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Fábregas: A tale of 2 crises, with twist

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Saturday, May 10, 2014, 12:01 a.m.

Long before Legionella bacteria appeared in ice machines in UPMC Presbyterian, the pesky bug lurked in water lines in Pittsburgh Veterans Affairs hospitals.

Same bug, different story. Other than proving that killer germs threaten the most vulnerable patients, the two episodes are anything but similar. In the end, two health care organizations that treat very sick people responded to a crisis in vastly different ways.

Some managers choose to be transparent. Others prefer silence. Some, such as the UPMC folks trying to unravel the ice machine incident, move swiftly. Others, such as the VA folks charged with treating our veterans, move so slowly that they deserve to be fired.

This week, some members of Congress and the American Legion, the nation's largest veterans service group, demanded the resignation of VA Secretary Eric Shinseki. They cited a litany of reasons that should have outraged the White House: delayed medical care at the Phoenix VA, the Legionnaires' disease outbreak in our backyard, and performance bonuses to managers overseeing all of it.

President Obama, however, thinks Shinseki is doing a great job. Instead of holding him accountable, the White House issued a statement saying Obama “remains confident in Secretary Shinseki's ability” to lead the VA. Excuse me while I try to stop laughing.

Shinseki, of course, didn't personally handle the care of veterans in Pittsburgh or Phoenix. But he oversaw those who did and waited until Thursday to order VA staff to conduct a national audit of patient access conditions and scheduling practices at each of its facilities.

It was about time.

In disclosing their own encounter with Legionella, Presby administrators went to great lengths to distance themselves from the VA, emphasizing that they checked and rechecked water lines and found no bacteria. Indeed, Presby CEO John Innocenti likened the experience to an episode of “Columbo,” the fictional detective of the 1970s.

“It was like a mystery of ‘How in the world can Legionella be formed in ice machines?' ” he said.

Although the patients with Legionnaires' were only in Presby, and the ice machines with Legionella were found only in Presby, Innocenti and other UPMC leaders opted to cast a wide net and inspect all 500 ice machines in all of the health system's hospitals.

Mind you, there are no federal or state guidelines on what to do when something like this happens. So UPMC could have done nothing to correct the problem and just prayed that no one else got sick. Instead, they came up with a two-part remedy that involved putting filters on all ice machines and sterilizing them. They educated staff about patients who are at risk to develop Legionnaires'.

I've heard questions about UPMC's response and whether they should have notified the public sooner. Those questions fail to consider that, although Legionnaires' was identified in the first of three Presby patients in October, it took months to link the bacteria to the ice machines. It assumes that the folks at UPMC were as secretive as their neighbors at the VA. So far, I don't see the similarity.

Like I said, same bug, totally different story.

Luis Fábregas is Trib Total Media's medical editor.

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