Dr. Jim Bagian, the VA’s chief patient safety officer, said the patients won’t be able to prove they were even exposed to endoscopic equipment that wasn’t properly sterilized. The equipment is used for colonoscopies and ear, nose and throat procedures. It was discovered in December that equipment was either not properly cleaned or set up.

Five patients have tested positive for HIV and 33 have tested positive for hepatitis since February, when the VA started notifying more than 11,000 people treated at three VA medical centers to get follow-up blood checks because they could have been exposed to infectious body fluids. The hospitals are in Miami, Murfreesboro, Tenn., and Augusta, Ga.

The blood tests are continuing. The agency has stressed that the positive results for the diseases may not have come from the VA’s problems with dirty equipment.

“At this point I don’t think we’ll ever know” how the patients were infected, Bagian said.

Some veterans and members of Congress want more explanation than that.

“Some of them did not have these infections before their colonoscopies,” said Mike Sheppard, a Nashville lawyer representing some former VA patients who tested positive for HIV and hepatitis.

Sheppard said the only way to find out how the infections were contracted is by examining all medical records – all of which are in the hands of the VA.

The U.S. House Committee on Veterans Affairs has tentatively set a June hearing for the VA inspector general to report on a review of the mistakes.

A spokesman for the American Society for Gastrointestinal Endoscopy said although the patients recently tested positive, they could have had the viruses for years – and before the VA treated them – without showing symptoms.

“I don’t believe there is going to be any way to definitively link their HIV positive status to the facility,” Dr. David A. Greenwald said Friday in a telephone interview from the Montefiore Medical Center in New York.

The initial December discovery of an equipment mistake at Murfreesboro led to a nationwide safety “step-up” by the VA at its 153 medical centers. Since then, the problems have been discussed with staff at all VA hospitals and with representatives of the equipment manufacturer.

“We look at these as our patients,” Bagian said. “We are not going to quibble about ‘Was it caused because you are an IV drug user?’ … Suppose it was drug use. We are still going to treat them anyway.”

Bagian said it would “be being a weeny or gutless jerk to try to hide behind it. The point is, take care of the patient.”

Each of the three centers had a different problem operating the same kind of equipment made by Olympus American, according to the VA. In Murfreesboro, the equipment was incorrectly rigged because of a mix-up and may have allowed body fluid residue to transfer from patient to patient.

Bagian said the VA doesn’t know how frequently that happened after the equipment was installed in 2003.

In Miami, a tube that was supposed to be cleaned after each colonoscopy was instead cleaned at the end of each day, Bagian said. And in Augusta, the ENT scopes used for looking into the nose and throat weren’t properly cleaned. Everyone who may have been exposed because of those problems was notified.

All the problems were human error, he said.

Nearly 11,000 former sailors, soldiers, airmen and Marines could have been exposed to infectious diseases because three VA hospitals in the Southeast did not properly clean endoscopic equipment between patients. On Friday, the VA revealed that another patient had tested positive for HIV, bringing the total to four such cases among patients who got endoscope procedures at hospitals in Miami, Murfreesboro, Tenn., and Augusta, Ga.

The agency also said a new hepatitis case had been discovered, increasing the number of positive tests to 26. More than 4,270 veterans still have yet to get test results.

Beyond those skimpy facts, the VA has said little else, citing an ongoing investigation.

It hasn’t answered questions from The Associated Press about why problems with cleaning the equipment – and possibly co-mingling infectious body fluids – went on for five years at the Miami and Murfreesboro hospitals and about a year in Augusta. The VA also refuses to say if it found similar problems at its other 150 hospitals or if more patients should get blood tests.

The VA has stressed that the positive tests are “not necessarily linked” to medical treatment at its hospitals, and infections don’t always cause symptoms and can go undetected for years.

Still, veterans are calling on the agency to release more information.

“This effort must involve continual updates on what the VA is learning about the extent of this situation,” Vietnam Veterans of America President John Rowan said in a statement Thursday.

More facts are little comfort, though, to those who are already infected – and those that don’t know.

A 60-year-old Navy veteran who had a colonoscopy at a VA hospital last year got an unimaginable phone call recently – a blood test showed he had HIV. A second test by the VA was negative, and now, the Tennessee man doesn’t know what to think.

“I screamed out loud, `No’ and went over and held my wife and told her what happened,” said the veteran, who spoke to The Associated Press on the condition of anonymity because he was afraid of repercussions against himself and his employer. “We had a nice, good cry. The things that go through your mind. You think your whole world is going to end. Her world could end, too.”

