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VA plans upgrades because of Legionnaires' outbreak

| Wednesday, March 20, 2013, 4:15 p.m.

Despite allegations from Congress, a labor union and military families in mourning, a top official with the VA Pittsburgh Healthcare System said on Wednesday that he does not know of any attempt to conceal the Legionnaires' disease outbreak linked to at least five veterans' deaths.

“As the overseer, I'm not aware of any effort to provide any kind of cover-up,” VA regional Director Michael Moreland said in a controlled interview provided to the Tribune-Review four months after the outbreak was publicly revealed.

Moreland rejected concerns from Congress that VA leaders withheld critical information about widespread Legionella bacteria at their Oakland and O'Hara campuses. “The first time Congress heard about this was when we notified them,” he said.

VA administrators used the interview to announce more than $10 million in safety improvements at the 224-bed Oakland hospital and the 262-bed Heinz campus in O'Hara. Testing for Legionella and Legionnaires' disease, a form of pneumonia caused by the bacteria, has been stepped up in the past year, and the VA plans to spend up to $800,000 mapping hospital pipes to identify areas that might encourage bacteria growth.

About 2,700 new plumbing fixtures will allow water to run through pipes at more than 130 degrees and keep the waterborne Legionella bacteria from reproducing. New sink and shower valves will cool the water to prevent scalding.

The upgrades should be in place by August, officials said.

“I cannot imagine how a hospital facility could spend even $1 million to implement a technology, much less $10 million,” Robert S. Miller, president of Earthwise Environmental Inc. in Bensenville, Ill., told the Trib. He said his company, which has not done work for the VA, disinfects hospital water systems for a fraction of what the VA intends to pay.

Proven, secondary disinfection systems that use chlorine, mono-chloramine, or copper silver, complete with 24/7 web-based monitoring features could easily be installed for less money, he said.

VA Pittsburgh CEO Terry Wolf warned Legionella are pervasive across the country.

“This is not a VA issue. This is not a VA Pittsburgh issue,” Wolf said, calling the hospital system “the place (veterans) have always believed in.”

Wolf and Dr. Ali Sonel, the VA Pittsburgh chief of staff, outlined the wholesale changes to Legionnaires' prevention since the Centers for Disease Control and Prevention identified the disease outbreak there in late October. By mid-November, CDC investigators found Legionella had spread throughout the pipes in the Oakland hospital.

As many as 21 Pittsburgh VA patients contracted Legionnaires' disease from bacteria-tainted water between January 2011 and November 2012, the CDC reported. Five of them died.

CDC guidelines suggest Legionnaires' cases in June 2011 and November 2011 should have alerted hospital officials to a problem. Congressional testimony shows the copper-silver ionization treatment systems meant to control the bacteria were not maintained well.

Relatives of Legionnaires' victims told the Trib that VA officials acknowledged the problem only in recent weeks despite Moreland's admission before Congress on Feb. 5 that he knew about Legionnaires' concerns in autumn 2011.

The American Federation of Government Employees, which represents VA Pittsburgh workers, called last month for Moreland's suspension and an investigation of his leadership. He leads Veterans Integrated Service Network 4, a Pittsburgh-based regional office that oversees most of Pennsylvania and Delaware, and parts of West Virginia, New Jersey and New York.

Moreland acknowledged on Wednesday, in retrospect, that the VA might have handled Legionella prevention differently, though he did not specify how.

Sonel said the CDC's “deep dive” review last fall helped uncover key new information.

Sonel defended the system's infection control team, saying its persistent questions were instrumental in revealing the outbreak with the CDC's support.

“The CDC shows up when you invite them,” Moreland said. “We invited them.”

He and Wolf said the VA Pittsburgh hospital system has strengthened monitoring for the Legionella bacteria in water and patients, having completed 1,051 urine tests in 2012 to check for Legionnaires' disease.

“I challenge you to find another hospital in Pittsburgh that has done that many (urine tests for Legionnaires') on their patients,” Wolf said.

Sonel said the Pittsburgh VA now requires doctors to check every pneumonia patient or possible pneumonia patient for Legionnaires' disease by using a urine test and — when possible — a respiratory culture.

That standard went into place in November, replacing looser guidelines that left Legionella testing largely to doctors' discretion, Sonel said. He said he was not sure how many more patients were receiving the urine and respiratory tests under the new rule versus 2011 and before.

Sonel said the VA now conducts 60 water tests at the O'Hara campus and nearly 120 tests at the Oakland hospital every two weeks. That's three or four times more Legionella tests than the VA Pittsburgh conducted before the outbreak, he added.

The tests are more accurate, too, since officials switched to 1-liter sampling containers recommended by the CDC, Sonel said.

They had been using 100-milliliter water samples suggested under national VA guidelines before the outbreak. Those VA standards are now under review.

“It's a volume strategy,” Sonel said, underscoring that test results show safe bacteria levels since the VA purged its plumbing in November.

VA administrators often spoke in measured words and permitted no audio recording of their Trib interview, which they limited to 30 minutes and only one reporter with no photographer. They would not explain their refusal to be recorded, a standard practice by journalists to help assure accuracy of quotes.

The Trib reporter was met by VA police at the Oakland hospital entrance and escorted to the interview in a second-floor conference room.

The interview occurred on the same day that VA officials briefed congressional staff members about the Pittsburgh outbreak and the prevention efforts. A House Veterans Affairs subcommittee investigation into the outbreak is among ongoing reviews that also include the CDC and a probe by the national VA Office of Inspector General.

“While today's briefing from the VA contained several steps in the right direction, much more needs to be done moving forward to ensure our veterans are receiving the best care possible,” said U.S. Sen. Bob Casey Jr., D-Scranton. “The families impacted by the Legionnaires' outbreak are rightly demanding a measure of accountability for what occurred and significant reforms to ensure this never happens again.”

Adam Smeltz is a staff writer for Trib Total Media. He can be reached at 412-380-5676 or Staff writers Mike Wereschagin and Luis Fábregas contributed to this report.

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