Las Vegas CBS KXNT- The prosecution rested its case on Tuesday morning. By Tuesday evening, the defense was complete, presenting only two witnesses.

Closing arguments are scheduled for Thursday in trial of Dr. Dipak Desai, the physician whose endoscopy clinic was identified as the source of a hepatitis C outbreak in Las Vegas.

A research physician who is also a professional expert witness testified for the defense that it’s not a medical certainty Rodolfo Meana died from hepatitis C. Meana is one of six patients whose hepatitis C infections are the focus of the trial. His death last year prompted prosecutors to add one count of second-degree murder to other criminal charges against Desai.

Dr. Howard Worman said Meana had a combination of other ailments that could have led to his death.

Meana’s hepatitis C infection was traced to the Endoscopy Center of Southern Nevada, which Desai owned and operated. Meana had a colonoscopy at the clinic in 2007. He left the United States to spend the end of his life in his native Philippines, and died in April of 2012.

The prosecution last week played Meana’s videotaped deposition for the jury, in which he described his physical decline after the infection.

The other defense witness was a nurse employed by the state agency that inspected the endoscopy clinic when it became the focus of a 2008 investigation by the Centers for Disease Control and the Southern Nevada Health District. Dorothy Sims told the jury that she observed clinic staff engaging in the so-called “double dipping” practice that’s been blamed for the outbreak.

Nurse anesthetists at the Desai clinic regularly administered a second dose of the sedative propofol to patients who began to stir during a procedure, without changing the syringe. Remaining medicine in the bottles was used on subsequent patients, even though the bottles were labeled “single-use”.

Investigating agencies identified the double-dipping practice as the most likely factor in the transmission of the virus, since the syringes retained tiny traces of blood from the first patient, tainting the medicine when they were double dipped.

Defense attorney Richard Wright asked Sims whether she or anyone from the other two agencies halted the process when they observed it during the inspection.

Sims said they did not, and that the practice at the time was considered not unsafe, but “not best practices.”

Sims was a supervisor in the same agency when Governor Jim Gibbons ordered inspections of all the state’s ambulatory outpatient facilities following the revelation that tens of thousands of patients might have been exposed to hepatitis or AIDS at the Desai clinic. She confirmed that similar injection practices were observed during an unannounced inspection at another outpatient facility.

The apparent defense strategy has been to deflect criminal negligence accusations against Desai and a former employee by demonstrating that the clinic’s injection practices were acceptable at the time, and the staff did not believe they were doing anything wrong.

Wright has noted throughout the trial that the Desai clinic was not alone in using propofol from the same vial on more than one patient.

Desai and nurse anesthetist Ronald Lakeman are charged with multiple counts of criminal negligence, insurance fraud, and one count of second-degree murder.


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