VA officials admit 10 more possible Legionnaires' cases, apologize and tout solutions
Legionella bacteria in the water at VA Pittsburgh Healthcare System hospitals may have sickened 10 veterans in the four years before a deadly outbreak of Legionnaires' disease blamed for five deaths and at least 16 others sickened in 2011 and 2012, VA Pittsburgh's chief of staff acknowledged Tuesday.
“To anyone that was impacted by this tragedy, we are truly sorry,” VA Pittsburgh CEO Terry Gerigk Wolf said of the system's Legionnaires' crisis, reading from a prepared statement to reporters at a closed-door briefing at the Heinz campus in O'Hara. “Our family, the VAPHS family, is heartbroken. We remain focused on learning from this tragedy and ushering in a new era of Legionella control.”
That new era includes an investment of more than $10 million in ongoing and planned plumbing upgrades at Pittsburgh VA campuses in Oakland and O'Hara, regular disinfecting of the water lines with chlorine and more rigorous testing for the waterborne Legionella bacteria that cause Legionnaires' disease when inhaled through mist.
“We want to be national and international leaders in this,” Chief of Staff Dr. Ali Sonel said of VA Pittsburgh's response to Legionnaires'. “We want to be a resource for other health care facilities.”
Sonel said twice-monthly water testing for Legionella bacteria conducted since Jan. 1 has shown minuscule levels in just 1.19 percent of 1,926 samples, down from more than 30 percent at times during the outbreak.
Testing at the VA lab now looks for even one colony of bacteria in one liter of water, a standard greater than the five- and 10-colony levels some private labs use when giving the all-clear, he noted.
Pittsburgh VA has treated only one case of Legionnaires' disease since Jan. 1 that might have originated in a hospital, Sonel said. That case was linked to exposure in another care facility that Sonel declined to identify.
In the meantime, the Legionnaires' outbreak remains under criminal investigation by the VA Office of Inspector General in Washington, Wolf confirmed. VA workers could face discipline or firings “as appropriate” depending on the outcome of that review.
A congressional oversight subcommittee and the U.S. Attorney's Office for Western Pennsylvania also are looking into the outbreak, which the Centers for Disease Control and Prevention reviewed last fall. Wolf said VA officials have not been contacted by the U.S. Attorney's office.
The CDC found 21 veterans probably or definitely contracted Legionnaires' disease, a severe form of pneumonia, from Legionella-tainted water at the Oakland and O'Hara facilities between February 2011 and November 2012. But the CDC acknowledged it did not check water testing records from the facilities prior to 2011.
Those records, obtained by the Tribune-Review under the Freedom of Information Act, showed elevated Legionella levels appeared in the Oakland hospital at several points from 2007 to 2010. Pressed on that point, Sonel acknowledged for the first time that the VA and CDC identified Legionnaires' cases in 2007, 2008 and 2010 that might have originated in the Pittsburgh VA system. He cited three cases each in 2007 and 2008 and four cases in 2010.
One case in 2007 was definitely acquired inside the Pittsburgh VA, Sonel said. All veterans involved in those 10 cases recovered.
Wolf said it is “absolutely untrue” the Pittsburgh VA tried to hide Legionella. She said the VA consistently reported Legionnaires' disease cases to the Allegheny County Health Department. The Trib reported Sunday about days-long delays in at least a third of the outbreak reports to the Pennsylvania Department of Health's electronic reporting system that most public hospitals must make within 24 hours.
Sonel questioned the effectiveness of state and CDC reporting systems for major infectious diseases and detecting outbreaks. He admitted the VA could have been quicker in reporting to the state. But he noted the state, CDC and Allegheny County expressed no concerns about an outbreak even after the VA entered the cases in an electronic database.
Under questioning, Sonel acknowledged inconsistencies of up to several days between CDC and VA documents showing when patients were diagnosed with Legionnaires'. He said some discrepancies could appear if a patient were first diagnosed with pneumonia and only later, on another date, diagnosed with Legionnaires'.
Sonel and Wolf appeared at the media briefing with Deputy Director David Cord and two executives from Phigenics, a Naperville, Ill.-based water management company hired by the VA to help oversee testing and treatment.
VA officials met earlier Tuesday with congressional aides and veterans' groups to review the efforts to fight Legionella.
“I was pleased they're moving in the right direction,” said Rep. Tim Murphy, R-Upper St. Clair, who attended the briefing. “Part of this is an equipment change, and part of this is a cultural change. I want to make sure there's a cultural change as well. There has to be accountability and responsibility acknowledged.”
Adam Smeltz is a Trib Total Media staff writer. Reach him at 412-380-5676 or firstname.lastname@example.org.
Show commenting policy
TribLive commenting policy
You are solely responsible for your comments and by using TribLive.com you agree to our Terms of Service.
We moderate comments. Our goal is to provide substantive commentary for a general readership. By screening submissions, we provide a space where readers can share intelligent and informed commentary that enhances the quality of our news and information.
While most comments will be posted if they are on-topic and not abusive, moderating decisions are subjective. We will make them as carefully and consistently as we can. Because of the volume of reader comments, we cannot review individual moderation decisions with readers.
We value thoughtful comments representing a range of views that make their point quickly and politely. We make an effort to protect discussions from repeated comments either by the same reader or different readers.
We follow the same standards for taste as the daily newspaper. A few things we won't tolerate: personal attacks, obscenity, vulgarity, profanity (including expletives and letters followed by dashes), commercial promotion, impersonations, incoherence, proselytizing and SHOUTING. Don't include URLs to Web sites.
We do not edit comments. They are either approved or deleted. We reserve the right to edit a comment that is quoted or excerpted in an article. In this case, we may fix spelling and punctuation.
We welcome strong opinions and criticism of our work, but we don't want comments to become bogged down with discussions of our policies and we will moderate accordingly.
We appreciate it when readers and people quoted in articles or blog posts point out errors of fact or emphasis and will investigate all assertions. But these suggestions should be sent via e-mail. To avoid distracting other readers, we won't publish comments that suggest a correction. Instead, corrections will be made in a blog post or in an article.
- Roman Catholic Church in midst of culture clash over gays
- 2 killed in single-vehicle crash in Pittsburgh
- East Liberty man charged with Larimer shooting
- Snake bites on the rise in Western Pa.
- Author of Americans with Disabilities Act celebrates its effects in Carnegie
- Western Pa. prosecutors zero in on human trafficking; legislation pending
- Pittsburgh police motorcycle officer seriously injured in crash
- Newsmaker: Mark Rubenstein
- Peduto pushes for affordable housing in East Liberty redevelopment
- Proposed 8-story apartment complex called too tall in North Side’s Garden Theater area
- Allegheny RAD executive director moving on after 2 decades