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Answers called for in VA outbreak
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Victor Yu and Janet Stout, Legionnaires' disease experts, at Special Pathogens Laboratory in Uptown.
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Pressure continued to mount Friday for the Pittsburgh Veterans Affairs office after U.S. Sen. Bob Casey and U.S. Rep. Mike Doyle both called for separate investigations into the Legionnaires' disease outbreak at the VA's hospital in Oakland.
Mr. Casey, D-Pa., sent a letter requesting that VA Inspector General George Opfer conduct an investigation, and Mr. Doyle, D-Forest Hills, asked the House Veterans Affairs Committee to hold an investigative hearing into the outbreak, which has killed at least one veteran and maybe as many as three, and sickened at least four more people.
Both members of Congress said they were calling for the inspections because the VA has not adequately answered their own questions in the past few weeks.
"It's not going to be good enough for us to accept pronouncements or press releases or statements from the VA saying, 'Don't worry. Everything is going to be taken care of,' " Mr. Casey said at a news conference at the Allegheny County Courthouse, Downtown.
"In this country that doesn't work very well," he added. "They need to answer the questions and be held to the standard that only a full-blown investigation can take."
Mr. Doyle said in a phone interview that he liked Mr. Casey's request, but "I just think it's reached the point [with the outbreak] where we need someone with subpoena power outside the VA to investigate.
"For our families of our veterans, for the VA employees, they're all entitled to justice," he said. "And we need to do a full investigation and let the chips fall where they may."
Pittsburgh VA spokesman David Cowgill said he had no comment on Mr. Casey's or Mr. Doyle's request.
The Pittsburgh VA said it has confirmed that five people have contracted Legionnaires' disease from the water system at its University Drive hospital in Oakland. One of those patients -- William Nicklas, 87, of Hampton -- died on Nov. 23.
Two other families say that men in their families -- John McChesney, 63, of Columbus, Pa., who died Oct. 23, and John Ciarolla, 83, of North Versailles, who died July 18, 2011 -- also died after contracting Legionnaires following stays at the University Drive facility. But it is not yet clear if they contracted it in the hospital or outside.
Legionnaires is a pneumonia-like disease that hospitalizes about 8,000 to 10,000 people each year, but the U.S. Centers for Disease Control and Prevention and other experts believe many more cases occur each year that are diagnosed as simple pneumonia or other afflictions. It can be fatal in 5 to 30 percent of cases, depending on whom it strikes and where it is acquired.
The Pittsburgh VA says there have been 16 other Legionnaires' cases since January 2011 the origins of which it can't determine. Mr. McChesney and Mr. Ciarolla apparently are included in that number.
Mr. Doyle said this week the Centers for Disease Control and Prevention, which is working with the VA to investigate the cause of the outbreak, told him in a reply to questions, that it may never be able to confirm where those other 16 Legionnaires' cases originated.
The CDC told Mr. Doyle that is because the 16 patients "didn't stay in the hospital for the entire exposure period, and most were confirmed with the urine antigen test, so there is no patient isolate that can be used to compare to an environmental one."
A "urine antigen test" can quickly confirm if a patient has the most common strain of Legionella, which has more than 70 strains.
"Patient isolates" are samples of mucus from the lungs from which Legionella -- the bacteria that causes Legionnaires -- can be grown. It then can be examined at the DNA level and compared to the sample of Legionella found in a hospital's water system.
Researchers Janet Stout and Victor Yu, Legionnaires' experts who worked at the Pittsburgh VA for decades until a dispute with management in 2006, said if the VA did not have isolates for all those Legionnaires' patients, that means the VA dramatically changed protocols that were in place when they worked there.
"We froze and kept all of the samples so that you could go back and see where it originated if there was ever a question," Dr. Stout said Friday.
When they worked there, Dr. Yu and Dr. Stout said the University Drive hospital protocol also required performing both the urine antigen and the mucus test on all patients diagnosed with pneumonia. They said it appears that is no longer the case, based on what the CDC said, since they confirmed cases with just the urine test.
"It just raises more questions," Dr. Stout said.
All of this news was alternately encouraging and frustrating for the families of Mr. Ciarolla and Mr. McChesney.
Maureen Ciarolla, Mr. Ciarolla's daughter, said she hopes both the inspector general and House Veterans Affairs Committee agree to do investigations because "I'd like to know who played God" with her father.
Evelyn McChesney, Mr. McChesney's wife, was encouraged by the calls, too.
"I guess I've been disturbed by the response, or lack thereof from the VA, too," she said. "It would be nice to have answers."
A member of Mrs. McChesney's extended family attended Mr. Casey's news conference Friday afternoon.
The man wanted to remain anonymous, but he said he made the trip to Downtown from Murrysville because he wanted to hear what Mr. Casey had to say.
"I am pleased that somebody's investigating," he said.
He said he is driven by his affection for John McChesney, who was cremated after he died, and his anger over how it may have happened.
"John was such a nice guy," he said. "He should be wrapping Christmas gifts for his grandkids right now. He shouldn't be in a box in his wife's house."
First Published December 15, 2012 12:10 am
