LAS VEGAS (AP) – The unsafe medical procedures that spread hepatitis C among patients at a large Las Vegas surgical clinic may be more widespread and more people may be infected than first believed, health officials testified Thursday.

Health inspections at 13 other area outpatient surgical centers found several violations of standard practices, Lisa Jones, head of the state licensing bureau, told a legislative committee on health care.

“We’re finding problems at a variety of different levels – medication reuse, in some cases syringe reuse in different procedures and functions. That’s why one of our very first actions is the need to get the word out on the street,” Jones said.

The public hearing was the first investigating an outbreak of the hepatitis C virus traced to the Endoscopy Center of Southern Nevada.

Six patients at the center have been diagnosed with acute hepatitis C, officials announced last week. The surgical center and five other affiliated clinics have been closed. Five nurses have surrendered their licenses.

In the largest patient notification effort in U.S. history, nearly 40,000 patients who received treatment at the center from March 2004 to mid-January have received letters telling them they are at risk for exposure and should be tested for hepatitis, strands B and C, and HIV.

Legislators also were told that not all patients who may have been exposed at the clinic were notified because investigators can’t be sure when the unsafe practices began at the Endoscopy Center, and the clinic did not provide a complete list of patients.

Hepatitis is a potentially fatal, blood-borne virus that causes inflammation of the liver and can lead to stomach pain, fatigue and jaundice. It goes undetected in as many as 80 percent of cases.

Health officials believe the virus was spread when clinic staff regularly reused syringes and vials of anesthesia intended to be used on one patient. Clinic staff told inspectors that the practice was ordered by management.

Inspectors also saw staff members inappropriately cleaning two scopes in one solution, officials said.

Health District chief Lawrence Sands said those practices are “unacceptable” and “should never have happened.” Sands said reusing syringes and vials of medication was a well-known violation of common safety standards, and he called for better oversight, whistleblower protection and education within the medical community.

The clinic’s majority owner, Dipak Desai, has refused to comment.

He released a statement expressing concern for the patients and assuring the public the problems had been corrected. He later took out a full-page ad in Sunday’s edition of the Las Vegas Review-Journal insisting that needles had not been reused and that the chances of contracting an infection at the center in most of the past four years were “extremely low.”

The Endoscopy Center had not received a full inspection by Jones’ bureau since December 2001, despite a policy of requiring inspections every three years. It was due this year for a federal review to renew its Medicare certification, but was unlikely to get it because of a funding shortage, Jones told The Associated Press.

Jones described her bureau as short-staffed and underfunded.

She would not comment more precisely on the nature of violations in other surgical centers.

Lawmakers urged the bureau to be more aggressive in shutting down facilities seen to be a major health threat.

The state licensing bureau did not shut down the Endoscopy Center, but instead instituted a “corrective plan” when it detected deficiencies. The city of Las Vegas pulled the center’s business license after a public outcry.

Southern Nevada Health District epidemiologist Brian Labus said the nearly four-year time period investigators are focusing on was based on an investigation into medication orders for single-patient vials.

Records show “there were fewer vials than there were patients every day,” Labus said, adding that inspectors could not be certain the practice wasn’t in place before March 2004.

“Prior to that, it’s possible those patients were exposed as well. We could not determine that from our investigation,” Labus said.

Labus also told the panel that the patient list provided by the center was incomplete.

“We know of patients who had been there whose names were not on the list,” said Labus.

Among those was state Assemblywoman Susan Gerhardt, who said that she and her husband had been treated at the center in 2005 and had not received letters.

“I think that the people who perpetrated this are absolutely monstrous. They cannot claim that they did not know the consequences of their actions,” she said.