Perhaps the most alarming allegation to come out of the Endoscopy Center of Southern Nevada hepatitis C scare is that physicians and nurses knowingly reused single-dose vials for multiple patients. This put upwards of 60,000 patients potentially at risk, shut down the clinic and jeopardized the careers of many staffers.

A physician-owner, who was reportedly boastful of his cost-cutting measures, ordered nurses to reuse the single-use vials and syringes and use less-than-required amounts of detergent to clean endoscopic equipment. Several nurses at the facility were aware of the unsafe practices and five of the center's CRNAs have surrendered their licenses. Staff are suspected of:

• fraudulent practice (they reportedly knew that anesthesia would be billed for 30 minutes when a procedure only took 15 minutes);
• failure to report breaches in infection control practices;
• failure to follow aseptic techniques to avoid contamination;
• delay in correcting implicated practices;
• failure to prevent the transmission of blood-borne pathogens; and
• failure to adhere to fundamental principles of safe injection.

For those involved, the fallout could include:

• loss of medical and nursing licenses;
• criminal charges for anyone who "knowingly endangered someone's life;" and
• medical malpractice and wrongful death suits.

Why didn't more come forward?
Silence usually has a few common causes. Some nurses feel that their complaints won't be heard and nothing will happen. Others fear that they'll be deemed incompetent if they speak up. There's no excuse for failing to protect patients or not reporting events that put patients in jeopardy. We're protected under the federal whistleblower law, the False Claims Act, known as qui tam. Creating a reporting system that lets people speak freely is the first step toward prevention.

Each of us has the moral, ethical and legal responsibility to follow the law and standards of care. Remember, the standard of care is what the reasonable person would do. What would a reasonable and prudent nurse, CRNA or doctor do? When you know that something's wrong, it's your duty to step up.

Don't stay — and don't stay quiet
There's no reason to stay in a facility where you know that standards are breached and patient safety is jeopardized. No licensing board or jury will accept excuses from nurses or doctors who have knowingly engaged in activities that caused patient harm and potentially death. There's never a justifiable reason not to report fraud, or to sit idly by while patients are jeopardized.

I have firsthand knowledge of this. I have reported fraudulent activity under the False Claims Act and given a federal deposition. Then I left the facility. A friend of mine, who is the executive director of a nursing board, says that there is no reason to stay where wrongdoing occurs. There are plenty of jobs out there.