# Las Vegas clinic exposes 40,000 to hep c and HIV - How? **URL:** \ **Category:** Factual Questions\ **Created:** [March 6, 2008, 4:04am UTC](https://boards.straightdope.com/t/las-vegas-clinic-exposes-40-000-to-hep-c-and-hiv-how/440284 "2008-03-06T04:04:27Z")\ **Posts on this page:** 13\ **Page:** 1
**Author:** ![hekk](https://avatars.discourse-cdn.com/v4/letter/h/50afbb/32.png) [@hekk](https://boards.straightdope.com/u/hekk)\ **Post date:** [March 6, 2008, 4:04am UTC](https://boards.straightdope.com/t/las-vegas-clinic-exposes-40-000-to-hep-c-and-hiv-how/440284/1 "2008-03-06T04:04:27Z")
[Link](http://hosted.ap.org/dynamic/stories/H/HEPATITIS_EXPOSURE?SITE=WIMIL&SECTION=HOME&TEMPLATE=DEFAULT) How does this happen? Isn’t the message “Don’t ever reuse needles!!” pounded into a person who is learning anything about the medical profession? Like on the first day of class?? Its hard to buy the “Management made me do it” line in this case, as they would have little to gain and so much to lose (needles aren’t THAT expensive, lawsuits and criminal prosecutions/business closure are) Just stupidity, or wholly untrained/unqualified staff is my guess. ---
**Author:** ![hotcoldhot](https://avatars.discourse-cdn.com/v4/letter/h/58f4c7/32.png) [@hotcoldhot](https://boards.straightdope.com/u/hotcoldhot)\ **Post date:** [March 6, 2008, 4:28am UTC](https://boards.straightdope.com/t/las-vegas-clinic-exposes-40-000-to-hep-c-and-hiv-how/440284/2 "2008-03-06T04:28:35Z")
I hate to say this but in my lifetime I have experienced some jobs where the bosses are REALLY cheap, I mean to the point of a few pennies cheap. Like I had one place to get a new pen or pencil we had to turn in the old one. I am not sure of the cause but I wouldn’t be surprised if it was a very cheap person. Short of that somehow, though I don’t know how, someone or some group of people is diverting the cost of NEW needles and keeping the money for themselves. ---
**Author:** ![Derleth](https://avatars.discourse-cdn.com/v4/letter/d/b9e5f3/32.png) [@Derleth](https://boards.straightdope.com/u/Derleth)\ **Post date:** [March 6, 2008, 11:08am UTC](https://boards.straightdope.com/t/las-vegas-clinic-exposes-40-000-to-hep-c-and-hiv-how/440284/3 "2008-03-06T11:08:37Z")
As a purely moral issue, no, managment _ **doesn’t** _ make you do that, any more than management could make you shoot random homeless people with a shotgun. ---
**Author:** ![OtakuLoki](https://avatars.discourse-cdn.com/v4/letter/o/ac8455/32.png) [@OtakuLoki](https://boards.straightdope.com/u/OtakuLoki)\ **Post date:** [March 6, 2008, 11:25am UTC](https://boards.straightdope.com/t/las-vegas-clinic-exposes-40-000-to-hep-c-and-hiv-how/440284/4 "2008-03-06T11:25:48Z")
**Derleth** , I agree. But I want to make damned sure that management gets put against the wall, first - then we can go after the minions. ---
**Author:** ![CookingWithGas](https://sea3.discourse-cdn.com/straightdope/user_avatar/boards.straightdope.com/cookingwithgas/32/485_2.png) [@CookingWithGas](https://boards.straightdope.com/u/CookingWithGas)\ **Post date:** [March 6, 2008, 3:11pm UTC](https://boards.straightdope.com/t/las-vegas-clinic-exposes-40-000-to-hep-c-and-hiv-how/440284/5 "2008-03-06T15:11:29Z")
The linked article sez > [@](#): > > In Las Vegas, clinic staff told inspectors they had been ordered by management to reuse the vials and syringes. Labus described the practice as an unwritten, but long-practiced policy. > > Investigators were told the practice was an attempt to cut costs, according to a letter of complaint from the city, which revoked the facility’s business license Friday. ---
**Author:** ![Fir\_na\_tine](https://avatars.discourse-cdn.com/v4/letter/f/a587f6/32.png) [@Fir\_na\_tine](https://boards.straightdope.com/u/Fir_na_tine)\ **Post date:** [March 6, 2008, 3:24pm UTC](https://boards.straightdope.com/t/las-vegas-clinic-exposes-40-000-to-hep-c-and-hiv-how/440284/6 "2008-03-06T15:24:14Z")
Ah, the good german defense! I was only following orders. I wonder if **Quotop** or **Picunurse** has seen this yet. I’d be interested in their take as medical professionals. ---
