Operating room doctors and nurses complained often about slick tools, and frustrated sterilization crews had to run extra wash cycles, the regulators reported, but hospital administrators did not fix the problem for weeks. In November and December, 3,800 patients at Duke Health Raleigh (formerly Raleigh Community) and Durham Regional hospitals were exposed to surgery with the contaminated instruments.

"Administrative staff failed to heed the multiple complaints of staff sterilizing and using the instruments, thus delaying the discovery of the error and needlessly exposing patients to these instruments over a longer time period," the investigation reports from the Centers for Medicare & Medicaid Services said. The agency oversees patient care at hospitals that receive payments from federal insurance programs.

When Duke Health officials disclosed the mistake in January, they assured patients that the likelihood of infection was "no more than the risk normally associated" with the procedures patients underwent.

But seven months later, dozens of patients who were exposed to the surgical instruments are reporting lingering health problems some minor, such as fatigue and joint pain, and others serious, requiring hospitalization.

Some patients say hospital officials dismissed their symptoms when they reported them, though they were urged to notify the hospitals of any signs of infection. They say the hospitals have not monitored the problems that arose.

As they search for proper treatment, many have asked Duke to tell them what was in the used hydraulic fluid a petroleum product called 32 AW manufactured by Exxon that may have picked up particles from its use in the elevator.

Duke has responded that it's still investigating and can't yet provide such details. Duke Health System officials declined to be interviewed, citing possible lawsuits. They issued a short statement reiterating that infection rates are not notably higher than would typically be expected and urging patients to talk with their doctors about concerns.

At least 50 patients who developed complications have taken their concerns to lawyers.

None have sued Duke or the hospitals, although two lawsuits have been filed, both naming the elevator company that drained the hydraulic fluid into the detergent barrels and the supplier that picked up the barrels and mistakenly redistributed them as washing fluid. One lawsuit has seven plaintiffs, the other just one.

Kelley and Shelley Bassett have hired a lawyer but have not filed suit. Kelley Bassett said the mix-up has left his wife sick and his family battered. Shelley, 32, underwent a lumpectomy for a benign growth in her breast in December at Duke Health Raleigh, and she remains sick. She said an infection set in that required another operation in January, while other problems arose.

Shelley Bassett, a mother of two who lives in North Raleigh, said she remains weak and suffers joint pain. Her digestive system has shut down, she said, causing her to lose more than 30 pounds and nearly die from a bowel obstruction in April. An avid tennis player, she has not picked up a racket since December. She hasn't worked, leaving a void in the family radio production business that her husband said has resulted in a 30 percent drop in revenue.

Shelley Bassett is now being treated at a Dallas, Texas, clinic specializing in environmental poisons. The Bassetts, their lawyer and Shelley Bassett's doctors have repeatedly asked Duke to disclose what was in the hydraulic fluid so doctors can know what toxins Shelley has been exposed to.

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