Iowa City VA Patients Not Told About Bacteria Problem
IOWA CITY, IA. Leaders of the Veterans Affairs hospital here plan to spend $6.5 million to combat a potentially deadly bacteria that has been found in the facility’s water pipes, but they have not informed patients about the problem.
Legionella bacteria can cause Legionnaires’ disease, a dangerous type of pneumonia. VA administrators confirmed to the Register that they’ve found the bacteria in several sinks and other water outlets in the past few years. But they said they’ve been able to control the problem, and they have not seen the need to cause alarm by telling patients.
“There’s a very, very low risk involved at these levels,” said VA pathologist Stacy Klutts, who is helping oversee the effort to resolve the problem. Klutts stressed that VA doctors have closely monitored patients for signs of the disease, and they have not found any infections.
Such assurances don’t satisfy Dick Allison, a Vietnam War veteran who uses the hospital and is a former employee. Allison learned about the Legionella bacteria from friends who remain on staff.
He’s upset that administrators aren’t being upfront with the public and letting patients decide for themselves whether they want to drink the hospital’s water or take showers in it.
Dick Allison, a Vietnam War veteran who used to work at the Iowa City VA hospital and still goes there as a patient, was upset to learn that the administration wasn’t notifying patients of Legionella bacteria in the facility’s water. The bacteria can cause the potentially deadly Legionnaires’ disease.
“I’m not looking to blame anybody, and I don’t want to hurt the VA. They’ve saved my life a couple of times,” he said. “I really think they’re making an effort to fix this. I only fault them for not telling people about it.”
The agency plans to replace all the plumbing in patient-care areas of the 600,000-square-foot hospital, starting next year. Several other VA hospitals nationally are undertaking similar projects, said Ed Ruppenkamp, chief engineer for the Iowa City VA hospital.
Allison, 65, who lives in the town of Washington, said VA employees who know about the issue have been quietly warning others. For example, he said, co-workers advised a pregnant nurse to drink only bottled water. Allison said he recently went to another hospital for a heart procedure because he didn’t want to risk infection.
He said he called the Iowa City VA a few months ago to inquire about the issue. Someone in administration called him back and said the bacteria had been found in just two spots a patient room and an ice machine. Allison said he knew the problem was more widespread than that.
Now he’s not sure what to think.
“That’s the whole problem,” he said. “When somebody lies to you once, you wonder if they’re lying to you about everything else.”
Engineer: ‘Trace’ of bacteria found
Legionella bacteria are common germs that can thrive in water pipes, especially in older systems in large buildings. They have caused several large and deadly outbreaks, including at the Pittsburgh VA hospital in 2011 and at University of Iowa Hospitals in the 1980s.
Experts say it’s impossible to completely eliminate such germs.
“Where there’s water, there’s life. That’s Microbiology 101,” Ruppenkamp said.
But Ruppenkamp described the positive test results as showing only “trace amounts” of Legionella, and he said the germs have not been found in the hospital’s main water system.
If there was a serious health risk, he said, patients would be notified and the facility would consider taking steps such as offering bottled drinking water. So far, he said, the VA has managed to keep the problem in check by aggressively testing the water and treating it with chemicals.
The staff also occasionally replaces pipes or puts special filters on individual faucets, he said. But the filters cost $100, restrict water pressure and have to be replaced often, he said. In areas with particularly susceptible patients, the hospital has installed devices that heat the water enough to kill bacteria, then cool the water back down.
Federal experts recommend that if the bacteria are found in a health care facility, steps be taken to “remediate” the problem, said Alison Albert, a spokeswoman for the federal Centers for Disease Control and Prevention. When asked if hospital leaders should notify patients in such a situation, Albert replied that it would be “a judgment call on their part.”
Lisa McGiffert, an analyst for the national group Consumers Union, said hospitals should be open with patients if there is a risk.
“If a patient gets Legionella while at the hospital, and the hospital didn’t provide at least general information to patients about what it knows about the bacteria being present in the water, everyone will say it should have,” said McGiffert, whose group publishes Consumer Reports magazine.
VA leaders said they would notify patients if there was a serious safety threat. Ruppenkamp said he’s confident there is no such threat.
