The center is the second in Southern Nevada where health inspectors found medical personnel routinely reusing syringes.

"It is more widespread than what we ever dreamed of," Dr. Ishan Azzam, the state's epidemiologist, said Friday of the unsafe practices at ambulatory surgery centers. "Whenever you are having unsafe injection practices, you are putting others at risk. ... Injections are extremely safe if done properly."

The surprise inspection was part of a sweeping probe of medical practices at the state's 50 ambulatory surgery centers. The probe began after a massive health alert resulted in the closure of the Endoscopy Center of Southern Nevada on Shadow Lane as well as several other valley facilities operated by the same doctors.

State inspectors also observed unsafe practices this week at three Reno centers, Willden said:

• St. Mary's Outpatient Clinic at Galena, where staff failed to disinfect medical instruments between patients.

• The Digestive Health Center, which also inadequately sterilized instruments.

• The Sierra Foot Center, where staff admitted to reusing syringes.

The licensing bureau has so far conducted 18 surprise inspections of ambulatory surgery centers, outpatient medical facilities where patients have surgical procedures that don't require hospitalization. Deficiencies were found at the Gastrointestinal Diagnostic Center and eight Northern Nevada centers.

Among the Northern Nevada clinics, only the three Reno centers had deficiencies that could lead to the spread of disease.

The clinics immediately corrected the unsafe practices, Azzam said, adding that the practices should not have been happening at health care facilities in the first place.

Six patients at the Endoscopy Center of Southern Nevada have tested positive for acute hepatitis C, a potentially deadly blood-borne disease that attacks the liver. And last week, letters were sent to 40,000 former patients of the center, notifying them that they need to be tested for hepatitis and HIV, the virus that causes AIDS.

The Centers for Disease Control and Prevention is sending two or three epidemiologist to Nevada to assist with the inspections, said Martha Framsted, a spokeswoman. They are expected to arrive Tuesday.

Dr. Julie Gerberding, head of the CDC, this week called Nevada's public health crisis "the tip of the iceberg" of a nationwide problem.

In a Friday afternoon conference call with reporters, Willden expressed frustration over the risky medical practices encountered during the surprise inspections.

After the announcement of the problems at the Endoscopy Center of Southern Nevada, Willden noted, health officials issued technical bulletins to all health care providers statewide about the hepatitis C cluster and how it might have occurred.

"I am shocked and I am frustrated that our surveyors are still seeing this," he said. "You would have had to not come into your office to not have read in the press about this issue."

Willden would not say whether the instances of syringe reuse at the Gastrointestinal Diagnostic Center on Maryland Parkway involved their reuse on one or more patients.

The licensing bureau had not given an official report outlining the deficiencies to the center's management, Willden said.

That report will be given to the facility Monday, Willden said. The clinic will have 10 days to submit a corrective plan.

Health professionals at the Endoscopy Center of Southern Nevada were found to have reused syringes on infected patients and contaminated vials of medicine that were shared among patients.

Late Friday afternoon, a Review-Journal reporter found the door locked at the Gastrointestinal Diagnostic Center, which is housed in a medical office building across the street from Sunrise Hospital and Medical Center.

A sign for the surgery center listed the names of three physicians: Luis Alberto Tupac, Uday Ramesh Saraiya and Enrique Jose Lacayo.

A woman who answered the phone at the clinic said the doctors had left for the day.

Messages left with the physicians' emergency answering services were not returned.

The licensing bureau can fine facilities $1,000 per deficiency for every day it occurs.

"I expect there will be fines associated with those deficiencies," Willden said of the four centers where deficiencies were found.

Review-Journal writer Brian Haynes contributed to this report. Contact reporter Annette Wells at awells@reviewjournal.com or (702) 383-0283.