When Clark E. Compston died Nov. 14, 2011, his son, Clint, was saddened as any son would be.
"He was a great guy," Clint Compston, 38, of Plum, said of his father, a former steel worker and carpenter from Aliquippa who had lung cancer.
Clint Compston figured that's really all there was to the cause of his father's death at 74 -- though doctors did mention that he had contracted Legionnaires' disease during his stay at both the Pittsburgh Veterans Affairs hospital in Oakland and a nursing home near Aspinwall.
"They just said, 'While your father was in here, he contracted Legionnaires' disease,' " Mr. Compston recalled, speaking publicly about it for the first time. "They didn't make it seem like it was a big problem. They made it seem like it was just my dad" who contracted the disease.
His father wasn't the only one. Six other patients at the Pittsburgh VA had contracted the disease, and one of them, John Ciarolla, 83, had died of it in July, just four months earlier -- though none of that was made public at the time.
Before the outbreak was announced by the Pittsburgh VA in November 2012, 21 patients would get sick and five of them, including Ciarolla and Compston, would die.
What led to the deaths of Compston, as well as another previously unidentified veteran, Lloyd "Mitch" Wanstreet, 65, further illustrates what was happening inside the Pittsburgh VA that allowed the outbreak to continue for 16 months after Ciarolla died.
While it seemed clear to Clint Compston that his father's doctors said he had contracted Legionnaires' at some point during his stay in the Pittsburgh VA, the VA didn't acknowledge that in its records.
On the death certificate, Clint Compston said one of his father's VA doctors listed the cause as lung cancer -- unlike two of the other four veterans who died during the outbreak and had Legionnaires' listed as a cause.
And in a report the federal Centers for Disease Control and Prevention made on the outbreak, it lists Compston's disease as "probably" being contracted inside the VA, not "definitely."
The CDC could not definitively say where Compston got the disease because the Pittsburgh VA could not find an "environmental" sample of the bacteria in the VA to compare it to a sample the VA took from Compston.
A VA official not authorized to speak has told the Post-Gazette that for most of the outbreak in 2011 and 2012, the Pittsburgh VA's infection control staff obtained environmental samples only from water in rooms where patients were treated or resided, but not in other parts of the building also served by the water system, as recommended by experts. The chief of infection control, Robert Muder, said additional environmental tests were not performed because his department was short-staffed, the VA official said.
As the outbreak continued, more VA patients would get sick with the disease in 2012. Three of them would die, including Wanstreet, a Navy veteran who died July 4.
He moved from his home in Jeannette into the VA's Heinz facility June 14, 2012, because he couldn't care for himself. Sores had developed on his legs from diabetes and were exacerbated by chemotherapy he was getting for cancer that had spread from his lungs to his brain and legs.
Despite all of that, his sister and primary caregiver, Sandy Riley, 60, of Swissvale said, "He was actually doing pretty well till he got this pneumonia.
"We were all under the impression [the move to Heinz] was just temporary."
If he "hadn't gotten [Legionnaires'] he might still be alive," she said.
After coming to Heinz on June 14, Wanstreet was either there or at the University Drive hospital until he died -- with the exception of a two-day visit home with his sister June 24 and 25.
Despite that, the Pittsburgh VA's infection control department said it could not determine where he contracted Legionnaires' because of that trip home, and also because it could not obtain Legionella cultures from the Heinz campus' water system, according to an Issue Brief put out by Pittsburgh VA director Terry Wolf's office June 29.
Issue Briefs, documents on important matters, are sent to regional VA director Michael Moreland's office.
Wanstreet's case is similar to that of Ciarolla's, who also left the VA facility briefly to visit his daughters' homes.
Wanstreet's case also is similar to Compston's because, even though they had obtained a bacteria sample from Wanstreet, they had not obtained an environmental culture from Heinz for comparison.
After Wanstreet was diagnosed with Legionnaires' on June 28, doctors told Ms. Riley that it "was caused by water, but they didn't know where he got it."
She believes her brother -- "who loved anything involving water: fishing, boating, swimming, you name it" -- may have contracted it from spending time at Heinz sitting by a decorative fountain in the patients' garden.
"If I know my brother, he was probably dipping his bandana in the water and wrapping it around his neck," she said.
That fountain has since been turned off because it was part of the same water system that tested positive for Legionella bacteria. Earlier Legionnaires' outbreaks -- including one at a Chicago hotel in 2012 -- have been tied to decorative fountains, which can aerosolize water and make it easier to breathe into the lungs.
Even so, at the time of her brother's death, Ms. Riley said none of his doctors gave her any indication that he might have contracted Legionnaires' at the VA.
The death certificate listed Legionella pneumonia as the primary cause of death, with metastasized adenocarcinoma a secondary cause.
"It's a shame," Ms. Riley said, "because it could have been avoided."
Clint Compston agreed.
"My brother called me from California, and he said since he started finding out more about the outbreak, he started getting more and more upset," he said. "He said he would have liked to have seen Dad one more time, and if he didn't get [Legionnaires'] maybe he might have lived three more months, or he'd still be around, and he would have gotten to see him."
Editor's note, posted Feb. 25, 2013: After this story was published, a source close to the investigation at the Pittsburgh VA said that the decorative fountain at the VA's H.J. Heinz facility near Aspinwall was not closed because of the recent Legionnaires' outbreak, but because it is shut down every October for winter cleaning until spring, when it is typically reopened. In addition, the source said the fountain was unlikely to have been a source of Legionella during the outbreak because it was more heavily chlorinated than the rest of the water in the facility because it was outside and there was a concern that a variety of bacteria might grow in the fountain, not just Legionella. Even so, another VA source said that the facility will not reopen this spring because of the concerns that it could be an easy source of Legionella.
Sean D. Hamill: email@example.com or 412-263-2579.