Friday, February 29

Causing Crisis: Health Clinic Spreads Virus

Sometimes a crisis communication checklist is not enough. The Endoscopy Center of Southern Nevada is attempting to apply some practices, but the message is failing to resonate. I’m not surprised.

This is the largest hepatitis C scare in the history of the country.

The Endoscopy Center of Southern Nevada was reportedly using single dose vials of medication, which had become infected with hepatitis C, a potentially fatal blood-borne virus, through their initial use and were used again. Hepatitis C is not the only potential infection that could have been spread.

The Southern Nevada Health District is asking some 40,000 patients who had procedures requiring injected anesthesia at the clinic between March 2004 and January 11, 2008, to contact their primary care physicians or health care providers to get tested for hepatitis C as well as hepatitis B and HIV. Given the transient nature of Las Vegas, it is nearly impossible to tell how many of these patients have moved out of the area or have been living with an infection for years.

The reality and gravity of the situation is severe enough that the statement released to the media by the Endoscopy Center of Southern Nevada fails to exhibit even a basic understanding of crisis communication, considering the severity of the issue.

“On behalf of the Endoscopy Center of Southern Nevada, we want to express our deep concern about this incident to the many patients who have put their trust in us over the years. As always, our patients remain our primary responsibility and we have already corrected the situation.”

Obviously not. If patients were the primary responsibility, this would have never happened. How could anyone even think such a statement was appropriate to include as a patient care message during a press conference that addressed wrongdoing of the worst kind — reusing single dose vials is widely known to pass infection.

The statement goes on to say things like “In addition to our corrective actions, we are on a mission to maintain the trust our patients have had in us during our years of service to southern Nevada.” They must be joking. And, unbelievably, they attempted to play the legal counsel card — pending class action suits already being organized and a criminal investigation — to limit their comments and refuse to take reporters’ questions. Unbelievable.

If you break off communication with the media during a severe crisis, they will have no alternative but to seek other sources. Every media outlet covering the story is doing exactly that.

According to the Las Vegas Sun today, several doctors unaffiliated with the Endoscopy Center of Southern Nevada have surmised that the clinic appeared to put profits ahead of patient care, directing staff to cut corners in order to accommodate the high volume of patients. The procedures were performed by certified nurse-anesthetists, with apparently no one at the practice willing to step up and say what they were doing was wrong.

These practices continued until the Southern Nevada Health District identified six cases of hepatitis C, five of which stemmed from the Endoscopy Center of Nevada. While the center continues to stress that the actual risk of anyone being affected by this is extremely low, it seems to be little consolation for the individuals. Elected officials are already calling for the removal of the clinic’s license.

This crisis has already been mishandled to the point of no return.

In such extreme cases, one might ask if the clinic is worth saving. While this could be debated endlessly, I’d rather focus on what they did wrong from a communication standpoint, which made this unrecoverable.

They are attempting to apply a truncated crisis communication formula frequently employed by public relations professionals who have little real world experience. Worse, they are being selective in which ones they are using — the statement doesn’t even include an apology, possibly for fear of admitting criminal negligence.

Look, crisis communication is a process and not a formula. You can come forward, apologize, explain the incident, address corrective measures, seek outside consult, promise it will never happen again, and perhaps demonstrate some measure of empathy (I was told the owner appeared empathetic at the press conference) all you want. But it won’t change gross negligence.

What the crisis communication team needed to consider.

• The clinic needed to come forward sooner and explain precisely what occurred and why it occurred, regardless of potential civil and criminal cases. If the crisis was caused by placing profits before patients as some speculate, an admission is appropriate.

• The clinic needed to apologize, at minimum, to the five people likely infected with hepatitis C by its procedures and offer immediate restitution. It further needed to voluntarily pay for a proactive location and testing of all 40,000 patients as well as family members that may have been affected as a result.

• The clinic needed to maintain an open door policy to address all concerns and questions from the media and other stakeholders, regardless of personal jeopardy, as personal and public safety remain at risk.

