Recent Blog Posts in May 2008

I've been traveling for depositions the last few days while the story of deficiencies among ambulatory surgery centers has been brewing.

What's clear from the recent publicity regarding surgery centers other than the infamous Endoscopy Center of Southern Nevada is that not so much is clear.

Apparently when the State determined that as many as 40,000 people who visited the Southern Nevada house of surgical ill-repute might be infected with some awful thing or another, the State decided that it might widen its probe. Not completely surprisingly, the State found bad practices elsewhere, including in Reno.

While bad practices are bad practices, it's not clear as of this writing just what the State may have found at locales north, and residents may wish to wait before rushing to judgment. My information is that allegations regarding Digestive Health Center in Reno are misleading and that local press may print clarifications in the coming days. So stay tuned and we'll see what happens.

Here are a few things we know:

First, people who have visited centers that have been cited for deficiencies or have questions about the investigation can talk to an expert by calling the health department's hotline at (702) 759-4636. The hotline can also be used by Northern Nevada residents; there is currently no hotline set up for local calls.

The foregoing was reported by the Reno Gazette Journal, which also indicated that "[f]or now, the state is advising the public to be patient."

Why, though, should the State think that people should or will be patient when the State itself has publicized vague information and directives?

Importantly, there has been no report that I know of that anyone in the Reno or surrounding areas has tested positive for some disease associated with bad practices at any northern Nevada facility. There is no known correlation between the spread of disease and northern Nevada deficiencies. And this distinguishes the northern Nevada inspections from the southern Nevada inspections.

Here are some other things we know:

State police, the FBI and Nevada's attorney general's investigators served warrants today at six southern Nevada medical clinics associated with a facility accused of infecting patients with hepatitis by reusing syringes and vials of medicine. According to the Reno Gazette Journal, police say the raids are part of a criminal investigation of officials at the Gastroenterology Center of Nevada;

Governor Gibbons said today in a news conference that better funding for more inspections of Nevada's out-patient surgical centers likely would not have prevented the unsafe practices that infected six patients with hepatitis C at a Las Vegas clinic. Frankly, this sounds somewhat absurd. Of course more inspections would have been useful. As things now stand, these clinics are inspected sporadically, and inspections occur once every seven or so years. Why wouldn't more inspections serve the public good?

The Nevada Health Department's site isn't especially enlightening, but there is a press release issued as of Friday and I reprint that below. Keep tuning in: I will be watching this story closely and will bring you unadulterated and balanced reports based upon media and independent research. For now, I agree that northern Nevadans should not jump to conclusions.

Here's the State's official press release, which can also be found at State Press Release on Surgery Center Inspections March 7, 2008

SEVERAL ADDITIONAL OUTPATIENT SURGICAL CENTERS
FOUND TO HAVE DEFICIENT PRACTICES

No Further Infectious Disease Reports Identified

Carson City--Nevada Department of Health and Human Services (DHHS) Director
Mike Willden announced today that the Nevada State Health Division, Bureau of Licensure and Certification (BLC) has found several outpatient surgical centers that have had deficiencies noted during Focus Surveys currently being conducted. The Surveys are being completed as part of the State's effort to inspect all fifty Ambulatory Surgical Centers (ASCs) in the state that perform outpatient surgical procedures.

In Northern Nevada, Focus Survey inspections have been done at ten of 19 ASCs. Three
facilities in Reno were found to be deficient due to a lack of using proper antiseptic practices or for not using proper infectious disease prevention procedures. Five other facilities were found to have problems that did not pose an infectious disease risk. In all eight cases, immediate corrective action was undertaken before BLC staff exited the facility. At two facilities, Sierra Vista Surgery Center and South Meadows Endoscopy Center, no deficiencies were noted. In Clark County, the Gastrointestinal Diagnostic Center will receive a formal Statement of Deficiencies on Monday, March 10, from BLC. The deficiencies noted at the facility are similar to those discovered at the Endoscopy Center of Southern Nevada. The facility will have ten days to submit its Plan of Correction to BLC (March 21, 2008). Upon further inspection, if the facility is found to be negligent in adhering to the Plan of Correction, the facility is subject to summary suspension of its license.

"It is important to note there has been absolutely no known infectious disease reports
associated with any of the facilities that were notified of deficient practices," Willden said.
"Further, the Bureau of Licensure and Certification does not leave a facility whose practices pose a threat to public health until corrective action is taken."

Willden said the State Health Division continues to work closely with the Washoe
County Health Division and the Southern Nevada Health Division to monitor any reports of infectious disease any of the three agencies discovers.

