One of the most striking differences between how the Veterans' Affairs Pittsburgh Healthcare System is addressing the threat of Legionnaires' disease in the wake of the outbreak in 2011 and 2012 that killed as many as six veterans, is money.
During a news conference held Monday to update the public on all of the efforts the Pittsburgh VA continues to pursue to prevent another Legionnaires' outbreak, Ali Sonel, Pittsburgh VA's chief of staff, said, essentially, that no expense is being spared.
"But, ultimately," he said, "it is the right thing to do" to reduce the risk to veterans.
In addition to $10 million that was already spent replacing all of the Pittsburgh VA's mixing valves on its faucets -- to allow hotter water to be flushed through them to help eradicate Legionella -- the VA is still pursuing a variety of projects, as outlined Monday, that will drive the ultimate cost of the outbreak up even further.
Those efforts include an ongoing project to map the VA's entire water system; to automatically track reams of data on the VA's water on a daily basis; and to replace nearly all of the Pittsburgh VA's hot water tanks with instantaneously heated tanks to further cut down on places for Legionella to grow.
And all of that doesn't even take into account the hundreds, if not thousands, of hours of overtime that VA employees have put in doing additional, in-house work on the water system.
Tony Dallmier, a regional manager for Phigenics, a water treatment company working with the Pittsburgh VA, said some of those efforts have already "virtually shut the door to Legionella infection" at the Pittsburgh VA.
The spare-no-expense philosophy stands in stark contrast to the Pittsburgh VA's actions in the past that led to the outbreak, seen most recently in 2011 and 2012, when the Pittsburgh VA was struggling to bring its copper-silver ionization water treatment system under control.
The copper-silver system was used to prevent the spread of Legionella in the Pittsburgh VA's water system, but in 2011 and 2012 VA officials realized they needed outside help to make the system work properly as Legionnaires' cases started to mount.
They called in two consultants -- Enrich and LiquiTech -- both of whom recommended that the VA adopt some sort of automated system that would report system data to the companies and help them make decisions about how to adjust the treatment system so that it was most effective against Legionella.
But the recommendations to buy an automatic reporting system went nowhere.
Pittsburgh VA director Terry Wolf said Monday that emails she has seen "say that [Pittsburgh VA] officials decided not to [buy the automated system] because of [high] costs."
Mrs. Wolf said she didn't see those emails until November, months after the decision to not buy the automated systems was made by other employees "far removed from me."
"I was not aware of those proposals until Nov. 14," she said Monday.
Costs also are believed to have played a role in the move that many believe led directly to the outbreak: the Pittsburgh VA's 2006 decision to close the Special Pathogens Laboratory that used to oversee the detection and eradication of Legionella, and get rid of the two Legionnaires' researchers who directed it, Victor Yu and Janet Stout.
One of the reasons the lab was closed -- and perhaps the main reason, many believe -- was to save money by letting go of some employees and consolidating it with another in-house VA lab.
In addition, on Monday, Mrs. Wolf said the VA is still debating what type of water treatment system will replace the copper-silver system that the Pittsburgh VA believes failed to control the Legionella, the bacteria that causes Legionnaires' when it is inhaled in water vapor.
The chlorine drip water treatment system -- that the VA put in place immediately after it revealed it had an outbreak in November -- along with occasional thermal eradication "has worked well" in controlling the Legionella bacteria in the water system, Dr. Sonel said.
Because of that, and with the memory of veterans who died after becoming infected with Legionnaires' during stays at the Pittsburgh VA, officials don't want to choose a replacement system "lightly," Dr. Sonel said.
Dr. Sonel said the VA is still debating whether to adopt the rarely used monochloramine treatment or the more commonly used chlorine dioxide system.
Sean D. Hamill: email@example.com or 412-263-2579 First Published September 23, 2013 5:30 PM