Posted: Oct. 6, 2008 | 10:00 p.m.
It was never the Southern Nevada Health
District's intent to embarrass anyone
when it determined what questions to ask
former patients of two Las Vegas
gastroenterology clinics regarding their
past risk factors for hepatitis B, C and
HIV.
But that's what attorneys for
patients who tested positive for
hepatitis C are saying could happen, and
many are advising their clients to
refuse to cooperate.
"We don't think asking a 70-year-old
woman about her previous sexual partners
is relevant,'' said Nia Killebrew, an
attorney who represents about 50 former
patients who have tested positive for
hepatitis C.
The health district's goal was to
learn how many patients acquired
blood-borne diseases during procedures
at the Endoscopy Center of Southern
Nevada between March 2004 and Jan. 11 of
this year.
But getting those questions answered,
and thereby getting a handle on what the
district calls the "big picture," might
never be achieved.
Many patients have not responded to
telephone questionnaires. Nor are they
enrolling in the district's Hepatitis C
Exposure Registry.
Killebrew has advised her clients not
to respond to the health district in any
capacity.
"I don't think the registry is
appropriate,'' Killebrew said.
Billie-Marie Morrison, an attorney
representing about 1,500 former
endoscopy center patients as well as 72
who have tested positive for one of the
three blood-borne diseases, says her
office "kick-started" the campaign to
not respond to the health district.
She said a person's drug or sexual
history is none of the district's
business. Also, she said, it is up to a
doctor to report if a patient has
hepatitis C, not the patient.
"All they (health district officials)
need to know is 'Did you have a
procedure, and where?''' Morrison said.
Morrison said her office sent a
letter to clients telling them not to
answer health district questions. A
letter was also sent to the health
district explaining this approach and
some concerns about the registry.
The district's registry, developed in
late June, was designed to assist
disease investigators in identifying
patients who had procedures at either
clinic, including those who are infected
with the hepatitis C virus. The health
district classifies patients who tested
positive depending on the answers they
give.
Case classification is based on
patient responses to certain risk-factor
questions. There are four case
classification categories: clinic
associated, possible clinic associated,
clearly unrelated, or indeterminate.
Originally the health district, as
well as volunteers from the federal
Medical Reserve Corps, conducted
interviews by telephone to determine
classification. The health district
developed the registry after some
patients refused to respond.
Patients were asked about the
location of their procedures and dates
of procedures, and whether Propofol, a
form of anesthesia, was administered.
They were also asked whether they'd had
any blood transfusions or organ
transplants before 1992, or whether they
have been on long-term hemodialysis.
They were also asked if they have had
sexual contact with a known hepatitis C
carrier.
The district and the federal Centers
for Disease and Control and Prevention
decided on the questions, said Brian
Labus, health district epidemiologist.
"These questions are based on known
major risk factors for infections of
hepatitis C.''
Failure to obtain information "will
have a negative impact on any
investigation we are doing,'' Labus
said.
Labus admitted the health district
doesn't have the authority to require
anyone to answer questions or to respond
to the registry. But in order for the
health district to better understand
just how many people acquired a
blood-borne disease at the 700 Shadow
Lane facility, the district would need
to hear from patients.
Out of 60,000 letters sent to
patients over the past seven months, the
health district has received 7,000
responses.
Labus said last month that his office
is currently in the process of analyzing
the data collected from those responses.
He expects to have a full report on that
analysis completed within the next few
months.
"It's not a nice statistical sample
of the clinic's population, but it will
give us some indication of what the
numbers mean,'' he said.
Dr. Nicola Thompson, an
epidemiologist with the CDC's division
of viral hepatitis, said a patient's
medical history is the cornerstone of
any public health investigation.
"This information helps investigators
identify past exposures or risks for a
specific disease or illness and is used
to determine the role that a given
exposure or risk may have played in the
development of the disease under
investigation,'' Thompson said.
"Collection of a medical history must
consider the timing and nature of
infections. Because an individual with
hepatitis C virus can be asymptomatic
and unknowingly infected for a period of
20 to 30 years, knowing the lifetime
risk for an exposure to a pathogen is
very important.''
Patients were put at risk, health
officials say, when a syringe would be
reused on an infected patient and then
used to draw anesthesia from vials
intended for just one patient. The vials
would then be used on other patients,
potentially spreading disease.
"My big thing with the registry is,
if you look at the last page, our
clients are asked to sign a release,"
Morrison said. "What that release says
is that the health district can release
that information to anyone the health
district wants. This is very private and
personal information. ... This
information could be turned over to law
enforcement for their investigation or
turned over to the defense.''
Morrison said the defense, meaning
attorneys for Dr. Dipak Desai and his
clinics, are attempting to obtain
information from the health district
about the hepatitis C cases, especially
the information contained in the
registry.
Attorneys for patients are trying to
block them from getting this
information, she said.
Desai is the majority owner of the
700 Shadow Lane facility, where eight
transmissions of hepatitis C have been
linked. One case has been linked to a
facility on Burnham Avenue.
The health district has confirmed
that 400 former patients have tested
positive for hepatitis C, but only 77 of
them are classified as having "possible"
links to the Shadow Lane clinic.
Morrison said her office has turned
over the names of individuals who have
tested positive for hepatitis C to the
health district. Whether those
individuals are included in the
district's figures is unknown, she said.
Jean Sternlight, professor of law at
UNLV's Boyd School of Law, said it's not
uncommon for plaintiffs' attorneys to
encourage their clients not to speak
with anyone other than the attorney
during civil cases.
"The reason is likely that they are
afraid their clients would say something
to the health district which would
misconstrue or misrepresent what has
happened,'' she said. "Attorneys don't
want their clients to say something that
might come back and haunt them. This is
the same reason attorneys tell their
clients not to speak with insurance
companies.''
But Will Kemp, another Las Vegas
attorney representing former endoscopy
center patients, said he is allowing his
clients to participate in the health
district's registry.
Kemp said his office has taken the
position that it will act in the best
interest of the public.
"As an attorney, though, there's
always concerns clients will give
inconsistent answers" when giving
depositions, he said.
Kemp said he knows of attorneys who
have directed their clients not to speak
with health officials because of that
fear. But, he said, the majority of
attorneys are cooperating with law
enforcement and the health district.
Travis Bennington, a Nebraska
attorney, said if attorneys are telling
clients not to divulge information to
health officials, they are probably
trying to protect them from
embarrassment.
Bennington represented 19 patients
who acquired hepatitis C at a Nebraska
cancer center in 2002. In all, 89
lawsuits were filed by former patients
of the cancer center.
That incident, considered the largest
hepatitis C outbreak in U.S. history,
also came as a result of unsafe
injection practices.
The CDC, along with Nebraska health
officials, identified 99 people who had
acquired hepatitis C at the cancer
center. The lawsuits ended after more
than four years of litigation,
Bennington said.
"Attorneys defending these types of
lawsuits use that sort of information
against the victims of malpractice,'' he
said. "It is usually a great source of
embarrassment, particularly for elderly
women.''
Contact reporter Annette Wells at
awells@reviewjournal.com or
702-383-0283.
