at the University of Nevada School of Medicine. The couple owns a $3.4 million, 8,700-square-foot home in Summerlin.

    A friend credits him for helping to found the Hindu Temple of Nevada and donating $250,000 to it.

    But the friend asked not to be identified because of what else he had to say about the doctor: that Desai is aggressive, intense and preoccupied with business.

    “If he cannot achieve something with you he will forget you in a minute,” the friend said.

    The Endoscopy Center of Southern Nevada opened in March 2004 in a medical building at 700 Shadow Lane, between two of the city’s largest hospitals — and across the street from the offices of the Southern Nevada Health District, which launched its surprise inspections of the facility in January.

    The business complements Desai’s Gastroenterology Center of Nevada, which has six valley locations.

    Although other doctors worked at the high-volume facility, it was Desai’s domain.

    Appointments were frequently double-booked, leading to two-hour waits in a standing-room-only waiting room, said a nurse who worked there in 2007.

    In assembly-line fashion, patients were hurried among nurses who would admit them, start an IV in their arm, take them to the room for the procedure, and then walk them to a recovery area before sending them out the door. “He would always say, ‘Time is money,’ ” the nurse said of Desai. “The faster we would go, the happier he was.”

    The flow of patients sounds impossibly fast, said Phyllis McGregor, a nurse who for 20 years directed the gastroenterology department at Centinela Hospital Medical Center in Inglewood, Calif.

    She ran three rooms where a total of 30 procedures a day were done, at the most. Desai was doing 60 procedures in two rooms — a pace that McGregor said compromised patient safety.

    The rush of procedures took its toll beyond the forgotten IV needle in Duke Breuer’s arm.

    Carrol Lathrop, a 70-year-old from Pahrump, says Desai perforated her bowels during a colonoscopy, and she was forced to wear a colostomy bag for a year before having surgery to fix the problem.

    Lathrop’s records from the clinic show Desai performed the procedure on Sept. 6, 2006. The notes are contradictory, observing on the one hand that she was in “discomfort,” “tolerated the procedure poorly” and that the “quality of the prep was inadequate,” while also saying “the colonoscopy was performed without difficulty” and she was discharged in “satisfactory” condition.

    The next day, Lathrop was in such agony that she went to Desert View Regional Medical Center in Pahrump where, according to hospital records, she was diagnosed with an “acute perforation” of the sigmoid colon.

    McGregor, the California nurse, says she has seen only two cases of perforated bowels in 25 years. In addition to hurrying procedures, Desai was a miser with supplies, his clinic nurse said. In a finding unrelated to the hepatitis C outbreak, the state Licensure and Certification Bureau found that technicians were not adding the proper amount of detergent to remove the blood, tissue and other body fluids from the endoscopes, nor were they discarding cleaning solution after each use.

    In addition, clinic staff was ordered to save money by cutting in half the disposable underpads that protect the beds, she said. The pads cost about 21 cents each.

    Desai also saved money — and made money — by using certified nurse anesthetists rather than anesthesiologists, who are medical doctors. Because the certified nurse anesthetists were salaried employees, unlike anesthesiologists, who would have billed insurance companies and Medicare independently, Desai was able to submit his own billings for anesthesiology. The nurse who worked in the clinic said keeping the anesthesia services in-house offered opportunities to overbill for services. For instance, she said the anesthesia for all procedures was billed at 30 minutes when none ever lasted more than 15.

    The Nevada attorney general’s office is investigating whether Desai defrauded insurance companies or Medicaid, the government’s insurance program for the poor.

    Using employee-nurses versus outside doctors to administer anesthetics may have contributed to a culture of compliance with Desai’s demands — including the unsanitary injection practices.

    Dr. Chris Millson, a Las Vegas-based board member of the American Society of Anesthesiologists, said an independent anesthesiologist would have gone “toe to toe” with Desai and prohibited the dangerous injection practices.

