In New Letter Casey Presses VA for Specific Answers on Legionnaires’ Outbreak

Casey First Pressed VA For Explanation, Yesterday In Personal Call To Secretary, Senator Secured Commitment from VA To ‘Get To The Bottom’ Of Outbreak

Questions Still Remain About How Outbreak Occurred, Steps That Need To Be Taken To Ensure Future Safety of Water

Washington DC- Today, U.S. Senator Bob Casey (D-PA) released a new letter to the Department of Veterans Affairs pressing the agency for specific answers as to how the outbreak of Legionnaires’ occurred at the Pittsburgh VA and what steps are being taken to ensure veterans at the facility and across the state have clean water. As the outbreak occurred, Senator Casey first pressed the VA to provide a clear explanation of the situation. Yesterday, in a phone conversation with VA Secretary Eric Shinseki, Senator Casey secured a commitment from the Secretary to get to the bottom of how the outbreak occurred and to improve communications with the public. Today’s letter from Senator Casey reflects the reality that specific questions remain unanswered.

“As more troubling reports emerge about the outbreak of Legionnaires’ at the Pittsburgh VA, the Department of Veterans Affairs owes patients and the community answers,” Senator Casey said.  “Our veterans deserve the best care and the idea that some were sickened and eventually died from unclean water is truly shocking and requires a full accounting from the VA.”

In November, an outbreak of legionnaires’ disease began at the Pittsburgh VA as a result of unclean water. When the outbreak occurred, Senator Casey called on the VA to explain how the outbreak occurred and outline steps to ensure veterans have clean water. Since the initial outbreak, there have been deaths linked to legionnaires and significant concern in the community Furthermore, the water quality of at least one additional site has been called into question.

The full text of Senator Casey’s letter is below.  

The Honorable Eric K. Shinseki

Secretary

Department of Veterans Affairs

810 Vermont Avenue

Washington, DC 20420

Dear Secretary Shinseki:

I appreciated the opportunity to speak with you yesterday regarding the outbreak of Legionnaires Disease at the VA Pittsburgh Healthcare System and your commitment to getting to the bottom of how this outbreak occurred.  As I mentioned on that call, I would be following up with additional questions.  The fact that there has been at least one confirmed death connected to this recent outbreak and the continued investigation of further illness is both tragic and deeply disturbing.  These men and women have made extraordinary sacrifices for our nation, yet we have failed in our duty to provide them with the quality of care that they have earned and deserve.

The Veteran’s Administration has an obligation to address ongoing concerns and to ensure that proper steps have been taken to prevent this from ever happening again.  Included within this letter are the specific questions that I would like to bring to your direct attention.

  • What specific steps has the VA taken to ensure the VA Pittsburgh Health System’s water system is safe and operational?  How have you guaranteed it is indeed safe and how have you communicated that to patients and staff?
  • Prior to the week of November 12, 2012, what, if any, periodic tests were conducted to determine bacteria levels in the VA Pittsburgh Health System’s water system?  Please provide the results of any such tests going back to January, 2011. 
  • On what date did officials at the VA Pittsburgh Health System first become aware of elevated bacteria levels in the water system which gave rise to the outbreak of Legionnaires Disease? Please provide the results of any tests underlying this determination. 
  • On what date did officials at the VA Pittsburgh Health System convey their concerns about elevated bacteria levels to VA officials in Washington, DC?
  • Please provide a timeline and description of all actions taken by the VA, beginning with when it became aware of elevated bacteria levels, to when it stated to investigate and control the outbreak of Legionnaires Disease at the VA Pittsburgh Health System.
  • Please provide a description of all procedures and protocols for routine examination and maintenance of the water system at the VA Pittsburgh Health System.
  • Please provide a description of all deferred maintenance items in connection with the water system and a schedule of when the VA plans to address these items. 
  • Is the VA doing an internal investigation of the water system within the Pittsburgh VA Health System?  If not, why?  If yes, when will it begin and when how long do you expect it to take?
  • What Legionella pneumophila serogroup number was detected at the Oakland, VA facility?
  • What specific actions are taking place to ensure that this incident is not repeated in Pittsburgh, or any other VA facility? 
  • How was the system being monitored and what corrective actions have been taken to prevent this from ever happening again?  Who is in charge of monitoring the water systems, and what are your procedures when bacteria like Legionnaires’ is detected?
  • The office has heard from family members that were treated at the Oakland facility, that patients were not bathed for days.  I have been informed that the Aspinwall and Highland Drive facility is currently undergoing testing and the water is shut off. What actions are taking place to ensure patients and employees are well cared for and not being put at additional risk while the water system is shut off?

I would like to request a complete briefing following your review of these issues.  Thank you for your personal attention to this matter. 

Sincerely,

Robert P. Casey, Jr.

United States Senator

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