Testimony From The Grave Part Of Recent Activity In Hepatitis C Trial

Desai, Lakeman, Mathahs

Jurors in a Las Vegas courtroom heard from the only victim in a 2007 Nevada Hepatitis C outbreak who died from the disease he contracted. Rodolfo Meana died in April 2012 in the Philippines at age 77, not six weeks after his deposition was recorded by the prosecution. That video was played in court yesterday.

From the Las Vegas Review Journal:

Meana, a Philippines military veteran who came to the United States in 1997, gave the 2012 deposition from his home through a video hookup in Adair’s courtroom with prosecutors and defense lawyers.

Jurors watched the videotape intently Wednesday as Meana answered questions with an interpreter at his side.

Dressed in slacks and a rolled-up, long-sleeved shirt, Meana explained mostly in English his experience with the colonoscopy and how he started feeling sick “after a month’s time.”

He said his skin turned yellow and he suffered from flu-like symptoms with “some sort of slight depression.”

After being informed that he tested positive for hepatitis C, he only did treatment for the virus for a week because it made him feel worse, Meana testified.

“Sir, what’s your health right now?” Chief Deputy District Attorney Pam Weckerly asked Meana.

“It’s very bad,” he responded. “My liver is no longer functioning, and I have kidney failure.”

After Meana’s death, a county medical examiner flew to the Philippines to observe the autopsy and bring back blood and tissue samples for prosecutors. The autopsy concluded he died of complications of hepatitis C.

In her testimony, Meana-Strong said her father was “alert” and led an “active” life until he was infected with the virus.

Eventually, he had trouble walking and had to give up driving, and toward the end he required 24-hour care, she said.

In other witness developments, Gayle Langley, a medical epidemiologist at the Atlanta-based Centers for Disease Control testified she saw nurse anesthetist Keith Mathahs improperly reuse a syringe months after the 2007 Hepatitis C outbreak. She said she told him to stop the practice after the procedure.

Langley was the second CDC physician who participated in the investigation of the outbreak to take the witness stand for the prosecution. Mathahs, originally charged with Dipak Desai and nurse anesthetist Ronald Lakeman, previously pleaded guilty in the case in exchange for his testimony.

Langley also testified that she witnessed nurse anesthetists at Desai’s now-closed Endoscopy Center of Southern Nevada improperly use bottles of the anesthetic propofol on multiple patients. It was the “double dipping” of syringes into bottles of propofol used on multiple [patients that caused the outbreak she concluded.

Previously another investigating physician, Melissa Schaefer, testified that Lakeman admitted in an interview that he “double-dipped” syringes into open bottles of propofol.

According to the Las Vegas Review Journal, last month Mathahs testified that re-use of syringes on multiple patients was common practice. Law Med is skeptical of the interpretation of the testimony by the Review Journal, wishing we could have heard it ourselves:

It was common practice for staffers under Desai’s orders to reuse single-use bottles of propofol, and disposable syringes, on multiple patients, risking the health of patients, Mathahs testified.

Law Med cautions that what may actually have been said was that multiple syringes were used in a single dose vial, but the syringes themselves were only used on a single patient. But we simply do not know. The alternative, actually using a single syringe on more than one patient would be unforgivable and a potential, though still unlikely, source of contamination. Since the syringe comes into contact with only an IV port in tubing containing sterile IV fluids, it requires the patients blood containing the Hepatitis C virus to have traveled into the tubing at some point (not an impossibility), deposit the virus which then remained there, followed by viral migration up the needle of the syringe into the syringe itself despite the syringe being used to inject its contents into the tubing (against the migration direction of the virus). The only testimony that needles attached to the syringes were reused came from  a nurse who later recanted that claim on the stand.

However, if a syringe which was already used on a patient was fitted with a new sterile needle and then inserted into an open vial of propofol, and propofol was then withdrawn from the bottle. some of the propofol would have to be injected back into the bottle with the syringe containing Hepatitis C already from the above scenario. Absent the return of some of the syringe contents to the bottle it seems impossible for contamination to occur, despite this being a prohibited practice.

Where does this leave us? It is POSSIBLE the contamination of propofol occurred and led to a Hepatitis C outbreak. Is it beyond a reasonable doubt? That is for the jury to decide. But it seems debatable and the defense has yet to begin their case in chief, which is expected to start on Monday. In any event the nurse anesthetists violated the standard of care and should expect to lose in any civil actions, where the standard of guilt is by a “preponderance of the evidence” rather than the more stringent “reasonable doubt”.

Desai and Lakeman are being tried on a host of felonies including 2nd degree murder for the death of Meana.

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