    “It’s not that a nurse anesthetist can’t argue with a physician,” Millson said. “But none did in this case.”

    On Wednesday, five certified nurse anesthetists voluntarily surrendered their licenses to the Nevada State Board of Nursing pending the outcome of its investigation.

    And on Friday Desai voluntarily agreed to cease practicing medicine pending the outcome of an investigation by the Nevada State Board of Medical Examiners.

  8. Interesting. Can you elaborate? That’s not what Gawande indicates though in the article:

    OHRP objected to the implementation of checklists as research that took place w/o informed consent of patients:

    Such research, however, poses an apparent ethical conundrum: it is often impossible to obtain informed consent from patients enrolled in quality-improvement research programs because interventions must be routinely adopted for entire hospitals or hospital units. When, for instance, research on a quality-improvement initiative that affects routine care is conducted in an intensive care unit (ICU), surgical suite, or emergency room, individual patients have no opportunity to decide whether or not to participate. Can it be ethical to conduct such research without informed consent?

    A nice assessment of OHRP’s objections and how to better handle the situation in an NEJM article. This article provides a time-line of the situation as well, so you will see that the IRB halted the research after the study was published and of course, after Gawande wrote about it. If the checklists were not implemented as a part of a research study, the OHRP would have no say in the matter. But generally people think (from the NEJM article):

    Is informed consent necessary for quality-improvement research? From both an ethical and a regulatory perspective, we believe that the OHRP’s stated conclusion about the need for informed consent was erroneous. Like most ethical norms, the requirement to obtain informed consent has legitimate exceptions. In emergency settings, for example, it is even considered ethical to include patients in a randomized trial of an experimental treatment without consent, provided that appropriate safeguards are implemented.

    Also : here is a snarky critique here of how human subject protections regulation are bungled and a general round-up of what researchers feel.

  9. Ennis

    You’re right. It would be more correct to labeled them doctor/physician/provider error instead of patient errors, but that’s how they are are referred to in the hospital. I guessing it does not refer to the patient actually committing the error, but rather the error being done to the patient by the physician.

    Checklists are a good idea but at least when it comes to bronchoscopies, marking the outside of the body does not help you since it does not in anyway correlate with what one is looking at on the video monitor. I actually suggested to the JHACO inspector that a radiographic marker (i.e a lead L or R) should be used rather than signing my initials on the left or right side of the body since the radiographic marker would actually be seen on the fluoroscopy but the sharpie signature would not. The JHACO inspector told me that would not fulfill the requirement and I still had to sign the side of the body that I was going to bronch. The problem I have is that at times the focus becomes on the form itself rather than the reason the form was created.

    Another example we have these SCORE IT forms designed to prevent deep venous thromboses (DVTs). I got called to fill out the form and check the appropriate form of prophylaxis since it was not filled out. The reason it was not filled out was because I admitted the patient with a DVT and had already placed him on anticoagulation. The nurse completely missed the point of the patients diagnosis in his zeal to check the box on the form.

    Upon discharge patient’s are supposed to be offered flu and pneumonia vaccines in most cases. I got called about a patient whom I did not order the flu vaccine for at discharge. The patient was being discharge after having been treated for influenza, so it would have been pointless to give her the vaccine, but the form still had to be filled out.

    In the end however if it leads to better patient care then I’m all for it.

  10. I’m a newbie on this board, and don’t really know how to quote just yet (and don’t have time, since I technically should be working already):

    This is a response to Rahul regarding checklists:

    The original plan was struck down by the aforementioned gov’t agency. Google the agency, and you should find articles indicating.

    Doctors, as a general rule, are usually divided over risk management. The doctors I’ve encountered (admittedly a very small sample) appreciate any ideas that will help reduce errors. But there are a significant number who don’t. In NY state, physicians can get a 5% discount on their med mal premiums if they attend a RM class once every year or two. But many don’t because a)they can’t be bothered, or b)they don’t have time or some combination of both. Usually these doctors make enough money that that 5% doesn’t cut it.