“Do I drink the water? Absolutely,” he said. “Have I taken a shower here? Yes.”
Elderly and frail, smokers at risk
Experts say Legionella bacteria pose little risk to young, healthy people. The germs are most likely to sicken people who are elderly and frail, especially if they have immune-system problems or are smokers.
A VA staff member who is worried about the situation said that fact is troubling.
“Have you seen our patient population?” asked the staffer, who spoke to the Register on condition that he not be identified. He noted that many veterans treated at the VA are elderly and sick, and they come from a generation in which most people smoked.
The staff member said he and some co-workers drink bottled water at the hospital because of the Legionella situation. He said he’s been told there have been at least 23 positive test results for the bacteria.
When the Register asked a hospital spokesman about that estimate, he said the Register would have to make a formal request for records. The paper has done so, but federal officials often take weeks or months to fulfill such requests.
Iowa project follows Pittsburgh outbreak
VA officials came under intense criticism after a 2011 Legionnaires’ disease outbreak at the agency’s Pittsburgh hospital was blamed for six deaths. Critics, including some members of Congress, said hospital administrators didn’t do enough to protect patients after the germs were found in that hospital’s water.
Ruppenkamp, the Iowa City VA’s engineer, said the VA has been aggressively testing all of its facilities to prevent the Pittsburgh incident from recurring. He said the $6.5 million for the Iowa City pipe replacement project was included in a recent bill Congress passed to improve the VA system in response to the recent controversy over patient waiting lists.
Dr. Loreen Herwaldt, an epidemiologist for the University of Iowa Hospitals and Clinics who does consulting work for the VA, said VA patients should be comforted by the fact that the agency tests its facilities so aggressively. National guidelines call for such testing only if there’s reason to suspect the bacteria are present in a hospital, she said. But the Iowa City VA found the germs because its staff tested the water before any such evidence surfaced.
A spokesman for the Des Moines VA hospital, the only other one in Iowa, said his facility also regularly tests its water for Legionella bacteria and has never found any.
Is using water at your home a risk?
Positive test results for small amounts of the bacteria do not prove an imminent danger, said Dr. Patricia Quinlisk, the Iowa Department of Public Health’s medical director.
“If you look hard enough for Legionella, you will find it,” she said.
Quinlisk, who is not involved in the Iowa City VA situation, said health care facilities should be vigilant about Legionella, because they house so many susceptible people. But she recommends against routine testing for it in other settings unless there is a reason to suspect it’s causing disease.
“If you called me and said you tested your water at home and found Legionella, I’d say, ‘Yeah, I probably could find some in the water at my house, too,’ ” she said.
About Legionnaires’ disease
THE BACTERIA: Legionella bacteria are common in the environment, but they tend to become most dangerous when they colonize water pipes or cooling towers in large buildings, experts say. Legionella are particularly worrisome in hospitals and nursing homes, which are full of vulnerable people.
THE DISEASE: The bacteria can cause Legionnaires’ disease, a dangerous form of pneumonia. The disease and the bacteria are named after an outbreak among participants in a 1976 American Legion conference at a hotel in Philadelphia. The outbreak, which stemmed from a contaminated cooling system, killed 34 people. The investigation led to a greater understanding of the causes and treatment of the disease.
HOW INFECTION HAPPENS: The bacteria infect people who breathe in droplets of tainted water. Examples of how that can happen include when someone is taking a shower or sitting in a hot tub, or when someone coughs up a bit of water while drinking and then inhales it. Infections also can come from vapor from air-conditioning cooling towers.
WHO’S AT RISK: Serious illness is most likely in people who are elderly, who have been smokers or who have other chronic lung problems or immune-system issues.
NUMBER OF CASES: The federal Centers for Disease Control and Prevention estimates 8,000 to 18,000 Americans per year are hospitalized with Legionnaires’ disease. The Iowa Department of Public Health says about 13 Iowans are known to be hospitalized with it each year. The latest recorded death in Iowa was in 2012.
SYMPTOMS: They include coughing, fever, shortness of breath, muscle aches and headaches. Infections can be treated with antibiotics. Legionella bacteria also can cause a less severe illness called Pontiac Fever, which does not include pneumonia, the CDC says.
Tags: Veterans News