It was not clear whether the Tennessee man was counted as a positive HIV test by the VA.

The VA said the problems with the endoscopic equipment had gone on for years, but were discovered in December when it learned the Murfreesboro facility wasn’t following cleaning procedures the manufacturer recommended. It issued an internal alert for hospitals to check their procedures, and the problem at Augusta was discovered in January.

On Feb. 9, the VA announced a nationwide safety check of endoscopic equipment used in colonoscopies and ear, nose and throat treatments. The procedure involves a narrow, flexible tube fitted with a fiber-optic device such as a telescope or magnifying lens that is inserted into the body.

Some veterans were warned in February to get tested, and more were alerted in March when the Miami hospital backtracked on its previous conclusion that it didn’t have a problem.

The day after the first HIV infection became public April 6, the VA announced that its top medical official, Dr. Michael Kussman, was retiring. Kussman still works at the VA but could not be reached for comment. VA spokeswoman Katie Roberts said there was “no connection whatsoever.”

The endoscopic equipment is made by Center Valley, Pa.-based Olympus American Inc., and the company has said its recommended cleaning procedures are clear.

The VA and its inspector general have started investigations, and congressional members of the Veterans Affairs Committee have asked for a hearing in late May to discuss how the VA has been handling the problem.

U.S. Rep. Steve Buyer, R-Ind. and ranking member of the committee, said in a statement he and his staff have been briefed weekly by senior VA officials. His office declined to release more information.

Private hospitals have also spread infectious diseases with unsterile equipment, but requirements to report such problems vary by state and there’s no national regulation requiring disclosure, according to Barbara Rudolph, director of The Leapfrog Group, which advocates for quality health care.

The VA is providing a hot line for veterans and their families and posts the information it is releasing on its Web site. Because the VA hasn’t ruled out other hospitals having had problems, some veterans are wondering if its more widespread.

In Cedar Rapids, Iowa, former Marine Allen Lusk had several colonoscopies at the VA hospital in Iowa City and tested positive for hepatitis B in December.

“I never had it till I started going to the VA,” said Lusk, 51.

He started using the VA in 2006 after he was injured when a car fell on him and he didn’t have health insurance. After seeing news reports about the contaminated equipment problems elsewhere, Lusk went to his county health department for an HIV test. He tested negative.

“To be honest, I’d like to see them come out and be honest about how big this really is,” he said. “It might be embarrassing, but in the long run it might be better for them.”

Initial tests show one patient each from VA medical facilities in Murfreesboro, Tenn.; Augusta, Ga.; and Miami has the virus that causes AIDS, according to a VA statement.

The three cases included one positive HIV test reported earlier this month, but the VA didn’t identify the facility involved at the time.

The patients are among more than 10,000 getting tested because they were treated with endoscopic equipment that wasn’t properly sterilized and exposed them to other people’s body fluids.

Vietnam veteran Samuel Mendes, 60, said he was surprised to learn of an HIV case linked to the Miami facility, where he had a colonoscopy. He was told he wasn’t among those at risk.

“I was hoping and expecting to not get anyone contaminated like that,” he said. “It’s probably a little worse than we thought.”

The VA also said there have been six positive tests for the hepatitis B virus and 19 positive tests for hepatitis C at the three locations.

There’s no way to prove patients were exposed to the viruses at its facilities, the agency said.

“These are not necessarily linked to any endoscopy issues and the evaluation continues,” the statement said.

The VA has said it does not yet know if veterans treated with the same kind of equipment at its other 150 hospitals may have been exposed to the same mistake before the department had a nationwide safety training campaign.

An agency spokeswoman has said the mistake with the equipment was corrected nationwide by the time the campaign ended March 14. The problems discovered in December date back more than five years at the Murfreesboro and Miami hospitals.

The VA’s disclosure was the department’s first comment since April 3, when the VA reported the one positive HIV test.

VA spokeswoman Katie Roberts has declined to provide any details on how widespread the problems might have been other than saying a review of the situation continues.

She said in an e-mail Friday that “there is a very small risk of harm to patients from the procedures at each site.” She said the HIV results “still need to be verified” in additional tests.

The VA statement shows the number of “potentially affected” patients totals 10,797, including 6,387 who had colonoscopies at Murfreesboro, 3,341 who had colonoscopies at Miami and 1,069 who were treated at the ear, nose and throat clinic at Augusta.

More than 5,400 patients, about half of those at risk, have been notified of their follow-up test results, the VA said.