    But in this new litigious world, aka the USA, we live in, many hospitals are forcing their staff and attending physicians to attend classes or follow RM procedures.

    Sure, there will always be arrogant doctors and nurses who resist. but look, we now have checklists to make sure that all surgical instruments are present and accoutned for after a procedure and before the patient is sewed back together.

  11. After reading the link provided by Vyasa (57), I am surprised none of the clinic’s techs, nurses or doctors (all of whom I consider to be highly educated and ethical) blew the whistle. Perhaps most were scared and are struggling to make a living, I don’t know. Could any of the employees (or even patients) reported the non ideal practices anonymously to a public health department in the earlier stages before this thing got out of hand? Or does the public health department have too much bureaucratic red tape and much paperwork is involved and maybe it is not worth the trouble?

  12. Regarding my previous post, I don’t personally know any of the workers/professionals at the Las Vegas clinic. I meant to say I generally consider most all people in the health care field to be ethical and highly educated. There might be exceptions, of course. Sorry about the confusion.

  13. I am a gastroenterologist (in training about a year from finishing my fellowship) in regards to the articel about desai and his practices. A colonoscopy is composed of two parts, this first is getting to the cecum (the area the appendix is and technically the starting point of the colon) and the second part is withdrawal which is the examination of the mucosa. Most experts say that the withdrawal time should be at least 6 minutes (in the most experienced hands) and upwards to 12 minutes if you are wanting to get a real good look. The time it takes to get to the cecum depeds on your skill etc, and it can be as fast as 1 minute and longer even an hour. A “colonoscopy” is actually the withdrawal. As with any surgical/procedural specialty there is a certain amount of machismo that goes along with it…(re Scrubs) It is not that unusual to here GI trainees brag about the speed in which they can do one…so the whole bragging part I get…do I agree? not sure…but I get it. Secondly mest surgi-centers employ CRNA (nurse anesthesists) because frankly they are cheaper…an MD anesthesiologist costs a lot more to employ than a CRNA. Do you need an anesthesiologist in GI? No..the problem (if you can call it one) is that everyone wants to be “knocked out” so you have to use propofol…which according to most places needs to be administered by an anesthesia practioner. You don’t need propofol for a good quality exam…you do need it for a quick one sometimes. In any case if you used infected needles and syringes, you were dumb, and you were wrong. Of course everyone is going to say he authorized the use, nut as someone else said, you can’t control your employees. Also in our group we do quality improvement studies each year, and we routinely go over our practices, and I think most practices are asked to do this as well, but I am not sure about private practice as I am not in. In terms of the volume of procedures this is an effect of medicare cuts. in the past if you for example did 100 procedures a week you made 100000 a year, now if you do 100 you get like 50000, but you your wife and your kids like the 100000 lifestyle so now you have do 150…its a vicious cycle (and befor anyone jumps on me these are not real numbers)

  14. oops. It looks like 2 doctors (who worked in the clinics) already complained. For some reason, it looks like their concerns were ignored or was not a priority, etc.

  15. As patient advocates, nurses are of course held accountable for infection control. They shouldn’t blame this on staffing practices over holding each person accountable.

  16. Should add to say that I meant staffing in terms of who is doing the tasks; of course being understaffed and overworked is never a good thing..

  17. I received a colonoscopy at this Las Vegas endoscopy center (as did my parents). I’m not really the type to feel much pain and suffering; honestly, I doubt I’ll feel any outrage unless I’ve actually contracted a disease. But I will say this:

    The place was entirely a production line. You get there and find out that they’re already 2 hours behind schedule. You complain in vain to receptionists and assistants who nod knowingly, because they’ve heard it all before. But what can you do? Leave? Let me remind you that you’ve just spent the previous day fasting and drinking about a gallon of disgusting liquids intended to clean you out. You don’t want to do that again anytime soon. You are the very definition of a captive audience.

