Health Alert Too Late, County Says

Los Angeles County health officials acknowledged Monday that they should have informed the public weeks ago about a Legionnaires’ disease outbreak at Good Samaritan Hospital, where nine patients became ill, including two who died.

Those health officials struggled to explain why they did not release information about the risk even though they knew that one of the patients infected with the respiratory ailment died in May. The second person died in June.

Doctors say it is unclear what role Legionnaires’ played in the deaths at the downtown hospital.

Some disease control officials said they withheld information to avoid public panic. But Dr. Thomas Garthwaite, director of the Los Angeles County Department of Health Services, said his agency should have released the information much sooner.

“I’ve always felt that you ought to be forthcoming, no matter what,” Garthwaite said. “It’s not a simple thing for a hospital that’s trying to stay in business. But it’s not fair to the public not to be aware what the challenges are.”

The county and hospital confirmed the outbreak Sunday night after a Times reporter received an anonymous tip and contacted them.

Good Samaritan officials stressed Monday that the problem is under control and that the hospital is safe for patients.

According to a timeline released by the county, health officials first learned of two cases of hospital-acquired Legionnaires’ at Good Samaritan in March. At that point, disease-control experts encouraged the hospital to test its water supply as the possible carrier. Those tests came back negative.

In May, the county became aware of two more cases, including the death of a 67-year-old man on May 12, and began its own investigation. Tests then showed the water system carried the bacterium for the disease, and the hospital took steps to decontaminate the plumbing system.

On May 25, a 55-year-old man entered the hospital with heart problems. He became ill with Legionnaires’ and died June 15, the county said. Officials have not released the identities of the deceased.

Dr. Thomas Shook, Good Samaritan’s chief of staff, said he doesn’t know how much Legionnaires’ contributed to the two deaths because both patients had other serious medical problems.

“They had kidney failure. They had diabetes. They had high blood pressure. They had severe cardiac disease,” Shook said. “I can’t tell you scientifically that the Legionella [bacterium] did not play a role, but there were many, many more serious problems on these patients’ problem list.”

All nine of the Good Samaritan patients were over 50 and had heart problems. Eight had cardiac procedures in the hospital that ranged from the insertion of a temporary pacemaker to coronary artery bypass surgery. And eight also spent time on the same floor of the hospital before becoming ill.

Fred Leaf, the health department’s chief operating officer, said his agency did not act quickly enough to alert the public. He said he did not know if a warning could have prevented other illnesses or deaths.

“Early on, we had enough that we could have done a simple press release that would have provided this information to the public,” Leaf said. “I do think Legionnaires’ is something of interest generally because it’s rather notorious from its initial identification” at a 1976 American Legion convention in Philadelphia. Twenty-nine people died in that outbreak.

Even while calling for more openness, Los Angeles County health authorities said Monday that ongoing investigations prevented them from disclosing the location of other infectious disease clusters. They said they would release more information only if they identified a compelling public reason.

Good Samaritan officials said they began holding forums for employees, volunteers and medical staff in April to educate them about Legionnaires’.

As far as the public goes, Shook said, “this is not something that merits broadcast information. In the big picture of hospital associated risks and so on, this is pretty small potatoes.”

A person becomes infected with Legionnaires’ by inhaling water droplets or mist containing the Legionella pneumophila bacterium. Those most at risk include cigarette smokers, people with chronic lung problems and patients who undergo major surgeries including transplants.

Nationally, Legionnaires’ disease affects 8,000 to 18,000 people annually. Most cases are acquired in the home or community, not health-care facilities. The disease is fatal in 5% to 30% of cases, according to the federal Centers for Disease Control and Prevention.

Symptoms include fever, chills and a cough. Some patients also have muscle aches, headache, fatigue, loss of appetite and diarrhea.

The Legionella bacterium is present naturally in the environment and can be found in hot tubs, water tanks, humidifiers, cooling towers and air-conditioning systems.

In other parts of the country that have dealt with recent Legionnaires’ outbreaks, health officials say keeping secrets undermines credibility. Pennsylvania health officials sent out news releases several times a day and held press conferences to keep the public informed during an outbreak last month.

“You don’t get into any trouble when you involve everybody and let everybody know,” said Dr. Joseph DiMino, director of the Montgomery County Health Department in Pennsylvania, where 12 people became ill, including two who later died. “When you try to hold something like that secret, when people find out, they think you’re lying.”

DiMino shut down the wing of the nursing home in which patients contracted Legionnaires’. He called the CDC and insisted that the agency send a team up to study the outbreak. After the nursing home was decontaminated, DiMino said, he even slept there to reassure wary residents and family members.

Experts said public health agencies are still learning about how and when to share information. Last fall, when anthrax anxiety gripped the country, health authorities were criticized for a slow initial response to calm public fears.

The lesson learned was that public health officials shouldn’t hold information back, said Stephen Morse, director of the Center for Public Health Preparedness at Columbia University’s Mailman School of Public Health.

In some cases, Morse said, public officials are reticent because they don’t want to bring bad publicity to a facility that may be working to solve the problem. “But I think there are many ways you can reassure people and provide reliable information without damaging the places where this is happening,” he said.

Some Legionnaires’ experts, though, said public disclosure of outbreaks may do more harm than good. Drawing attention to hospitals trying to solve the problem may discourage other facilities from finding out whether they have the bacterium in their water systems.

Los Angeles health officials acted appropriately to protect the public, said Dr. Jon Rosenberg, a medical epidemiologist with the California Department of Health Services.

“If you think that a hospital is unsafe for patients and it can’t be made safe, then you close it down,” he said. “By not closing it down, you’re saying that, to the best of your knowledge, it’s safe for patient care to go on.”