Improper foot care might have been the source of a Hep C outbreak.

The first of what could be numerous legal complaints against HCRManorCare has been filed in relation to a hepatitis outbreak in North Dakota last year.

Attorneys representing two of 44 people infected at a Minot, ND, nursing home sent their class-action complaint to the skilled nursing giant in mid-April, according to local news reports. HCRManorCare had 21 days to respond.

The company, however, already had called the accusations a rush to judgment since the origin of the August 2013 outbreak had not been established. The North Dakota Department of Health is investigating the incident, which has been called the second-largest outbreak of hepatitis C.

None of the infected residents died from the disease, but all are still coping with its effects, The Associated Press reported. More than 500 people were notified for screening.

The “most rudimentary of care” would have prevented the infections, plaintiff attorney Mike Miller told the AP. Health officials cited in local reports said that foot or nail care, or blood services, could be the source of the infections, all of which have been genetically linked at the 114-bed facility.

HCRManorCare said it is working with authorities
to ensure resident and employee safety. The company said it has been both “cooperative and proactive” in reviewing and pursuing infection-control practices.

The case was filed in U.S. District Court in Bismarck on behalf of 78-year-old John Fenner and 84-year-old Lilas Guttormson. Besides asking for class-action status, they are seeking unspecified damages.

The North Dakota outbreak accounted for one-fourth of all hepatitis cases nationally since 2008, officials at the Centers for Disease Control and Prevention said. Comparatively, a 2009 outbreak at an endoscopy clinic in New York, where more than 3,000 people were screened, was associated with two infections.

Hepatitis C is a viral
infection of the liver. Frequently it is spread during
the re-use or accidental sticking of needle tips.

About 80% of people infected with HCV have mild or no signs or symptoms initially. Symptoms include tiredness, loss of appetite, nausea or abdominal discomfort.