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LAS VEGAS - Nearly 40,000 people learned this week that a trip to the doctor may have made them sick. In a type of scandal more often associated with Third World countries, a Las Vegas clinic was found to be reusing syringes and vials of medication for nearly four years. The shoddy practices may have led to an outbreak of the potentially fatal hepatitis C virus and exposed patients to HIV, too.

The discovery led to the biggest public health notification operation in U.S. history, brought demands for investigations and caused scores of lawyers to seek out patients at risk for infections. Thousands of patients are being urged to be tested for the viruses. Six acute cases of hepatitis C have been confirmed. The surgical center and five affiliated clinics have been closed.

In letters that began arriving this week, patients who received injected anesthesia at the Endoscopy Center of Southern Nevada from March 2004 to mid-January were urged to get tested for hepatitis B and C, and HIV.

... Health inspectors say they observed clinic staff using the same syringe twice to extract anesthesia from a single-dose vial, which was then used to treat more than one patient. The practice allows contaminated blood in a used syringe to taint the vial and infect the next patient. Of the six patients so far diagnosed with acute hepatitis C, five received treatment at the clinic on the same day in late September.

... In Las Vegas, clinic staff told inspectors they had been ordered by management to reuse the vials and syringes.... Investigators were told the practice was an attempt to cut costs, according to a letter of complaint from the city, which revoked the facility's business license Friday. ... The clinic's majority owner, Dipak Desai, a political contributor and member of the governor's commission on health care, has refused to comment on the allegations.

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