BISMARCK, N.D. — Two more confirmed cases of hepatitis C have been tied to a Minot nursing home that's the subject of a federal lawsuit.

The new cases bring the total associated with ManorCare to 47 and add to the list of possible plaintiffs in the lawsuit filed last spring by two ManorCare residents who contracted the disease, which can cause chronic liver problems and even death.

In an effort to speed up the case, which promises to linger for months, U.S. Magistrate Judge Karen Klein issued an order late last month spelling out the rules for protecting patient confidentiality as attorneys exchange information.

North Dakota's health department this week said it had confirmed three more cases of hepatitis C related to an outbreak in Ward County that began a year ago, bringing the total to 50. State Epidemiologist Tracy Miller said two of the new cases have ties to ManorCare.

State and federal health officials have not been able to pinpoint an exact cause of the outbreak, but they suspect it may have been associated with foot care, nail care or blood services.

Manorcare residents John Fenner, 78, and Lilas Guttormson, 84, sued in U.S. District Court in April, seeking unspecified money damages. Their attorney, Mike Miller, said he'll meet a Nov. 15 deadline to file a motion for class-action status, meaning the lawsuit would cover all victims.

A scheduling order indicates a judge won't decide until next year sometime. It also lists other motions deadlines stretching into late next year.

"It's a big case," Miller said. "Just getting all of the attorneys together and finding time to take depositions, it really takes an effort."

Fenner and Guttormson claimed ManorCare was negligent in its care and also committed consumer fraud by failing to live up to its public representations of a quality care facility. A judge in July dismissed the consumer fraud count at the request of both sides.

ManorCare in June filed a third-party lawsuit against Minot's Trinity Health, saying a Trinity employee who provided blood draw services might be to blame for the outbreak. Trinity rejects the claim.

Defense attorneys are now also seeking records from two other area care facilities, though the reasons are unclear. Miller said he did not know, and defense attorneys with the Smith Bakke firm did not respond to an Associated Press request for comment.

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