    As a former retail business co-owner, I’m all about being greedy and cutting corners and taking any possible advantage over unsuspecting customers. So I understand what Dr. Desai is all about. The difference, though, is that my practices weren’t creating a public health risk, and I never had to take a professional oath.

    Stuff like this is why Indian people don’t trust their own kind.

  18. 68 · Vegas Patient said

    Stuff like this is why Indian people don’t trust their own kind.

    Wow, thought I was the only one who had that idea. (By the way, I wish you good luck and hope all is well for you and all of the other clinic patients #68)

    This really hurts me deeply say this. I have been to 9 Desi doctors/dentists over the past 30 years or so. I have only seen (a grand total of) one Desi physician who was helpful to me and unfortunately he relocated to another state. Be fully aware this is only my experience, but my non desi physicians & dentists are way nicer ,more competent and never make me feel rotten about myself. I believe in the patient doing whatever they can for their own health, so I am no overeating, drug abusing, smoking couch potato at all.

    I have lived in six states and always changed physicians/dentists with every move. I treat everyone with proper respect and realize not everyone will act respectfully in turn, but most all of the Desi doctors/dentists I have consulted were rather brusque, condescending and even incompetent in some cases. This is one reason why I don’t choose a brown physician, even though I am very much a brown person myself. I have had too many terrible experiences. Maybe the desi physicians don’t want to look like they are giving extra help/favors to brown patients, i don’t know (I never demand extra time/favors, services for nothing, + i always pay and show up on time, etc.) Just to reiterate, this is only my experience and it is a very limited sample. Maybe the “second generation” MDs etc are better. There are always two sides to every story, of course. However, I treat everyone the same and with respect regardless of color, status, but for some reason, i have better results with non brown medical professionals.

    In one instance, there was one northie physician who often made fun of southies (indian), their names etc. I happen to be an andhra southie and it made me wonder if he had some bias against southies like me. For the record, I never brought up the issues of being a fellow Indian, north or south, or try to bond in some way when I saw the Indian physicians. I was very business like and refrained from any small talk out of respect for the physcian’s time. I stopped going to that person and I later found out that three other patients (one non Indian included) did not care for him and a bad time too. Luckily, we have choices in this system and you are always free to look elsewhere.

  19. Depending on type of anesthesia given, it is routine for RNs to push sedative drugs. It is standard practice in most free standing ambulatory surgical centers depending on what the specific drug is. Guidelines vary slightly from state to state. If a patient, however, needs sedation of a higher level than what RNs can push through a syringe AND this deeper sedation requires monitoring by an MD (as with Propofol), then the big guns are called in. What they use and who they use to sedate people is based on each individual patient’s tolerance to sedatives ,difficulty and length of the case as well as other issues that vary from patient to patient.

    Yes, everyone wants to be knocked out, but that doesn’t happen unless big bad Propofol and an anesthetist are used. You don’t get it if you don’t ask your doc for it. Now, even if you ask for it you still may not get it. Major insurance companies,like Aetna, will not pay for your colonoscopy if you get propofol… unless you meet their requirements. They feel that using Propofol and an anesthetist drives up the cost of the procedure. So, as long as it is less money out of their pockets, they don’t mind that you are writhing in pain (even moderately sedated) asking for your “Mummy” to make it stop. This is an uncomfortable procedure, people! Just because they can Versed away your discomfort during the procedure, doesn’t mean that there was no pain.To compound this unpleasant experience, now you have to worry about weather you’ve got the last patient’s Fentanyl backwash in your veins.

    All this while six feet of scope disappears up your arse.

