Dr. Tom Safranek, the state epidemiologist, said poor medical practices at Dr. Tahir Javed's clinic in Fremont may be to blame.

The patients, who were suffering from cancer or blood disorders, were treated at the clinic in 2000 and 2001. Just before it shut down last month, the clinic advised 612 patients to get tested and nearly 500 did.

It is possible that a clinic worker used a syringe to administer medicine to a patient who had hepatitis C, then drew more medicine from the same vial for the patient with the same syringe, Safranek said.

Doing that would contaminate the rest of the medicine in the vial, and infect other patients given the drug, he said.

Medical charts are being examined, and current and past employees of the clinic are being questioned by state health officials.

Javed left the United States in July and returned to his native Pakistan to attend to his ailing mother, Safranek said.

State health officials were notified of the problem in September by an Omaha doctor who had two patients with hepatitis C who also were patients at Javed's clinic.

In all, 485 people sought tests after receiving letters from the clinic. Of the others, some chose not to be tested, others may have been tested by their own doctors, and others died.

The state said it was not aware of any deaths among the patients with hepatitis C. Doctors said they do not know what effect the virus would have on the clinic's already ailing patients.

Hepatitis C is a viral infection of the liver and the most common bloodborne infection in the United States. People who have been infected may experience fatigue, loss of appetite and yellowing of the skin. The virus can eventually lead to cirrhosis or cancer of the liver. Health officials are confident no other patients have to be contacted because of changes made at the clinic in 2001, Safranek said, declining to elaborate.

In Oklahoma, a hepatitis C outbreak that infected more than 50 people this year was blamed on a nurse anesthetist who told health officials he reused needles and syringes. ___

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