Experts support Casey's VA plan
By Mike Wereschagin and Adam Smeltz
Published: Wednesday, March 27, 2013, 12:01 a.m.
Infectious disease experts said on Tuesday that Sen. Bob Casey Jr.'s proposal to require that Veterans Affairs hospitals nationwide report Legionnaires' disease diagnoses within 24 hours would close a major gap in disease surveillance, making it easier to spot outbreaks.
“The sooner we have that good tip (about a disease outbreak), the sooner we can go into prevention mode. I think having the VA as part of that system would be a very good thing,” said Paul Etkind, senior director for infectious diseases at the National Association of County and City Health Officials in Washington. The group represents 2,800 public health departments across the country.
A Tribune-Review investigation showed that laws that require other hospitals to report infectious diseases to state and county health departments don't apply to the VA. Casey said that that legal gap allowed a Legionnaires' outbreak in the Pittsburgh VA Healthcare System in February 2011 to remain secret until November 2012. The outbreak sickened as many as 21 people, five of whom died.
“We shouldn't have to legislate this,” Casey, D-Scranton, said at the Allegheny County Courthouse as he announced the draft legislation. “This should be standard practice at the VA, but it isn't.”
VA spokesman David Cowgill declined to comment on Casey's legislation, but said the VA “is engaged with members of Congress and other stakeholders on this issue, and we look forward to continuing to work together on this important issue.”
Casey said he hadn't consulted with the VA on his draft legislation, which would require the nation's 152 VA medical centers and nearly 1,400 outpatient clinics to notify their workers, the federal Centers for Disease Control and Prevention, state and county health departments, and the national VA headquarters in Washington within 24 hours of any Legionnaires' cases.
Health experts say Casey's proposed bill would help state and county health investigators spot outbreaks sooner when multiple cases are reported from the same medical facility. The Pennsylvania Department of Health, for example, investigates Legionnaires' cases based on a patient's home county, rather than where the disease was diagnosed.
“If we don't have the basic reports, then we're not going to be able to find the links between them,” said Dr. Ronald Voorhees, acting chief of the Allegheny County Health Department.
He suggested that Casey expand the proposal to require that the VA report other infectious diseases as well.
If a VA hospital finds Legionella bacteria in its water, Casey's bill would require hospital officials to notify patients who might be affected — something the VA Pittsburgh should have done before its public announcement of an outbreak on Nov. 16, Casey said. That was 17 days after the CDC alerted the VA that Legionella bacteria found in two patients matched bacteria in the Oakland VA's water.
Proper warning might have protected World War II Navy veteran William Nicklas, 87, of Hampton, his family said.
Nicklas checked into the Oakland VA on Nov. 1 because of complications from his heart medication; he died on Nov. 23. His death certificate listed Legionnaires' disease as a contributing cause of death.
“He sure as heck wouldn't have picked the VA if he knew they had Legionella in their system,” said Judy Nicklas, William Nicklas' daughter-in-law. “Everybody should be notified within 24 hours so people can make their choices accordingly. I just think it's a shame that five people had to die before this happened.”
Cowgill said the VA Pittsburgh “has taken appropriate steps and continues to take action based on expert reviews, to control Legionella and ensure the safety and protection of our veterans.”
Casey said he'll introduce his bill in a couple of weeks, once the VA inspector general releases its report on the outbreak.
The Office of Inspector General, which set a self-imposed deadline of March 31 for the report, said in an email on Tuesday that there would be a “minor delay.” Casey said the report is expected in April.
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