Three facilities in the Reno area who were identified as being deficient due to a lack of
using proper antiseptic practices or for not using proper infectious disease prevention procedures are:

St. Mary's Outpatient Clinic at Galena
18653 Wedge Parkway, Reno

Improper sterilization procedures

Digestive Health Center
5250 Kietzke Lane, Reno

Improper sterilization procedures

Sierra Center for Foot Surgery
1801 N. Carson Street, Carson City

Staff admitted reusing syringes

Willden said the State Health Division will post on its website (http://health.nv.gov)
information about all ASC inspections by BLC. Members of the public may call (775) 684-5900
24 hours a day to receive information about any questions related to the inspections or infectious
disease prevention.

I continue my discussion of driving safely with the following about distractions:

A recent study by the National Highway Traffic Safety Administration estimates that driver distraction is a factor in 80 percent of all motor vehicle crashes.

The list of distractions in an automobile is long and continues to grow. The bottom line here is that we just have to pay closer attention to our number one responsibility behind the wheel: driving safely. Here are some tips to help achieve that objective.

Focus On The Task At Hand

- Start with the basics and drive defensively. Make it your goal to have a "perfect" trip.

- Don't turn your head to talk or look at scenery or another person.

- Don't fool with the radio or other nonessential equipment when the road is busy. When driving in unfa­miliar areas, turn off the radio for maximum concentration.

- Personal grooming and reading are obvious no-no's.

- Experts say we eat one in ten restaurant meals in our automobile, often while weaving through traffic. Don't eat or drink while you drive.

- If you don't know exactly where you're going, get directions before you leave.

- If you need to look at a map or reach into your purse or briefcase, pull over. The same applies to dealing with troublesome children.

- Do not engage in stressful or emotional conversations that may be distracting.

- Illness is a distraction. When you're sick, your reflexes are slower than normal and your senses may be fogged. Consider staying home until you are alert.

- Read the labels on medications and talk to the pharmacist. Many medications such as antihistamines can make you dizzy or drowsy.

The Rolling Phone Booth

Using a cell phone while driving is a leading cause of driver inattention.

- Learn and follow all local and state laws. When you travel, review local requirements.

- Learn how to operate your phone without looking at it.

- Never take notes or look up phone numbers while driving. Use a small tape recorder to take notes.

- Keep conversations brief so you can concentrate on your driving.

- A cell phone should only be used when it is absolutely necessary. The Cellular Telecommunications & Internet Association offers these safety tips for cell phone users:

- Take the time to become familiar with the features of your phone such as speed dial and redial.

- Position your phone so you can reach it while maintaining a proper view of the road and all mirrors.

- Dial while the vehicle is stopped. If you absolutely must dial in light traffic, dial a few numbers, check traffic, and continue dialing when it's safe. Or, have a passenger dial for you.

- If you place a call while moving, stay in the lane reserved for slower traffic.

- Use Speed Dialing for frequently dialed numbers.

- Always assess the traffic situation before receiving calls. Allow voice mail to answer the phone when it's unsafe to speak, e.g., heavy traffic or bad weather.

- Let the person you are speaking to know you are driving. If neces­sary, suspend conversations during hazardous driving conditions or situations.

- The National Safety Council rec­ommends not using a cell phone at stoplights. You may notice cars moving in the next lane, but your light could still be red.

- Hearing impaired drivers should pull over to use the phone. Too much of your attention will be diverted to deciphering the sounds. 

Prescription and over-the-counter (OTC) medications are intended to keep us healthy. In the wrong circumstances - especially when we are behind the wheel of a vehicle - our drugs could contribute to our early demise. To be sure your medications don't abuse you, please remember:

- It is your responsibility to know what you're taking and how it affects you. If you have a question, ask your doctor or pharmacist.

- Bodies are different and every­one will not react the same to medications. Furthermore, a drug can affect one person differently in dif­ferent situations.

- Don't mix medications, or mix any kind of drug with alcohol, until you have consulted with your doctor or pharmacist.

- Try to use only one pharmacy.

- The problem with some drugs, such as cough medicines, is that they have a high alcohol content. Read the literature you get with any drug to determine whether it con­tains sedatives or alcohol.

Driving Alert

Even at recommended doses, OTC drugs can affect driving ability as much, or in some cases, even more than illegal drugs, pre­scription drugs, or alcohol.

- Antihistamines are the principal culprit, according to the Southern California Research Institute. They can cause drowsiness, dizziness and blurred vision.

- Sleeping pills and night-time cold medications can also impair drivers. Obviously, a medication intended to help you sleep is not going to make you a good driver.

- Ibuprofen, a commonly used pain reliever, can reduce concentra­tion levels and cause drowsiness.

- If you're taking a medication for the first time, don't plan on driving after you take that first dose. Wait to see how it affects you.