◙ FIRST RESPONDERBrian Labus determined what went wrong at the Endoscopy Center of Southern Nevada in Las Vegas.

When the largest hepatitis C outbreak in U.S. history hit Las Vegas in 2007, Brian Labus was first on the scene. Six years later, the senior epidemiologist at the Southern Nevada Health District stood mere miles from where the outbreak occurred and broke the news that brought his investigation full circle.

"Dr. Desai received a life sentence today," he told a rapt audience, referring to Dipak Desai, MD, co-owner of the Endoscopy Center of Southern Nevada. The man at the center of the outbreak, who actually encouraged unsafe injection practices in a misguided effort to save money and speed cases, was found guilty of 27 charges, including second-degree murder for an infected patient's death.

Back in 2007, Mr. Labus received reports of 2 cases of acute hepatitis C. He discovered a common link — both patients had gone to the Endoscopy Center of Southern Nevada. A third case struck early in 2008 as Mr. Labus discussed the first 2 cases with the CDC.

"It became pretty obvious that there was a problem at the center because we were investigating more cases at a single facility in a very short period than we'd typically see in the entire county over the course of a year," says Mr. Labus.

When observing Dr. Desai's staff in action, Mr. Labus saw that they repeatedly contaminated single-dose vials and used them as multi-dose vials. He reviewed patient records to determine how many individuals he had to contact. The number ballooned to a staggering 63,000 former patients, enough to fill a football stadium.

"It was on a massive scale — that's why it got so much attention," says Mr. Labus. The investigation cost the state health department approximately $1 million, but they were able to fine the center only $3,000.

One positive has come from the fallout, however: Campaigns have been launched in many states to educate caregivers about safe injection practices. Says Mr. Labus, "It's incumbent on the people running individual facilities to pay close attention to what's happening daily and ensure staff is doing all they can to protect patients."