• The clinic needs to verbalize empathy, sympathy, and embarrassment over its procedural practices without any trite statements revolving around preserving patient trust and promises that it will never happen again. It would seem more logical for the clinic to voluntarily dedicate 100 percent of its resources to the crisis.

• Dipak Desai, medical director and majority shareholder in the practice, needs to step forward as his own spokesperson and promise to step down immediately after overseeing restitution to the victims. Desai also needs to fully cooperate with all investigations and help determine which doctors and nurses were engaged in these procedures or knew about the procedures but neglected to speak up.

All this should have already happened. However, it did not. Given the severity of the crisis and the initial handing, it’s likely this will be unrecoverable. And frankly, despite placing it in the living case study slot, maybe that is for the best if it does not recover.



Anonymous said...

This is so very frightening. We saw this on the news here in Kansas City.

Rich on 2/29/08, 1:57 PM said...


It is always frightening when your most trusted relationships are participating in actions that are not to be trusted.

It's deplorable this would happen; even more so that that it would happen and they would skirt the issue.

Many crisis communication issues are neither black not white, but this one sure seems to land squarely in one shade over the other. In such instances, full disclosure as fast as possible is the only way to survive, with a heavy emphasis on providing restitution to any victims. I expect the medical community will become the sharpest critics.


Anonymous said...

hello I know you are very busy. I found your blog in the blogging group on blog catalog. I really need a little help here I asked the group but didn't get a response. I am having trouble creating link text in my post. I know normally it is a simple matter of an HTML code but it doesnt work. I have a job depending on this working correctly.

The only reason I am asking because I am a little desperate here, and want to turn the job in by tomorrow.
thanks in advance.

Rich on 3/1/08, 1:23 PM said...

Hello Adrienne,

I didn't see the question asked in my group, but adding a link in a post is pretty basic html code.

The address above has what you are looking for under HTML Link Examples.

Rich on 3/1/08, 1:25 PM said...


The city of Las Vegas shut down the endoscopy clinic yesterday afternoon, according to The Las Vegas Review-Journal.

Charlie Wolfe on 3/2/08, 6:49 AM said...

This was a great article and very informative. Thanks for sharing it.
P.S....really enjoyed your site!

Rich on 3/2/08, 7:20 AM said...

Thanks Charlie,

There is more to come for this story. That is certain.


Anonymous said...

The more they put it off, the bigger the issue will become. It's not something that will just go away if ignored. And besides, we're not talking about a petty fight between two friends here. This is a hospital being responsible for possibly infecting a lot of patients with Hepatitis-C. It's a scary thought and I hope such a thing never happens to me. And media, being really good at hunting other sources, will inevitably put the hospital in a position they might not be able to recover from.

Kim on 3/3/08, 10:43 AM said...

You would think that the first step would be for the Endoscopy Center to pay for testing for any former patient who might have been exposed. But no. Guess it's not important enough.

Dr. Desai could afford to take out a full page ad in the Las Vegas Review-Journal's Sunday paper to "thank" the Southern Nevada Health District for bringing deficiencies to his attention. Nowhere in his carefully written "letter" does he apologize for his actions.

I hope he can sleep at night in his 8,500-square-foot mansion knowing his greed might kill people who placed their trust in him and his medical facility.

He should be brought up on criminal charges, as should EVERY employee at his business who knowingly engaged in unsafe medical practices or knew and never said a word. And, they should be stripped of their rights to work in the medical field again.

Anonymous said...


When my life and I first heard this news, we were incredulous. In my mind, this crisis goes way beyond ethics and communications, both of which the clinic seem to know little. This is criminal.

Rich on 3/3/08, 12:59 PM said...

Lewis, Kim, and Julie,

I am running a follow-up post today. It seems to me that the communication strategy employed is a near duplicate to the failed attempt by Jack In The Box a few years ago. Details to come.

