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Digital Issues

Nevada Hepatitis C Doctor Ruled Competent for Trial

The latest twist in a case full of them finds a Las Vegas doctor accused of exposing patients to hepatitis C ruled competent to stand trial.

Despite initially being found incompetent due to the effects of 2 strokes suffered in recent years, Dipak Desai, MD, is now set to stand trial on criminal charges stemming from a 2008 hepatitis C outbreak, along with 3 staff members from his Las Vegas-area endoscopy clinics. Nevada state medical experts who recently examined Dr. Desai found that he is mentally fit enough to proceed, said David Roger, district attorney for Clark County, Nevada, in the Las Vegas Review-Journal.

Dr. Desai and 2 of his nurse anesthetists, Keith Mathahs, CRNA, and Ronald Lakeman, CRNA, now face a March 12, 2012, trial date on felony charges including racketeering, insurance fraud and neglect of patients.

Another trial is scheduled to begin on May 22, 2012, in which Dr. Desai and his clinic manager, Tonya Rushing, face a count of conspiracy and 25 counts of healthcare fraud. An indictment alleges that the pair carried out a scheme from January 2005 through February 2008 to inflate the length of medical procedures and overbill health insurance companies, the newspaper reported.

Among other charges, Dr. Desai is alleged to have encouraged unsafe injection practices that led to 7 patients being infected with hepatitis C, an outbreak that was discovered in early 2008.

The Endoscopy Center of Southern Nevada, along with 5 affiliated centers that Dr. Desai also owned, were shuttered in March 2008 after an investigation found the center had reused syringes, single-use vials of anesthesia and scope-cleaning solution. At that time, the Southern Nevada Health District also notified 40,000 of the center's patients that they may have been exposed to hepatitis C as well as hepatitis B and HIV. About 250 former patients infected with hepatitis have since filed medical malpractice lawsuits.

Along with Mr. Mathahs and Mr. Lakeman, Dr. Desai was indicted on 28 felony counts in 2010. Dr. Desai pleaded not guilty to the charges. Originally scheduled to stand trial in March 2011, Dr. Desai's attorneys argued that he was unable to aid in his own defense as a result of suffering 2 strokes. Court-appointed experts agreed. Dr. Desai was sent to a state hospital for more evaluation, which effectively postponed his trial.

State medical authorities have now found Dr. Desai fit to continue with legal proceedings. Elizabeth Neighbors, PhD, director of the state's mental health hospital in Sparks, revealed the results in letters last week, which indicated that Dr. Desai "'meets the criteria to be considered competent to proceed with adjudication,'" Mr. Roger told the press.

Eighth Judicial District Judge Kathleen Delaney will hold a hearing to accept the hospital's reports and make a final determination on Dr. Desai's competency. The doctor's attorney will have an opportunity to dispute the findings.

Mark McGraw

Winners of OR Excellence Pre-Registration Contest Announced

Next month, Kimberly Schoeberl will enjoy Outpatient Surgery Magazine's OR Excellence conference in style. The nurse manager from the Mayo Clinic in Rochester, Minn., won the grand prize in our early-bird registration drawing and will get to stay in a luxury suite at the Manchester Grand Hyatt San Diego during her trip to the third-annual ORX, scheduled for Oct. 5 through Oct. 7.

Three runners up will enjoy a sunset dinner cruise with their fellow colleagues, on us. Andrea Thompson, OR charge nurse for Big Sky Surgery Center in Missoula, Mont.; Joseph Smith, president of Reid Outpatient Surgery and Endoscopy in Richmond, Ind.; and Sara Osinski, RN/QI Leader for Hamot Surgery Center in Erie, Pa., will be enjoying the hospitality on the bay.

Congratulations to our winners! It's not too late to join them at our surgical education and networking meeting. Simply visit us at ORExcellence.com to view a program and to register, or call (888) YOUR-ORX.

Stephen Archibald

Ultrasound Doesn't Lead to Better Blocks

Using ultrasound guidance to place nerve blocks doesn't lessen patient pain, but the technology has increased the use of regional anesthesia, say researchers in the October issue of Anesthesia & Analgesia.

A review of studies involving nearly 1,700 patients treated with ultrasound-guided or traditional nerve location techniques - using electrical stimulation or anatomical landmarks to target nerves - revealed no significant advantage for either approach.

"Ultrasound guidance was not found to be inferior to traditional nerve localization techniques for any outcome," say the study's authors.

But ultrasound's apparent lack of pain-relieving advantages might be beside the point. In an accompanying editorial, anesthesiologists John Antonakakis, MD, and Brian Sites, MD, director of the Dartmouth-Hitchcock Center for Ultrasound-Guided Regional Anesthesiology in Lebanon, N.H., say the equal outcomes are actually a "victory" for ultrasound, which has been credited with driving the widespread use of nerve blocks for surgical anesthesia and post-op pain control.

"Given the wide popularity of ultrasound-guided regional anesthesia, we are confident that ultrasound will continue to expand the application of regional anesthesia," they write, "allowing clinical benefits to be realized by a maximum number of patients."

Daniel Cook

InstaPoll: Are You Receiving Co-Pays on the Day of Surgery?

Tell us in this week's InstaPoll how successful your facility is at collecting the patient's portion of payment for surgery on the day of the procedure.

According to the results of last week's poll, infection prevention is your greatest concern in controlling access to your ORs. The results, with 105 responses:

  • Infection prevention: 59%

  • Patient privacy and confidentiality: 24%

  • Security: 10%

  • Congestion: 5%

  • Theft: 2%

    Dan O'Connor

  • News & Notes

  • Which oral pain med is best? Ibuprofen tops single-dose oral analgesic options for treating acute post-op pain, according to a Cochrane Library review of 350 studies involving 45,000 patients. Researchers classified an effective dose as one that provided a 50% pain relief over 4 to 6 hours. The study's lead author, Andrew Moore, PhD, DSc, of Oxford University in England, told the New York Times that combining ibuprofen with Tylenol has the highest pain-relieving success rate.

  • Bariatric patients unaware of post-op options A study recently presented at the American Society of Plastic Surgeons' annual conference found that the majority (75%) of bariatric patients are not informed of the post-op body contouring options available to them, but 40% of these patients might undergo plastic surgery if they were aware. Of the 284 post-bariatric patients studied, 25% reported discussing body-contouring procedures with their bariatric surgeon pre- or post-operatively, 14% were referred to a plastic surgeon for consultation and 11% had a body contouring procedure. Patients cited lack of awareness and expense as primary reasons for not having body contouring done.

  • Tip of the week Putting an allergy alert bracelet on every patient, even if that bracelet is marked "NKA" for some of them, is an inexpensive safeguard that ensures no allergy or sensitivity is overlooked during the perioperative process, says Louise DeChesser, RN, CNOR, MS.
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