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Insurer’s Duty to Monitor Care is Central Question in Civil Suit

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Las Vegas CBS KXNT – Should the state’s largest medical insurer have known that one of its contract health care providers was engaging in risky medical practices? That’s the claim in a lawsuit by patients who contracted Hepatitis C at an endoscopy clinic run by Dr. Dipak Desai.

Health Plan of Nevada argues that it would have been virtually impossible for any outsider to come into the clinic and observe the practices that were later found by the CDC and state investigators to have passed the virus from one patient to another. Desai’s clinic was determined to be the source of an outbreak of the blood-borne disease after three cases were reported several weeks apart in 2007 and 2008.

But plaintiff’s attorney Robert Eglet says there were readily visible signs of improper procedures at the clinic. Eglet told KXNT On Thursday that had the HMO investigated, it would have seen generally unsanitary conditions, and practices that posed a general health risk. Viewing the specific practices responsible for the hepatitis infections would not have been necessary to conclude that the clinic routinely engaged in improper procedures, he said.

But health insurers have no duty to monitor patient care, said Health Plan of Nevada attorney Peter Bernhard. They do have a duty to bring qualified practitioners into their network, Bernhard told KXNT following the company’s opening statement in court on Thursday. The insurers rely on licensing and certifying agencies for assurances that the a doctor is qualifications for the work.

HPN asserts that Desai’s decision to depart from best practices caused the infections.

The jury will be asked to decide the extent to which the insurer should have been accountable for the quality of the practitioner’s care. The trial is expected to take several months.

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