**Author:** ![KneadToKnow](https://sea3.discourse-cdn.com/straightdope/user_avatar/boards.straightdope.com/kneadtoknow/32/3999_2.png) [@KneadToKnow](https://boards.straightdope.com/u/KneadToKnow)\ **Post date:** [March 6, 2008, 3:40pm UTC](https://boards.straightdope.com/t/las-vegas-clinic-exposes-40-000-to-hep-c-and-hiv-how/440284/7 "2008-03-06T15:40:03Z")
So much for the ad campaign … ---
**Author:** ![Sigene](https://avatars.discourse-cdn.com/v4/letter/s/df788c/32.png) [@Sigene](https://boards.straightdope.com/u/Sigene)\ **Post date:** [March 6, 2008, 4:02pm UTC](https://boards.straightdope.com/t/las-vegas-clinic-exposes-40-000-to-hep-c-and-hiv-how/440284/8 "2008-03-06T16:02:47Z")
Doesn’t excuse the practice at all, but to make sure its clear; the needles were not reused…but the syringes and vials were. So if one patient required 1cc out of a 10 cc vial, instead of throwing out the remaining 9cc, they stuck another needle in and pulled out some more. I can see where that is more believable than sticking multiple people with the same needle. ---
**Author:** ![Qadgop\_the\_Mercotan](https://sea3.discourse-cdn.com/straightdope/user_avatar/boards.straightdope.com/qadgop_the_mercotan/32/83_2.png) [@Qadgop\_the\_Mercotan](https://boards.straightdope.com/u/Qadgop_the_Mercotan)\ **Post date:** [March 6, 2008, 4:18pm UTC](https://boards.straightdope.com/t/las-vegas-clinic-exposes-40-000-to-hep-c-and-hiv-how/440284/9 "2008-03-06T16:18:22Z")
According to the reports I’ve read, needles were not re-used. Syringes were. They were used on the same patient ostensibly. But if a syringe which was to give an anesthetic agent was empty and more anesthetic was needed, a new needle was put on it, it was stuck into a multi-dose vial of anesthetic agent (or whatever) and then drawn up, to give to the same patient. The problem with that approach is that often, blood gets into the syringe via the first needle, then gets put into the multi-dose vial by the second needle. Then it gets into the next patient via the contaminated vial. Not quite so gross and blatant a violation as re-using needles and syringes between patients, but a very distinct violation of non-contamination procedures nonetheless. And an indefensible practice, too. ETA: I swear **Sigene** ’s post wasn’t there when I started writing! ---
**Author:** ![Ca3799](https://avatars.discourse-cdn.com/v4/letter/c/9f8e36/32.png) [@Ca3799](https://boards.straightdope.com/u/Ca3799)\ **Post date:** [March 6, 2008, 4:33pm UTC](https://boards.straightdope.com/t/las-vegas-clinic-exposes-40-000-to-hep-c-and-hiv-how/440284/10 "2008-03-06T16:33:38Z")
My interpretation is that the employees reused vials of meds as multi use/multi patient medications when they should have been single use medication vials and discarded after each patient. This would save money in the number of vials used, but would leave the actual vial at risk for contamination. I believe I also read (or perhaps just interpreted) that employees may have, say, filled a large syringe for injection purposes in the mornings for the anticipated patient load that day, and then just changed needles between patients. This, too, would leave the syringes at risk for cross contamination, particularly if they were not careful to place a new needle on the syringe between patients. These are poor ideas for saving time and money. I further suspect that the employees who would do things like this were not actual nurses, but some kind of “medical technologists” or any of the permutations of “aid” “assistant”, “technician”, etc. that is so common in the medical field. It is commonly assumed that anyone wearing scrubs is some kind of nurse, which licensed and registered nurses find a constant source of irritation. The lady that takes your blood pressure at your Doctors office is quite likely not a nurse, but you have probably referred to her as such. The “techs”, “aids”, “assistants”, etc., often have little training and are easily trained to do things “the company way” without having an understanding of why “the company way” may not be a good idea. I know at my work, I often use only part of a vial of something and discard the remaining medication. One of the meds I commonly use has 4 doses in the vial. I have never used more than 3 doses on one patient, and sometimes use only one or two. I use a new needle and syringe for each dose. I would never, ever reuse the same needle (ouch, dull), or syringe, even on the same patient. And, I would never “save” this leftover medication for the next patient, even though the vial would still be ‘clean’. These are all single use items. I could, however, see someone thinking “Gee, that’s a waste of 1, 2, or 3 doses of this stuff. How can I reduce waste?” Hopefully the person thinking this is a trained nurse or doctor who would consider the error and risk potential. ---
