VA official: Don't tell until asked about Legionnaires' outbreak among veterans
Editor's note: This story is the second of two parts.
A high-ranking official with Veterans Affairs Pittsburgh Healthcare System wanted the agency to keep quiet about a deadly Legionnaires' disease outbreak rather than warn the public, internal emails indicate.
Deputy Director David Cord called David Cowgill, then VA Pittsburgh's chief public affairs spokesman, and indicated he didn't want to make public the outbreak unless “we received a specific inquiry” from news media, Cowgill wrote in an email on Nov. 14, 2012. The email is among nearly 7,000 pages of internal VA emails and documents the Tribune-Review obtained through a Freedom of Information Act request.
“He does not want to be proactive and go to media with a statement,” Cowgill wrote to Nicholas Haller, assistant to the chief of staff, Dr. Ali Sonel. “This would just be a response if they come to us, which we are anticipating they will.”
VA Pittsburgh Director Terry Gerigk Wolf overruled Cord, spokesman Mark Ray told the Trib on Friday. The VA announced the outbreak on Nov. 16, 2012, two days after Cord's conversation with Cowgill.
“The email you cite does not represent Mr. Cord's stance on engagement,” Ray said.
Confronted with a deadly crisis, VA Pittsburgh leaders tried to insulate themselves from scrutiny, internal emails show.
Top medical and administrative officials clamped down on the flow of information about the outbreak during which at least six veterans died and 16 fell ill from February 2011 to November 2012. Administrators limited contact with federal and county health authorities and expressed bitterness and frustration with inquiries from Congress and the news media, according to the emails and other documents.
At one point, an investigator with the Centers for Disease Control and Prevention warned Sonel that secrecy impeded her investigation.
“Without these documents (the CDC requested) we will not be able to help determine the contributing factors to the outbreak, and the trip report (the CDC's account of the outbreak) would reflect this as a lack of collaboration between the CDC and (VA Pittsburgh) in the investigation — I would rather avoid that,” Alicia Demirjian, a CDC epidemic intelligence surveillance officer, told Sonel in a Dec. 3, 2012, email.
Ray, responding to a Trib inquiry, wrote in an email: “VAPHS fully cooperated with the CDC during the outbreak and continues to do so to this day.”
Among documents the VA was reticent to hand over to the CDC was a report by Enrich Products Inc., a Wilkinsburg water treatment company.
Enrich was hired during the outbreak to review VA Pittsburgh's copper-silver ionization system, which was designed to contain bacteria that cause the pneumonia. The consultant's report showed several instances in 2011 and 2012 when the copper and silver ion levels were too low or too high.
When infection control nurse Patricia Harris told VA leaders on Nov. 21, 2012, that the CDC wanted the consultant's report and other documents, Cord asked in an email to Harris, Haller, Cowgill and the then-infection control chief, Dr. Robert Muder: “Do they have any intention on disclosing this info to anyone?”
Cowgill replied with a suggestion: “It would be best if we not refer to the current review as an investigation.”
VA leaders worried the CDC would share the information with the Allegheny County Health Department, emails show. Sonel, in messages to CDC's Demirjian, said he was “unsure I can rely on” county health officials regarding their contacts with the public.
“Not for forwarding. We will have to discuss how information is shared with Dr. (Jim) Lando (a CDC epidemiologist) and the Allegheny Co. Health Department,” Sonel wrote.
The VA was “very unhappy” that the health department disclosed a patient's death to the news media, Sonel said. He accused the department of providing an inaccurate date of death and a Legionnaires' case tally that conflicted with the VA's outbreak totals.
Lando and the county Health Department director, Dr. Ron Voorhees, defended the information they released in two Nov. 30 emails to Sonel.
“There was a disagreement about the level of information that (the department) disclosed,” Voorhees told the Trib in an email, though the department and the VA have since resolved their problems.
The VA eventually sent Demirjian documents she requested. Sonel barred subordinates from sharing more with the CDC without his clearance.
“The communication to the CDC is restricted with regard to Legionella,” Haller wrote to Dr. Mona Melhem, associate chief of staff, on Dec. 13, 2012.
“Dr. Sonel wanted to ensure that (the agency) was fully and accurately answering CDC questions,” Ray explained in response to a Trib inquiry about the matter.
VA officials in Washington echoed that, saying the department “believes in transparency” and cooperated with all investigations of the outbreak.
CDC spokesman Benjamin Haynes declined to say whether VA delays affected its investigation.
The CDC in January 2013 reported that Legionella had been “widespread” in the Oakland hospital, that the copper-silver system operated below standards and that VA workers delayed some internal reports about Legionnaires' patients.
VA vs. Casey
Concerned about VA Pittsburgh's public image, leaders grumbled about what they considered an increasingly negative tone in congressional statements and news stories.
U.S. Sen. Bob Casey Jr., D-Scranton, seemed to irritate VA Regional Director Michael Moreland by publicly urging the VA inspector general to investigate on Dec. 21, 2012.
Cowgill told Moreland and Cord that the VA soon would release a series of news releases that would result in positive stories about the agency.
“Then if our friendly Senator could stop, we could move forward,” Moreland replied to Cowgill and Cord. “Maybe Terry (Gerigk Wolf, VA Pittsburgh director) wants to invite Casey to visit?”
That Moreland blamed Casey for holding back the VA shows that top officials believed “they were above basic congressional oversight during the Legionnaires' crisis,” said Casey spokesman John Rizzo.
“The leadership during that crisis was woefully inadequate,” Rizzo said.
Moreland retired last year. Phoenix House, a New York-based nonprofit that runs 120 drug and alcohol programs in 11 states, hired Moreland as its senior vice president and chief operating officer. A spokeswoman would not put the Trib in touch with Moreland and referred questions to the VA.
Though the VA repeatedly has said it “strive(s) to provide accurate and timely information,” VA leaders' emails tell a different story. Cord said the VA Pittsburgh should keep its advertising spending secret because that's what private health care companies do.
In another email, Cowgill wrote that a news release saying Legionella was found in a veteran who died at the VA would not be sent to media outlets until after regular business hours on a Friday, to minimize the exposure.
Cowgill, in an email to Moreland, Cord and other top leaders sent at 4:33 p.m. Feb. 8, 2013, wrote that he was told “to release this to the local media between 5:00p-5:30pm, but not before 5:00p. They don't want this on the 6:00p news.”
Mike Wereschagin and Adam Smeltz are Trib Total Media staff writers.