LAS VEGAS (AP) - After seven weeks of testimony, a jury in Las Vegas is due to begin deliberating Friday whether a former endoscopy clinic owner and his former employee are guilty of murder, patient neglect, insurance fraud and other criminal charges in a 2007 hepatitis C outbreak described as one of the largest ever in the U.S.
A prosecutor, David Staudaher, ended 11 hours of closing arguments by both sides Thursday telling the jury of seven women, five men and five alternates that former Dr. Dipak Desai and nurse anesthetist Ronald Lakeman recklessly and negligently put patients at risk with the reuse of syringes and vials of the general anesthetic propofol during procedures at a Desai clinic.
"It all comes down to trust," Staudaher said, accusing the clinic owner and the employee of disregarding the risk to patients in order to save money.
"Desai was running the show," he said, "and Ron Lakeman was doing it and instructing others to do it."
Prosecutors allege that seven people suffered bodily injury and illness as a result of becoming infected with hepatitis C during endoscopy and colonoscopy procedures on two dates - July 25, 2007, and Sept. 21, 2007 - at Desai's Endoscopy Clinic of Southern Nevada.
The murder charge stems from the death in April 2012 of 77-year-old former patient Rodolfo Meana.
Desai, 63, and Lakeman, 66, each have pleaded not guilty to all 28 charges, also including theft and obtaining money under false pretenses. If convicted, each could be sentenced to spend the equivalent of the rest of his life in prison.
Neither testified in his defense, and their lawyers told jurors Thursday that the state failed to prove its case.
Attorney Richard Wright, representing Desai, said evidence didn't prove that Desai and Lakeman could foresee Meana's death resulting from their actions.
Jurors heard a medical examiner testify for the prosecution that Meana's death resulted from contracting hepatitis C at Desai's clinic. They also heard a defense expert testify that it was likely that Meana died as a result of other ailments.
But they also heard memorable videotape of Meana describing how he suffered flu-like symptoms, depression and his skin turned yellow after he contracted the incurable liver disease during a colonoscopy. He died several weeks after the recorded deposition.
Attorney Frederick Santacroce, representing Lakeman, said his client was a competent longtime nurse-anesthetist who had been made a "scapegoat" and a "sacrificial lamb" in the case.
Wright said the injection practices their clients were being blamed for were common at the time in many other clinics.
"Even if the state proved 'sloppiness, laziness and arrogance,'" Wright said, echoing the words of prosecutor Pamela Weckerly earlier in the day, it hadn't proved that Desai intentionally endangered patients.
"This case is about conscious, reckless disregard of a dangerous practice," he said.
Wright pointed to confusion at the time in advisory regulations about whether unused propofol in previously opened vials could safely be used on more than one patient. He noted that a federal Centers for Disease Control and Prevention report in 2008 found 28 of the 51 outpatient surgery centers in Las Vegas had "injection control deficiencies or practices including reuse of propofol vials and syringes."
"Everyone else was doing it," Wright told the jury.
The outbreak became public in February 2008 when the Southern Nevada Health District shocked the Las Vegas community with an advisory that led 63,000 clinic patients to get tested for potentially fatal blood-borne diseases, including hepatitis and HIV.
Local health officials and CDC investigators used DNA clues to trace the infections of nine people to Desai clinics. They said they thought the hepatitis C infections of another 105 patients might have been related to similar practices, but said they couldn't rule out other sources of infection.
Staudaher reminded jurors that they heard from most of the other employees and doctors who worked at the Endoscopy Center of Southern Nevada.
But Wright said many of those witnesses were granted immunity or threatened with prosecution if they didn't cooperate.
Former nurse anesthetist and one-time co-defendant, Keith Mathahs, 77, pleaded guilty in December to five felony charges, including criminal neglect of patients resulting in death, insurance fraud and racketeering. He testified for the prosecution and could get probation or up to six years in state prison when he is sentenced.
Desai's former clinic business manager, Tonya Rushing, was granted immunity and testified. She is due to stand trial with Desai starting Aug. 20 in U.S. District Court in Las Vegas on conspiracy and health care fraud charges in a separate federal case alleging they schemed to inflate anesthesia times and overbill health insurance companies.
Before the jury arrived for closing arguments, Desai stood as Wright again told Judge Valerie Adair that Desai is so incapacitated by strokes since 2007 that he was incapable of testifying and unable to help in his defense.
"It's the equivalent of him being tried in abstentia," Wright said.
The judge responded that Desai's fitness for trial was established by doctors and judges before jury selection began April 22, and she wasn't going to start new competency hearings.