  20. just to follow up on ebeth,

    I did 300 of these last year and I only used propofol once in a non intubated patient, of the remainder i only witnessed 15 people who could not be sedated properly with versed, so I don’t think you need proprfol. (that being said I ave only done these and never received one) Additionally, there are disadvantages to using propofol, the first is that the sedation is deeper, so you need more monitoring and the deeper the sedation the higher the risk. Secondly, blood pressures can drop to unsafe levels with higher doses and 3rd, one of the biggest and most dangerous complications of a colonoscopy is a perforation of the colon, this happens when there is a lot of pressure on the colon from the scope. Endoscopists can use the feel of the scope, and the reaction of patients to know when there is excess tension, with propfol patients can not let you know there is pain or discomfort so you have a higher chance of perforating. Of course as ebeth said, the insurance companies dont consider this when considering payment, they just look at money.

    Oh and the scope is only 150 cm long and typically only 80 to 90 are in a person…not 6 feet

  21. Yes. I was exaggerating for effect. There are some 180s and 160s out there and that, my friend, is nothing to sneeze at.

    I guess my point was that in addition to the feelings of fear, apprehension and embarassment a patient feels the last thing he should have to worry about is human integrity… Integrity of the insurance companies, center administrators, providers and most of all the GD nurse who should have know better.

  22. Any medical professional that deliberately reused a needle on another person and also knew there are life-threatening diseases that pass from shared needles, should be put in prison just like a murderer and for every life they have harmed, the time increased.

    And for all you absolutely insensitive boobs who believe, “oh it’s not so terrible having HiV and Hep C,” you must but OUT OF YOUR MIND! To even say such a thing is horrible much less infer it on the www.

    I have Hep C thanks to the medical community giving it to me. I have spent the first 20 years of my adulthood tiring too easily and the last 8 years incredibly sick. Enduring doctor after doctor failing me and then the unethical doctor, who professes to be a Hep C expert, deliberately withholding medicine from me to protect her HMO corporate goals. I was too naive to think there are criminal doctors but it’s true. Sin is an equal opportunity inevitability.

    I hope it’s possible that some of this is ignorance of how this needle can spread disease, but my intelligence says nope to that hope.

    My experience has taught me that there is much that needs to improve in the practice of medicine. I have a very good suggestion on how to help the Hep C doctors due a better job of qualifying the danger there patient is in but I am not optimistic that I can penetrate the arrogance of the elitist system. I am open to rebuttle on my pessimism and forgive me if I am being unfairly harsh.

    To all the victums of this tragedy, I am so happy you have each other for support and too fight this injustice and I pray there is fierce punishment if negligence is absolute.

  23. regardless of if there death sentences they are still disease and infections that could have been prevented and ruined peoples lives… 1 question how would you feel if you had it and the possibilities of giving it to other people and your children you should really think before you say “They are not death sentences” because who wants to be sick or take medication for the rest of your life because a doctor which we trust with our lives was careless!!!

  24. The real bad part of this is that the State Board of Nursing has not published the names of the five CRNAs who surrendered their licenses. So did these anesthetists actually surrender their licenses? You sure can not tell from the Board of Nursing website. Here it is months after the news broke and they still have not posted the names as they have done in all other disciplinary actions. And that leads to a second question, “Which licenses did they surrender?”

    To practice in Nevada they need two licenses, one as a RN and one to be an anesthetist. If these five surrendered their anesthesia license they may still have their RN license and may still be working and giving drugs in Nevada. Was part of the surrender deal an agreement not to publish the names in the Board of Nursing website? Just why has the Board of Nursing chose not to release the information and confirm the surrender?

    This is starting to reek of a cover up. If the names are not listed with the next release of disciplinary actions, that is three times the Board has not released the information. Three strikes and they are out. Then it shall be time to investigate the Board of Nursing as they are the Board of Medicine.

  25. To the moron that states that the American Government infects blacks with AIDS???? AIDS was created by fecal matter getting into the delicate area of the anus and rectum from damage caused by friction….unlike the vagina that has thicker skin and membranes to handle friction caused by sex. Many African Americans are in the closet about their sexuality as well as all races. AIDS is pretty much poop getting into the bloodstream….kinda like MRSA. This is the reason why many with AIDS contract hepatitis. Keep your ignorant conspiracy theories to yourself.