**Author:** ![picunurse](https://avatars.discourse-cdn.com/v4/letter/p/7bcc69/32.png) [@picunurse](https://boards.straightdope.com/u/picunurse)\ **Post date:** [March 6, 2008, 11:12pm UTC](https://boards.straightdope.com/t/las-vegas-clinic-exposes-40-000-to-hep-c-and-hiv-how/440284/11 "2008-03-06T23:12:41Z")
I did see the news story. I agree with / **QtM** , while not at the level of reusing needles, it’s still gross. I know such things happen. When I worked in San Diego, a doc who owned a clinic in Mexico tried to get us to give him used [Swan-Ganz catheters](http://www.nlm.nih.gov/medlineplus/ency/article/003870.htm) to use for “teaching”. We didn’t give him any and reported his request to our medical director. He lost his privleges at our hospital and eventually lost his California medical licence. As far as I know, he’s still practicing in Mexico. ---
**Author:** ![irishgirl](https://avatars.discourse-cdn.com/v4/letter/i/8edcca/32.png) [@irishgirl](https://boards.straightdope.com/u/irishgirl)\ **Post date:** [March 7, 2008, 12:24am UTC](https://boards.straightdope.com/t/las-vegas-clinic-exposes-40-000-to-hep-c-and-hiv-how/440284/12 "2008-03-07T00:24:56Z")
Yuck! Sharps go in the sharps bin, syringes go in the sharps bin, single use vials go in the sharps bin, even if almost full. The only exceptions I can think of is a) when someone has been given a controlled drug (say IV morphine) which was titrated to pain, so that only half the syringe was used. In that case, if I expected them to need the other half of the dose in the next hour I would label the syringe clearly with the drug, the dose and the patient name and keep it locked in the controlled drugs cupboard. That syringe could only be given to that patient as it would be listed under their name in the controlled drug book. b) something like 50% dextrose which is a multi use vial- even so, a clean syringe is used every time any of it is withdrawn from the vial. Anyone who draws back to check for flashback (and so introduces blood into a syringe) rather than flushing a cannula with saline hasn’t been taught how to give IV drugs properly. Even if the administrator of the medication was a tech, wouldn’t they still have to check the dose/expiration date/prescription with a nurse or doctor? Here 2 nurses or 1 doctor and 1 nurse have to check all IV/SC/IM meds together (including administration technique) and no-one else except a doctor or a nurse can give parenteral medications in a medical setting. For example, nurses where I work can’t give IV opioids. I prescribe the dose I want, a nurse witnesses me draw up the drug, then she’ll check the drug, dose, expiration date and route of administration with me and watches me administer the drug, and we both sign the patient prescription sheet and the controlled drug book. There is a serious systems failure if this was able to happen. This isn’t the time to blame individuals, it’s time to blame the system. ---
**Author:** ![brazil84](https://avatars.discourse-cdn.com/v4/letter/b/8491ac/32.png) [@brazil84](https://boards.straightdope.com/u/brazil84)\ **Post date:** [March 7, 2008, 12:42am UTC](https://boards.straightdope.com/t/las-vegas-clinic-exposes-40-000-to-hep-c-and-hiv-how/440284/13 "2008-03-07T00:42:35Z")
An independent third party – such as the state health department – ought to do regular audits as well as occasional surprise inspections. If they’re checking the local deli to make sure the meat is properly refrigerated, they ought to be checking any kind of local health clinic to make sure it’s being run properly.