The Southern Nevada Health District said the mid-2006 case affected a patient at the Desert Shadow Endoscopy Center, one of six clinics headed by Dr. Dipak Desai. Another clinic in the group, the Endoscopy Center of Southern Nevada, was identified late last month as the source of the six recent cases.
The clinics that are part of Desai's group either have been shut down or face operating restrictions pending the outcome of investigations into practices at the Endoscopy Center that may have contaminated vials of medication. Notices were sent to 40,000 patients as a result of the recent outbreak, urging tests for hepatitis and HIV.
Also Tuesday, Gov. Jim Gibbons said he's hoping that three doctors serving on the state Board of Medical Examiners will resign as part of his housecleaning efforts following the hepatitis outbreak. He also ordered the removal of the head of a state licensing bureau that oversees clinics including the endoscopy centers.
If the doctors don't step down, Gibbons said he'll move ahead with a legal effort to remove them for "cause." But he added he hoped the board members "will do what is right for the people of Nevada" and resign without a fight.
The panel members, Drs. Javaid Anwar, S. Daniel McBride and Sohail Anjum haven't resigned yet, but did recuse themselves from any board meetings dealing with the endoscopy center. The medical board terms of Anjum and McBride run until mid-2009 while Anwar's four-year term doesn't expire until mid-2011.
McBride on Monday termed the governor's move "outrageous," adding that he won't step down and accusing Gibbons of "trying to inject politics into the board process." He said that if the Board of Medical Examiners seemed to move slowly on the hepatitis issue, it was because Gibbons' Board of Licensure and Certification delayed informing the examiners' panel until after stories of the problem broke.
McBride said he believed that both intended to stay on the board. Anwar and Anjum didn't immediately return calls seeking comment.
Tony Clark, the medical board's executive director who Gibbons also wants replaced, said Monday he wouldn't step down at Gibbons' request and instead would follow the direction of the board, which by state law decides whether he stays or goes.
Gibbons wants the three doctors replaced because of their associations or business dealings with Desai.
Repeating remarks from Monday, Gibbons said Tuesday he wants a medical examiners board "that can vote on critical issues that go to the confidence of our health care system in Nevada."
Gibbons also said he hadn't spoken with Desai, who served on Gibbons' health care transition team following the governor's November 2006 election. He also served on the Board of Medical Examiners from 1993 to 2001, including a stint as chairman of its investigative committee. Desai has refused to answer questions about the outbreak.
The hepatitis outbreak sparked a massive health alert by local, state and federal health agencies.
The case also prompted a sweeping probe of Nevada's 50 surgical centers by state health inspectors, who have found similar unsafe procedures at several other clinics.
Gibbons also has defended the Endoscopy Center, saying more cases of hepatitis C would have been discovered by now had its doctors and nurses been grossly negligent.
Health officials found no evidence of doctors or nurses reusing needles at the endoscopy center. But they think nurses contaminated single-use medication vials with reused syringes and then used those vials on multiple patients.