There was so much to consider, I did not even have space to explore the blatant breach of ethics. According to reports, staff members knowingly placed patients in harm's way at the urging of the administration.

Once again, we're faced with case study that appears to demonstrate how easily people are willing to do the wrong thing provided they "think" they are relinquishing their own responsibility to authority. Stanley Milgram was right.


Anonymous said...

I cannot find words strong enough to adequately describe my contempt for the reprehensible pieces of shit that work at Desai’s place of business. When I called said place of business, there was only a recorded message (without apology) referring one to another non-info recording at the Southern Nevada Health District. When I accompanied my wife there to obtain copies of her medical records on 3 March, the place was vacant. There was no sign or any info on the door. They seem to have folded their tents and fled like thieves in the night.

Anonymous said...


I encountered Dipak Desai’s home address on the internet. Since he was not at his place of business 3 March 08, I attempted to ‘visit’ with him at his home on the evening of 3 March 08 in order to determine how my wife could obtain copies of her medical records (which she is entitled to under the law). Although I am not a medical professional [one could argue that Dipak Desai isn’t either] common sense tells me that these records are important for ‘continuity of care’.
Not surprisingly, the gate guard at the private community where Desai’s massive home is located, indicated that Desai was not taking visitors. When queried how he knew that without calling, the guard stated the information came from data on what appeared to be a hand held computer.
Alas, the search shall continue.

Anonymous said...

Fred Olmstead, legal counsel of the Nevada State Board of Nursing does not see an “immediate threat”.

Javaid Anwar, President of the Nevada Board of Medical Examiners “needs evidence that a doctor is a threat before suspending a medical license”.

Lisa Jones (who was interviewed on KNPR’s State of Nevada on Friday, 29 Feb) is the Chief, Bureau of Licensure and Certification. When asked why the business had not been shut down she replied, “That is definitely the big question that is being posed.”
[Question? This is a no-brainer!]
She advocated giving the business in question an opportunity to make a correction before considering shutting the facility down. She didn’t believe the “severity, scope and degree of harm” warranted closing them down. [Ms. Jones, what number over 40,000 at risk denotes a degree of harm that might move you to take action?]

Kudos to Mayor Oscar Goodman who provided leadership and used common sense by preventing these quacks from continuing to harm the public through their irresponsible and despicable actions.

Anonymous said...


Every employee (or independent contractor--or whatever legal shading they might hide behind)of this despicable third world entity bears responsibility...from the billing administrators to the operating room (if it is so called) including the bookkeeper/accountant and the individual(s) that order the supplies.
[This is difficult to phrase and also avoid applying the words 'person' or 'people' to them.]
Any employee of this shoddy business (it IS a business, not a vital health care facility) could have stopped these outlandish practices by merely speaking up. Even if their jobs were at risk they would go to their grave knowing for themselves that they had been courageous, had done the right thing, and had saved lives...isn't that what their oath is about?
AND OH BY THE WAY, there is a nurse and doctor shortage in Las Vegas, so other employment would have been almost immediately available.
I have not found a complete list, but the following two names have been associated with procedures at the business in question during the time period in question.


Ronald Lakeman, CRNA
Janine Drury, RN

NOTE: Dipak Desai isn't the only owner--just the majority shareholder. Who are the others?

Kim on 3/6/08, 1:31 PM said...

Desai's cohorts/co-owners:

Vishvinder Sharma, MD
Clifford Carroll, MD
Eladio Carrera, MD

The DA had better bring these a** clowns up on charges.

I saw a story on KVVU Fox 5 News this AM, where the reporter went to a medical supply company. Turns out the cost of the syringes Desai and his cronies were reusing to save money cost just a few cents each. It's tragic what these "doctors" did.

Rich on 3/7/08, 8:14 PM said...

Thank you for all of your comments. My thoughts and prayers are with the patients. In case you misses it, I published a patient interview right here along with some ideas of what constitutes restitution.


Anonymous said...

Great analysis. You hit the nail on the head on your analysis their bullshit "apology".


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