The death of a Delmont man in November 2011, after contracting Legionnaires' disease that was initially dismissed by the federal Centers of Disease Control and Prevention as not being part of the Pittsburgh Veterans Affairs outbreak, may have begun there after all, according to interviews and documents obtained by the Pittsburgh Post-Gazette.
Most significantly, a spokesman at Forbes Regional Hospital said in a statement that the hospital is convinced that Frank "Sonny" Calcagno, 85, a Navy veteran who died Nov. 23, 2011, at Forbes, did not contract Legionnaires' there, as the CDC and the Pittsburgh VA believed.
"When looking at the full picture surrounding the case over time, however, including Forbes water test results and the lack of any other legionella cases, it is clear that this patient was not exposed to legionella at Forbes," spokesman Dan Laurent wrote in an email.
The only other place Calcagno stayed in the weeks before he was diagnosed with the disease at Forbes was at the Pittsburgh VA.
If that is the case, that would make Calcagno the sixth veteran to die shortly after contracting the disease during the VA outbreak in 2011 and 2012. After a 2-month-long investigation, the CDC in February determined that 22 men were sickened and five of them died during the outbreak at the Pittsburgh VA.
But it found that another 11 veterans -- including Calcagno -- who had been patients at the Pittsburgh VA and had Legionnaires' at some point, contracted the waterborne disease outside of the Pittsburgh VA.
The Pittsburgh VA's chief of staff, Ali Sonel, said the VA relied on the CDC's investigation -- which also involved staff from the Allegheny County Health Department and the Pennsylvania Department of Health -- in determining where all of the identified patients contracted Legionnaires'. He referred questions on that issue to the CDC.
A CDC spokeswoman, Alison Patti, said officials at the CDC were too busy with other projects to comment this week.
Calcagno's daughter, Debbie Balawejder, 58, of Monroeville, wasn't surprised to hear others say now that her dad contracted Legionnaires' at the Pittsburgh VA.
She recalled that last November, after the Pittsburgh VA publicly revealed that it was dealing with an outbreak, "I was watching the news and when I heard about these people at the Pittsburgh VA dying from it, I turned to my husband and said, 'I know that's where he got it.' "
Calcagno's longtime girlfriend, Becky Krezan, 75, who lived with him for the past 30 years, said no one at Forbes ever bothered to say where they thought Calcagno was infected.
Calcagno's case appears to have been inadvertently dismissed as not being part of Pittsburgh VA outbreak because of a simple mistaken date.
During a review of Calcagno's case, the CDC investigators determined that the date of "onset" -- that is, when he first began showing symptoms of Legionnaires' -- was on Nov. 5, 2011, according to the case review documents obtained by the Pittsburgh Post-Gazette from the VA through a Freedom of Information Act request.
To determine the earliest possible date that a patient might have first contracted the disease, the CDC typically counts backward from the onset date by a full 10 days. But for this investigation, the CDC used a wider response time of 14 days.
Counting back from Nov. 5 put the earliest possible date of infection on Oct. 22 -- the second full day that Calcagno was a patient at Forbes.
But in another portion of the case review, the CDC investigator wrote that he was "admitted to Forbes Regional 10/21/2011 and + on 11/5/2011." That positive sign refers to Calcagno testing positive for Legionnaires' on that date.
It would be unusual for a patient to show the first onset of symptoms, be diagnosed, tested and have a test result come back the same day.
The CDC's own list of the 32 possible Pittsburgh VA Legionnaires' cases shows that the time between onset and diagnosis -- which is typically the day a test result is returned -- can be as much as 10 days.
Forbes would not provide a date that they believe Calcagno first began showing symptoms.
His family says he began having a cough in the last days at the Pittsburgh VA, and it worsened after he got to Forbes on Oct. 20. (The Pittsburgh VA says he was admitted to Forbes on Oct. 21 but the family says he was admitted on Oct. 20, the same day he left the Pittsburgh VA because he had been having health problems. He had been at the VA since Aug. 28 -- during the beginning of the worst parts of the outbreak of Legionnaire's disease.)
Sometime at about the end of his first week at Forbes, Mrs. Balawejder said she noticed her father's cough getting worse and that he had developed a fever, and she asked the doctors and nurses about it and was told: "Oh, that's just from his pneumonia."
Legionnaires' is a potentially lethal form of pneumonia that is caused by the bacterium Legionella. It is transmitted by water, typically when a patient inhales the infected water into their lungs while showering or bathing.
For younger, healthier people who contract it, Legionnaires' typically is not fatal. But for older, immune compromised patients like Calcagno, the CDC estimates that the percentage who die after contracting it can be as high as 30 percent -- which is about the percentage of Pittsburgh VA patients who died after contracting it there in 2011 and 2012.
Experts say, however, that if the correct antibiotics are given to patients soon after infection, the disease can be cured, even in immune-compromised patients.
Forbes says that Calcagno received antibiotics after being diagnosed with Legionnaires' and was in recovery when other issues worsened.
But part of Mrs. Balawejder's and Ms. Krezan's anger is that they said they were never told that Calcagno had contracted Legionnaires' until a week before he died.
Her father's doctor at Forbes, Palaniappan Muthappan, merely mentioned it one day as if Mrs. Balawejder had known for a while.
"I told him, 'No one told us that.' And he said, 'Well, it's on the chart,' like it had been there a long time," Mrs. Balawejder said. "Well, I don't read the chart."
Her father had a series of other physical problems -- heart and liver problems, as well as thrush in his mouth and throat that made eating and drinking difficult -- that also contributed to his death.
Before he entered the Pittsburgh VA on Aug. 28, 2011, because he had been feeling delirious from the anti-anxiety drugs, "he was fine," Mrs. Balawejder said.
"He was still driving himself, still paying his bills on his own, still working at Shop n' Save," she said, referring to his full-time job bagging groceries and stocking shelves at the Holiday Park grocery store.
The Pittsburgh VA doctors helped treat some of his underlying problems, including fluid in his lungs, during a seven-week stay there.
He made so much progress that near the end of his nearly two-month stay at the VA, Mrs. Balawejder said his doctor told her: "Your dad has at least five good years left in him."
That was before he contracted the Legionnaires'.
After he died, Dr. Muthappan ruled that the immediate cause of his death was respiratory failure, with underlying causes of pneumonia aspiration and renal failure. There is no mention of Legionnaires' on the death certificate.
Losing Mr. Calcagno is a loss Ms. Krezan is still coping with, she said.
They had been together ever since they met in 1983, after Mr. Calcagno and his wife divorced.
Ms. Krezan said she fell for Mr. Calcagno instantly, not just for his handsome looks, but for his spunk.
"He was something else, honey," she said. "If you haven't met him, you missed something."
Sean D. Hamill: firstname.lastname@example.org or 412-263-2579.