Legionnaires' kills Pittsburgh VA hospital patient
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The VA Pittsburgh Healthcare System declared Friday that the water system at its University Drive hospital in Oakland is now clear of Legionnaires' disease-causing bacteria that has killed at least one patient.
At the same time, however, the Department of Veterans Affairs announced that while it has only confirmed that five cases of Legionnaires' originated in the hospital's water system, there have been another 24 cases of Legionnaires' reported at the hospital since January 2011 -- eight cases in which patients picked up the disease from outside the hospital and another 16 that the VA is not sure where patients contracted the disease.
One of the five who got Legionnaires' at the hospital has died, and the family of another patient who died thinks he may have contracted the disease at the hospital.
Ronald Voorhees, interim director of the Allegheny County Health Department, said the VA told his office that the victim was the one most recently confirmed with Legionnaires' disease, on Nov. 22.
Since then, the VA has refused to say anything publicly about that fifth patient, although they said the other four are recovering.
U.S. Sen. Bob Casey, D-Pa., said of the patient's death:
"This is a terrible tragedy. Our nation's veterans make great sacrifices to serve this country and they deserve the best care. The VA should act expeditiously to investigate these cases to ensure that every appropriate measure is put in place so this never happens again. The veterans at this hospital and their families deserve answers as to how this happened."
Earlier in the week Mr. Casey wrote to Veterans Affairs Secretary Eric Shinseki to express concern about the situation in Pittsburgh and to call on the agency to investigate the cause of the outbreak.
News of the 16 cases was distressing to two former VA Pittsburgh researchers -- Victor Yu and Janet Stout -- renowned Legionnaires' experts who left the hospital after a dispute with management in 2006 and 2007, respectively.
They believe that if the VA in 2006 had not destroyed three decades worth of specimens of Legionella they kept both from patients at VA Pittsburgh and other hospitals that the VA would have known definitively where all 29 cases originated.
If the thousands of specimens still existed, "we could go back to the freezer and pull (the Legionella isolates) out and compare them to the samples from the patients and analyze them on a molecular level and say definitively whether they acquired them from the VA or not," Dr. Stout said. "Part of the confusion now is they don't have those isolates to compare them to now."
VA Pittsburgh declined to answer any questions Friday about Dr. Stout and Dr. Yu's accusations.
The VA's announcement that there may be many more cases tied to the hospital greatly upset one Pittsburgh-area family.
The son and daughter of John Ciarolla, 83, said when their father died at the University Drive hospital on July 18, 2011, they were told the Legionnaires' disease he had was acquired during two, daylong visits at his daughters' homes more than a month earlier.
"They made us believe he caught it somewhere else," said Maureen Ciarolla, who lives in Monroeville, where her dad visited for a day at the end of May 2011. "We've all been feeling so guilty because we thought it was our fault."
Mr. Ciarolla also visited another daughter, Sharon Heinnickel, at her home in Greensburg on Father's Day, June 5, 2011. But that was the last time Mr. Ciarolla was outside either the nursing home at the VA's H.J. Heinz campus, near Aspinwall, or the hospital on University Drive, Ms. Ciarolla said.
In the months prior to his death, Mr. Ciarolla was in and out of the University Drive hospital for several long stays, always returning to the nursing home on the Heinz campus, his daughter said.
Ms. Ciarolla said she got angrier, still, when she read in a Pittsburgh Post-Gazette story this past week that the Legionella bacteria has a 14-day incubation period.
That meant that her father probably could not have acquired the disease from the home visits because they were much longer than 14 days before he was diagnosed with Legionnaires' disease during an emergency room visit to the University Drive hospital in early July 2011.
The VA refused to answer questions about Mr. Ciarolla's death.
After their father died, the two sisters were sent water sampling bottles to test the water in their homes.
Looking back, that upset Mr. Ciarolla's son, John, more than anything.
"I am annoyed that they had an ongoing problem down there, they never told us, and they sent us on a wild goose chase over it by giving us these water sample bottles," he said.
"I didn't believe that it came from [my sisters'] water. I still don't."
Ms. Ciarolla said she doesn't believe her father's case could be considered to be one of the eight cases that the VA confirmed came from the community because she and her sister never sent back their water samples.
"We already felt guilty. Neither one of us could deal with the fact that it might be our fault for taking him out of the nursing home," she said. "I would have never forgiven myself if I knew for sure. I didn't want to know."
The Legionnaires' outbreak at the University Drive Hospital was first confirmed by the VA on Nov. 16, when it said it had four cases that it knew started in the hospital. On Thanksgiving day, Nov. 22, it confirmed a fifth case.
While Legionnaires' cases occur regularly and are typically not fatal, the fact that this outbreak occurred at the University Drive hospital has generated additional attention because it used to be home to the research lab where Dr. Yu and his colleagues in 1982 confirmed that the disease is spread through water systems.
About 8,000 to 10,000 people each year are hospitalized with the disease, but the U.S. Centers for Disease Control and Prevention and other experts believe many more cases occur each year that go undiagnosed as simple pneumonia or other afflictions.
Legionnaires' can be fatal in 5 percent to 30 percent of cases, depending on who it strikes and where it is acquired.
Ms. Ciarolla said that her father's death certificate listed his cause of death as pneumonia, with no mention of Legionnaires' disease.
Dr. Yu and Dr. Stout believe that this outbreak occurred because since they left the VA, the water treatment system there that had worked so well for so long was mismanaged.
Dr. Stout said prior to this current outbreak, there was not one case of Legionnaires' disease at the University Drive hospital that was confirmed as being acquired in the hospital since 1997.
That was four years after she and Dr. Yu had a copper-silver ionization system installed to treat the hospital's water. Two weeks ago the VA declared that the outbreak was due to the failure of the copper-silver system and it was switching to a chlorination system favored by the CDC.
First Published December 1, 2012 12:00 am