updated 3/9/2008 2:12:19 PM ET 2008-03-09T18:12:19

A statewide inspection of outpatient surgery centers like the one believed to have spread hepatitis C to its patients has uncovered dangerous practices at four other clinics, a health official said Friday.

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The state swore to quickly inspect all 50 Nevada outpatient surgery centers after it was discovered the Endoscopy Center of Southern Nevada spread the blood-borne virus to at least six patients by reusing syringes and sharing vials of medication.

Of the 18 clinics inspected by Friday, three in northern Nevada and one in Las Vegas will be cited and fined for improper disease prevention techniques, state health division chief Mike Willden said.

Willden said there was no evidence that the clinics were responsible for any outbreaks of disease.

The Gastrointestinal Diagnostic Center in Las Vegas will be cited for repeatedly reusing syringes, he said. Willden could not say whether the center also reused medication vials. Clark County pulled the center's business license, shutting it down shortly after the announcement.

Willden said the Digestive Health Center in Reno had problems with sterilization of equipment, but he did not elaborate.

The center did not immediately return a call for comment.

Dr. Dennis Yamamoto, a partner at the Digestive Health Center, said the infractions found at his clinic were "not even close" to those discovered at the Endoscopy Center.

"We have every confidence that we didn't do anything wrong in the sense of putting any patient's health at risk," he said, adding that the practice in question had been stopped. "They said don't do it, so we don't do it."

At St. Mary's Surgery Center at Galena, inspectors found problems "with the lack of high-level disinfection or sterilization of instruments used between patients," Willden said.

"There have been no known cases of infection from any of our patients, but we encourage anyone who is concerned about their treatment to contact their doctor for appropriate follow-up care or treatment," St. Mary's Center said in a statement.

A staff member at the Sierra Center for Foot Surgery in Carson City reported reuse of syringes. The clinic did not respond immediately to a request for comment.

The FBI is investigating possible Medicare fraud at the Endoscopy Center of Southern Nevada, Rep. Jon Porter's spokesman, Matt Leffingwell, said.

The FBI does not comment on open investigations. The Southern Nevada Health District said it would not confirm the conversation between the congressman and its chief, Dr. Lawrence Sands, for the same reason.

At issue is whether the surgical center may have billed the federal Medicare program for 30-minute appointments that did not last that long, Leffingwell said.

A spokeswoman for Nevada Attorney General Catherine Cortez Masto said the state is also investigating whether the practices may have resulted in insurance or state Medicaid fraud.

"We're looking at whether they billed for two vials and only used one," spokeswoman Nicole Moon said.

Six cases of acute hepatitis, a potentially deadly virus that attacks the liver, have been traced to the Endoscopy Center. Nearly 40,000 patients have been notified that they are at risk and should be tested for hepatitis B and C and HIV.

The clinic has been temporarily closed and fined $3,000.

Health officials believe the virus was spread when clinic nurses used the same syringe twice to administer anesthesia, contaminating the vial. The staff also was found treating multiple patients with vials of medication intended for a single patient only.

Five of the six people infected received treatment at the clinic on the same day.

The owner of the clinic, prominent gastroenterologist Dipak Desai, has refused to answer questions about the outbreak.

Unlike some nurses at the clinic, Desai has not surrendered his medical license. He agreed to "voluntarily cease the practice of medicine" until the state Board of Medical Examiners completes its investigation, the board said Friday.

The state regulatory agency in charge of inspections at outpatient clinics has been criticized for falling behind on its inspection schedule. The Endoscopy Center had not received a full inspection since December 2001, despite a bureau policy of inspecting ambulatory surgical centers every three years.

Copyright 2008 The Associated Press. All rights reserved. This material may not be published, broadcast, rewritten or redistributed.

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