More VA Legionnaires' disease cases likely undiagnosed
By Adam Smeltz
Published: Thursday, Feb. 7, 2013, 12:01 a.m.
An outbreak suspected of sickening 21 veterans and killing five might have infected an untold number of other Pittsburgh VA patients with Legionnaires' disease, which can go undetected without special tests, pathologists warned on Wednesday.
“I would be shocked and amazed if any physician were to say all the cases were diagnosed,” said Dr. Cyril Wecht, a pathologist and former Allegheny County coroner who served on a federal committee that investigated early outbreaks of Legionnaires' in the late 1970s.
Rep. Tim Murphy, who helped organize a congressional hearing to review the outbreak, urged the Centers for Disease Control and Prevention and the Allegheny County Health Department to investigate whether Legionella bacteria invaded the water systems at neighboring facilities in Oakland. They include UPMC hospitals and the Petersen Events Center.
“It's not something to be panicked about,” said Murphy, R-Upper St. Clair. “It is something to pay attention to if you already are very sick.”
A spokeswoman for UPMC, which has three hospitals near the VA Pittsburgh Healthcare System hub on University Drive, declined to comment.
She referred to written testimony that two UPMC department heads supplied this week for the congressional subcommittee, which outlines how UPMC Presbyterian has safeguarded its tap water.
County officials did not return calls for comment.
CDC spokesman Tom Skinner said federal reviewers “stand ready to help” state and local health officials with any follow-up.
The tap water at the VA hospital has become a central concern in ongoing federal reviews of the Legionnaires' outbreak, first revealed publicly by VA officials in November. They confirmed five hospital-acquired cases of the disease, a sometimes fatal form of pneumonia caused by Legionella, and tied the problem to tainted water in the VA system.
Findings by the CDC, released in part at this week's hearing, show that 21 Legionnaires' cases probably originated within Pittsburgh VA hospitals between Jan. 1, 2011, and Oct. 31, 2012. Five were fatal.
CDC and VA officials won't confirm the names of the deceased.
Thirteen patients were in the Oakland hospital, according to the CDC. Six others had been in both the Oakland hospital and the H.J. Heinz Campus in O'Hara. Two visited only the Heinz campus.
Several people who testified at the hearing accused VA workers of failing to maintain water treatment systems. The head of a company that designed the VA's treatment system said his employees saw VA staffers falsify testing records.
Union leader Kathi Dahl said VA associate director Lovetta Ford told her that she could pretend to be sick and skip testifying. Ford could not be reached for comment.
“You have to be shocked by what appears to be a cover-up,” said Philadelphia attorney John N. Zervanos, representing the family of the late John Ciarolla, 83, of North Versailles. Ciarolla died of pneumonia in the Oakland VA in July 2011, leading his loved ones to believe he was exposed to Legionella inside the hospital.
The family “plans on investigating the matter,” Zervanos said.
Relatives of World War II veteran William E. Nicklas of Hampton, who died of Legionnaires' in the Oakland VA, announced plans to sue.
Others sickened by the VA's Legionella problem might never be identified or counted in the CDC's official tallies, independent health experts said. CDC reviewers relied on records of VA Legionnaires' cases and laboratory-confirmed Legionella incidents, according to congressional testimony.
If VA patients developed pneumonia from the bacteria and were not tested specifically for Legionnaires', they would not show up in those diagnosis records.
Cleveland Clinic microbiology director Gary W. Procop called it “definitely possible” that some Legionnaires' cases might have escaped the CDC review. Confirming a Legionnaires' case often involves specialized testing of urine or a culture from the respiratory system, he said.
“The doctor has to have it in their thought process, or it doesn't get done,” Procop said.
An effort to establish “a baseline of Legionella” in Oakland, as Murphy wants to do, could be helpful, Procop said.
“It probably wouldn't be bad to determine the average number of Legionella cases in all the hospitals in a certain area if there's reason to believe that one hospital has a higher rate,” Procop said.
Although Legionella can appear in any water supply, Murphy emphasized that hospital patients with weak immune defenses are especially vulnerable to Legionnaires'.
Pittsburgh VA spokesman David Cowgill would not immediately comment Wednesday on its testing practices for Legionnaires' but addressed the outbreak generally.
“We provided comprehensive testimony regarding the issue on Feb. 5 to the House Committee on Veterans' Affairs,” Cowgill wrote via email. “We will continue to work with the committee and the Pennsylvania congressional delegation on the way ahead.”
Adam Smeltz is a staff writer for Trib Total Media. He can be reached at 412-380-5676 or firstname.lastname@example.org.
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