Pa. Senator Casey's bill demands VA disclose outbreaks promptly

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Saying he is upset it has to be mandated, U.S. Sen. Bob Casey on Tuesday proposed legislation requiring that the nation's Veterans Affairs' facilities report every Legionnaires' case and whether Legionella has been found in their water systems within 24 hours of detection.

"To be blunt about this, we shouldn't have to legislate this," Mr. Casey, D-Pa., said during a news conference in the Allegheny County Courthouse. "This should be standard practice at the VA -- but it isn't."

The goal, he said, is that the various health agencies, and the central VA office itself, will have the information in real time to stem any outbreak.

Sen. Casey talks about Legionnaires' disease legislation

Sen. Bob Casey today proposed legislation that would require all VA hospitals to report both the detection of Legionella in water systems and cases of Legionnaires' in patients within 24 hours of detection. (Video by Nate Guidry; 3/26/2013)

No one should have to experience "the horror at least five families have lived through" at the Pittsburgh VA, he said.

The legislation is a result of one of the shortcomings that played a role in allowing a Legionnaires' outbreak at the Pittsburgh VA to sicken 21 patients, killing five veterans in 2011 and 2012 before it was brought under control last November.

The Pittsburgh Post-Gazette reported on March 10 that the Pittsburgh VA did not report, or properly report, six of 21 cases, as it had pledged to do voluntarily years ago. Also, with the state and federal branches of the National Electronic Disease Surveillance System, there was not a central place analyzing the data so outbreaks could be detected. These all played a role in the outbreak.

Mr. Casey was previously angered to learn that before this past fall, the Pittsburgh VA leadership never notified all of its doctors and other employees that it had been battling persistent levels of Legionella in its water since early 2011 and experiencing more and more Legionnaires' cases that may have been contracted in the VA.

To address that, a provision in the legislation requires that a VA facility report any probable or confirmed Legionnaires' cases -- and what facility they occurred in -- and any Legionella detection to county and state health agencies, the federal Centers for Disease Control and Prevention and the central VA office in Washington, D.C. But it also requires the VA facilities to notify the facility's doctors and employees within 24 hours.

After the case is reported, the legislation would require the VA facility to create a plan to "manage and control the impacted water system."

The plan would be sent to all of the same agencies and employees, as well as to hospital patients.

VA facility officials also would have to tell those agencies and people where the positive sample was found, what the impact is on patients and what it is doing to assess the water system.

The facility also would have to detail how it found and confirmed the Legionella sample, including showing copies of maintenance logs and staffing in maintenance and infectious disease departments.

"This is, I think, the bare minimum that should be done in the face of the deaths of five veterans who served this country," Mr. Casey said.

He said he would formally introduce his legislation after the VA's inspector general's office completes its investigation of the Pittsburgh VA outbreak sometime in April. The VA's investigation, which should include recommendations for preventing such occurrences in the future, could change what he proposes, he said.

Pittsburgh VA spokesman David Cowgill said Tuesday in an email that the "VA does not provide official views on legislation outside of formal requests, such as congressional hearings."

But, he added, "VA is engaged with members of Congress and other stakeholders on this issue and we look forward to continuing to work together on this important issue."

Jeffrey Levi, executive director of the Trust for America's Health, a Washington D.C.-based nonprofit that seeks to make disease prevention a national priority, said he was glad to hear Mr. Casey propose changes in the wake of the Pittsburgh VA outbreak because "it will call attention to the larger problem."

"But what really needs to happen is we need to systematically change how we do surveillance across the health system, including the VA," he said. "This is not a disease specific problem, it's a systemic problem."

Maureen Ciarolla, daughter of John Ciarolla, 83, who was the first veteran to die during the outbreak on July 18, 2011, agreed.

"I think it should be all in -- and not just Legionnaires' but all infectious diseases and outbreaks," she said.

Judy Nicklas, the daughter-in-law of William Nicklas, 87, of Hampton, the last veteran to die during the outbreak on Nov. 23, 2012, was glad to hear about Mr. Casey's legislation, too. But she wants the public to be part of the groups notified within 24 hours after detection of a case or Legionella.

"Anyone walking into that hospital should know," she said. "And you should have the option of going or not going to that hospital.

"I just think it's sad that it took five people to die for it to get this attention."

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Sean D. Hamill: shamill@post-gazette.com or 412-263-2579.


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