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MELISSA BLOCK, Host:

In Las Vegas, the district attorney is investigating criminal wrongdoing after six patients were found with contracted hepatitis C at a medical clinic. Health officials are trying to contact 40,000 patients who received anesthesia by injection at the Endoscopy Center of Southern Nevada. Health authorities say clinic staff reused syringes and vials putting patients at risk of blood-borne disease including hepatitis B, hepatitis C and HIV.

Brian Labus is senior epidemiologist for the Southern Nevada Health District. He's in charge of tracking down the clinic's patients.

Thanks for joining us.

BRIAN LABUS: Thanks for having me.

BLOCK: And Mr. Labus, what's your understanding of the practices that were going on at this clinic?

LABUS: We identified the two problems that in conjunction put a number of patients at risk for exposure to blood-borne pathogens. First, the clinic was using syringes the second time on the same patient if they needed to give them an additional injection, in the process, contaminating the vial. Then they were reusing that vial on another patient with a clean needle and clean syringe and exposing them potentially to the blood of other patients.

BLOCK: You know, apparently, clinic staff had told some investigators that they were ordered to do this to reuse supplies to save money.

LABUS: It sounds like this was a common practice with the clinic and it wasn't something that just happened on one occasion.

BLOCK: There is an open letter published in the local news over there in Las Vegas from the head of the clinic expressing sympathy for this, not an apology, but sympathy and saying the evidence does not support that syringes or needles were ever reused from patient to patient. Are they basically saying this didn't happen?

LABUS: No, I think they're just clarifying how the transmission occurred. We never saw them reuse a needle or syringe on multiple patients. What we saw them do is in the process of reusing the syringes contaminating a vial, and then exposing patients by using that vial with a second patient. So the risk is basically the same level, the procedure itself is slightly different.

BLOCK: Walk us back, Mr. Labus, how did this investigation start? Why was there suspicion about this clinic?

LABUS: We had a number of reports from physicians in our community of acute hepatitis C infections. We have three reports in early January, and upon interviewing those patients, all had reported undergoing procedures at the Endoscopy Center of Southern Nevada. So we began investigating, in the process, we identified three additional cases - or six cases identified so far.

BLOCK: And how are you able to link them specifically to this clinic?

LABUS: All these patients had procedures at the clinic, one of them in July, five of them on the same day in September. We've been able to test the virus from four of those people on that same day in September, and it shows that it all came from a common source, so it's not a coincidence. It's not like they all got it, just happen to show up at the same time. We can show that they were all infected from the same person's blood.

BLOCK: Mr. Labus, what are the risks if someone does contract hepatitis C? What happens?

LABUS: The majority of people infected with hepatitis C have no symptoms. They don't know it. That's our biggest concern in this and why we want people to get tested. About 20 to 30 percent develop acute symptoms which can include jaundice, the yellowing of the skin or the whites of the eyes. For all the other people, though, they won't have any symptoms and they may be having liver damage that they're not aware of. Ultimately, it can result in severe liver problems such as cirrhosis or liver cancer.

BLOCK: And as we mentioned, it wouldn't be just hepatitis C that will be a worry here, it could be hepatitis B, HIV?

LABUS: These patients were exposed with blood of other patients. So anything that those other patients had, they could potentially be exposed to. Now, looking at how common those diseases are in the population, hepatitis C is really our main concern. We can't say that there's zero risk of the other diseases, but it's much, much lower than that of hepatitis C.

BLOCK: Now, you now have to go back and try to find these tens of thousands of patients. This goes back four years that you're looking at, how do you do that?

LABUS: Well, we've taken two approaches. We got a list of patient addresses from the clinic going back to March of 2004 and began sending letters to nearly 40,000 people. Now, we know that we don't have a complete list and we know that some of the addresses are just going to be non-deliverable, and so we've also been trying to reach out to the many patients of this clinic through the media.

BLOCK: What do you tell these patients when you reach them about their risk?

LABUS: We're telling them that they potentially been exposed with blood of other patients and they should be tested for hepatitis C, hepatitis B and HIV. The challenge we face is that on any one day, we can't determine the actual risk to an individual patient. We know this practice was common and had occurred over many years. But we can't say which individual patients were exposed with blood of which other patient. They can't really define that risk exactly for them, and that's why we're telling all of them to get tested.

BLOCK: Meantime, investigations are multiplying, lawsuits are multiplying, what happens from here?

LABUS: We will continue our public health investigation. We're still drilling into the details of what happened on two days were we have known cases. And as the community starts to get tested, we'll get reports of anyone who test positive and start to get a better picture of what happened over those four years of that clinic.

BLOCK: Well, Brian Labus, it's good of you to talk to us. Thanks so much.

LABUS: Thank you for having me.

BLOCK: Brian Labus is senior epidemiologist with the Southern Nevada Health District in Las Vegas.

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