Legionnaires’ in Illinois

“When one [veteran] died, it was enough," said Erica Jeffries, director of the Illinois Department of Veterans’ Affairs at the General Assembly’s veterans affairs hearing on January 9, 2018 in Chicago. The hearing was to discuss the persistent outbreaks of Legionnaires’ disease at the state-run Illinois Veterans’ Home in Quincy, Illinois: in the past three years, thirteen veterans have passed away from the disease at the home, and sixty-one residents and staff members contracted it.

Legionnaires’ disease is a type of pneumonia caused by Legionella bacteria and is transmitted by vapor from sources like air conditioning, water pipes, and water tanks. Patients are diagnosed by detecting the bacteria in urine, blood tests, or symptomatic pneumonia. When detected, antibiotics can be prescribed, and patients typically recover. However, the elderly are particularly susceptible due to weakened immune systems, which is why Legionella bacteria is especially dangerous in nursing homes.

Sam Posner, Associate Director for Epidemiological Science at the Center for Disease Control, reported that nationally there were six thousand reported cases of Legionnaires’ disease last year—five thousand cases more than the year before. Three hundred of those cases were in Illinois. It appears that incidences of Legionnaires disease are on the rise across the country because of aging infrastructure. Pipes become corroded with age from regular water flow, which damages the protective lining and exposes the iron in the pipes to the water. Legionella bacteria use iron as a fundamental nutrient. The corrosion allows water to leach the iron from the pipes making it available for the bacteria to boost its production. Additionally, the iron reacts and inactivates chlorine disinfectant in the water that is supposed to kill harmful bacteria like Legionella. It comes as no surprise then, that the rampant outbreak occured at the Illinois Veterans’ Home, which is a 130-year-old facility.

The first outbreak, in July 2015, took the lives of twelve residents. A year later, Jeffries released a statement attesting to the utmost quality and cleanliness of the water in the home; unfortunately, the legionella bacteria that cause Legionnaires’ disease are very difficult to eradicate. In the fall of 2017, more residents at the home tested positive, and one—a Korean War veteran—passed away.

The hearing held earlier this month addressed not only how to prevent more deaths from Legionnaires’ in the home, but also to discuss possible negligence by the staff. Additionally, considering the outbreak has persisted for three years now, the hearing discussed the fate of the Illinois Veterans’ Home and how best to keep the resident veterans safe.

The hearing began with a moment of silence for the veterans who passed away. American Legion Post 37 honor guard were present to honor the lost veterans. The audience was full.

Dr. Nirav Shah, Director of Illinois Department of Public Health, opened his statements with his goal to provide the committee with a “full and transparent look” at the veterans’ home’s response to Legionnaires’ disease. Even though State Senator John Cullerton, current residents, and staff members testified to the high quality of care at the facility, the hearing committee wanted to investigate possible negligence that resulted in the tragic deaths.

The committee first reviewed the actions by Shah and the Department of Public Health after the first outbreak of Legionnaires in 2015. The facility underwent a 6.4 million dollar emergency state-funded upgrade to the water pipes and plumbing system, and the renovation included new water heating technology, chemical treatments, and filters to ensure clean water. After these renovations, Jeffries said that the Illinois Veterans’ Home has “the cleanest water, probably, in the state.” However, perhaps she spoke too soon: legionella bacteria rebounded a year later, and reopened review into the veterans’ home.

Jeffries appears open to any ideas moving forward—including building a new facility, renovating the old facility, or renovating the recently closed Kent building on the Quincy campus. However, nothing was definitely decided at the hearing. The renovations or the new building would cost hundreds of millions of dollars, but, despite the high price tag, many representatives are on board. Fiscally conservative Representative David McSweeney said, “Build a new facility in Quincy on the current site, use Kent if that works, or look at other alternatives while we’re at it . . . I’ll vote for that bill.”

However, even if a new building is in the cards for the Illinois Veterans’ Home, the hearing committee still must decide on short-term plans for the facility and its residents.

As 40 percent of the residents have dementia, it would be very difficult to move them to a different location. Jeffries and Governor Bruce Rauner assured the hearing committee that the Veterans’ Home is safe for the residents, and the Governor sought to prove this by living in the home for a week, drinking and showering with the facility’s water. Additionally, the Center for Disease Control has never recommended moving residents after a legionella bacteria outbreak.

The fact remains that the residents need to be protected from future outbreaks. Plans were outlined to install new shower heads to trap bacteria. Residents’ temperatures are taken every four hours to ensure that the residents are healthy, safe, and comfortable. Jeffries also reports that the Illinois Veterans’ Home has their water tested three thousand times each month. She also brought it to the attention of the hearing committee that the nursing staff of the facility has been cut in half, and argued that it would be much easier for the home to monitor every resident with sufficient staff.

Despite the reports of high quality care, Representative Stephanie Kifowit shares, “We have reports of an individual being given Tylenol for multiple days,” rather than the appropriate antibiotics. Further investigation on the allegations of improper care is to come.

Additionally, Shah and Jeffries were questioned by the committee on why the facility waited five days to inform the governor and the public about the recent outbreak. They responded that the information was not released immediately in order to ensure the correctness of their facts and they did not want to cause hysteria. Shah also cited other cases of Legionnaires’ in which a publicly released statement was delayed.

However, as was expressed at the hearing, families of the residents deserve full transparency. Kifowit also noted that no public notice was made even after five reported cases of Legionnaires’ disease. In response, Jeffries claimed that the delay in notifying the public was to ensure the correctness of their facts. The CDC was notified thirty-six hours after the first instance of Legionnaires’ outbreak.

In the end, there was no conclusion regarding the facility’s possible negligence. However, the committee agreed that in the future the families of the residents and the public should be notified sooner of a health problem.

Committee members left with plans for a second hearing on February 7 with members of the governor’s office present. The only unanimous consensus was that the facility should be much more proactive instead of reactive when dealing with water safety and with the overall care of the residents.

The image featured in this article is licensed under Creative Commons. The original image can be found here.