The Friday statement said the VA is “continuing to notify individuals whose letters have been returned as undeliverable, and working with homeless coordinators to reach veterans with no known home address.”

The statement also said the VA has assigned more than 100 employees at the three locations to “ensure that affected veterans receive prompt testing and appropriate counseling.”

All three sites used endoscopic equipment made by Olympus American Inc., which has said in a statement it is helping the VA address problems with “inadvertently neglecting to appropriately reprocess a specific auxiliary water tube.”

Charles Rollins, 62, who served three tours in Vietnam with the Navy from 1966 to 1969, said the news concerns him because he’s used the Augusta ear, nose and throat clinic several times.

“That’s terrible,” he said by phone as he socialized at an American Legion post in Augusta.

The positive test was the first reported since the department warned veterans treated at three clinics that they might be at risk.

The VA previously reported that hepatitis was found in 16 patients, but the agency cautioned there was no way to prove that the patients contracted the illnesses because of treatment at their facilities.

In an e-mail late Friday, the agency said it was investigating “the possibility of such a relationship.”

The VA earlier this year warned more than 10,000 veterans to get blood tests because they could have been exposed to contamination while getting colonoscopies in Murfreesboro, Tenn., and Miami.

The endoscopic equipment in question was also used at an ear, nose and throat facility in Augusta, Ga. All three sites failed to properly sterilize the equipment between treatments.

The VA has said it does not yet know if veterans who were treated with the same kind of equipment at its other 150 hospitals may have been exposed to the same mistake before the department had a nationwide safety training campaign. An agency spokeswoman has said the VA is certain the mistake with the equipment was corrected nationwide by March 14.

The problems dated back for more than five years at the Murfreesboro and Miami hospitals.

So far, less than a third – 3,174 – have been notified of their test results. The agency also is trying to locate patients whose warning letters were returned.

The statement Friday did not say where the patient who tested positive for HIV was treated, and the agency did not return telephone and e-mail messages Monday.

In all, at least five veterans have tested positive for hepatitis B and 11 for hepatitis C, which is potentially life-threatening.

No infections have been reported from Miami.

All three sites used endoscopic equipment made by Olympus American Inc., which said in a statement it is helping the VA address problems with “inadvertently neglecting to appropriately reprocess a specific auxiliary water tube.”

The problem put patients at risk of being exposed to other patients’ body fluids.

Megan Longenderfer, an Olympus spokeswoman, said the company sent notices to 5,800 “customer accounts,” but a facility could have more than one endoscope.

A lawyer with more than a dozen clients who had colonoscopies at the VA hospital in Murfreesboro said some have tested positive for hepatitis but none for HIV.

Attorney Mike Sheppard said in an e-mail Monday that one client had espoghageal cancer and died from “massive infection” soon after getting a colonoscopy. He said medical records are being reviewed for any connection between the infection and exposure.

Michael Goucher had been reported missing by his uncle.  Goucher’s car was found earlier this week abandoned on a rural road in Price Township. On Wednesday, Goucher’s body was discovered in a nearby wooded area. He had been stabbed more than 20 times.

Police said that evidence found in the vehicle led them to Shawn Freemore, and that under questioning Freemore confessed.

According to court documents Freemore said he met Goucher in a chat room and the two men agreed to have sex. He said they had the liaison in Goucher’s car.

Earlier this month he agreed to a second hookup with Goucher, again in the car.  But, the court documents, citing Freemore’s confession, said that Freemore changed his mind at the last minute. Armed with a knife, Freemore allegedly told police he ordered Goucher out of the car and then stabbed him in the neck.

Groucher fell to the ground, and according to the court documents, as he tried to get up Freemore stabbed him 19 times in the stomach.

Freemore told police he went through Groucher’s pants to find the car keys, then covered the body with snow. He then drove the car off, later abandoning it and walking home.

Relatives told The Pocono Record that Groucher joined the Army after graduating high school in 2006. He was stationed for two years in Alaska as a convoy driver and mechanic.

While on leave from the military he volunteered with the East Stroudsburg Crime Watch. After completing his military service, Goucher worked as a custodian at an area high school and was the assistant organist at a local church.

He was out to his family. “If there’s a lesson to be taken from this tragedy, it’s to warn kids, especially the younger kids, about the danger of getting together with strangers they meet online,” Groucher’s uncle, William Searfoss, told The Pocono Record.

Freemore has a criminal record for burglary, shoplifting and drug paraphernalia possession.