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(87 people stricken by Legionnaire's Disease. 9 die and 1 survivor has
to get dialysis treatment 3 times a week. All because Flint was trying
to save money over the backs of poor people. What a criminal system.)
NY Times, Feb. 23 2016
Legionnaires’ Outbreak in Flint Was Met With Silence
By ABBY GOODNOUGH
FLINT, Mich. — It was the Fourth of July, a warm summer night in 2014,
but Tim Monahan was shivering in a thick blanket as he watched fireworks
from his front yard here. By the next afternoon his temperature had shot
to 104.6, and doctors at the hospital he had checked into puzzled over
what was wrong.
Two days later, they had an answer: Legionnaires’ disease, a virulent
form of pneumonia caused by a type of bacteria that can multiply in
water systems. Mr. Monahan, now 58, was given antibiotics and eventually
recovered, but his case turned out to be at the leading edge of a
Legionnaires’ outbreak that sickened at least 87 people in the Flint
region, killing nine of them, from June 2014 through October 2015.
State officials still say they cannot conclusively link the outbreak to
Flint’s contaminated water supply, partly because sputum cultures were
not collected from patients. But the possibility of a link was raised in
internal government emails as early as October 2014, and state officials
did not inform the public of the outbreak until last month.
The Legionnaires’ cases started popping up as Flint residents were
complaining about the foul-smelling, discolored water flowing into their
homes after the city switched to a new water source, the Flint River, in
April 2014. Soon they were reporting rashes and stomach ailments, and
whistle-blowers eventually pointed to alarming levels of lead in the
water supply and in children’s blood.
An examination of government emails, and interviews with people who
survived Legionnaires’ and relatives of those who died, shows the
government response to the Legionnaires’ outbreak followed the same
pattern that prevailed throughout the Flint water crisis: a failure to
act swiftly to address a dangerous problem or warn the public.
Even as more residents became critically ill with Legionnaires’ disease,
and some died, the officials remained mired in jurisdictional battles,
according to emails released by the Michigan Department of Health and
Human Services and the health department in Genesee County, which
includes Flint. Some at the state level seemed more concerned about
following bureaucratic protocol, and not raising public alarm, than
protecting residents.
Janet Stout, an expert on Legionnaires’ disease at the University of
Pittsburgh whom county health officials asked for help last year, said
she believed state health and environmental officials had impeded the
investigation — health officials by refusing to invite the Centers for
Disease Control and Prevention to dispatch experts to help with the
investigation, and environmental officials by not helping the county get
the answers it needed about Flint’s water.
“The people that were pushing this aggressively were at the bottom, the
county, and they were not getting cooperation from the levels above
them,” Dr. Stout said.
State health officials said the county had repeatedly rebuffed their
advice and offers of assistance during the outbreak, although they did
step in starting early in 2015. Jennifer Eisner, a spokeswoman for the
State Department of Health and Human Services, said that while it
“presented the Genesee County Health Department with the investigation
requirements,” the county “either did not fulfill them or did not
acknowledge a need for additional support from the state.”
‘A Ridiculous Tragedy’
The revelations in January about the extent of the outbreak left Mr.
Monahan and several others who contracted Legionnaires’ disease during
that period stunned and furious.
“What gets me is how fast the state has just denied — ‘We can’t prove
it’s the water,’ ” Mr. Monahan said. “I think they’re so afraid of tying
nine deaths to this. The whole thing is just such a ridiculous tragedy.”
Low levels of Legionella bacteria are commonly found in cold water
coming into buildings, and they usually do not make people sick.
Problems arise when the bacteria multiply in warm-water distribution
lines, with large buildings like hospitals and hotels at particular
risk. People get Legionnaires’ disease from inhaling mist that contains
the bacteria, or by getting contaminated water in their lungs by choking
on it, sometimes without notice.
The switch to Flint River water caused pipes to rapidly corrode, because
the city and state failed to treat it with anti-corrosion chemicals. Dr.
Stout said she believed the corrosion, combined with the dislodging of
other materials that typically line pipes, allowed Legionella to grow in
city water as it warmed over the summer in building distribution systems.
The state concluded that about 30 percent of the people who became sick
had no known exposure to Flint water in the two weeks before their illness.
Most of those who contracted the disease during those 18 months remain
anonymous. Some names emerged in court documents, as three Genesee
County residents who recovered from Legionnaires’, and the family of a
fourth who died from it, have sued McLaren Flint, a hospital that many
who fell ill with Legionnaires’ had visited in the two weeks before they
got sick.
The lawsuit says the hospital failed to “exercise reasonable and
ordinary care” to warn them of “dangerous conditions” there. It also
names as defendants several current and former employees of the State
Department of Environmental Quality, which has been widely faulted for
its slow response to Flint’s water crisis.
A spokeswoman for the environmental agency, Melanie Brown, said it
provided guidance to McLaren and another Flint hospital, Hurley Medical
Center, last year, after the first phase of the outbreak, identifying
“best practices.”
Among those suing McLaren is Connie Taylor, who has survived the disease
but at a tremendous toll: She now needs kidney dialysis three times a week.
A widow with diabetes, she was admitted to McLaren for stomach problems
in September 2014. She went home the next day, but within a week she
returned to McLaren complaining of exhaustion and chest pain.
A chest X-ray showed she had pneumonia, she said, and she was readmitted
to the hospital. Within days, she was transferred to the intensive care
unit, and doctors told her daughters that she might not survive.
“It just took me right down,” Ms. Taylor, 62, said. “They called my
family in from out of town. And then my kidneys failed.”
She left the hospital in late September — but without knowing she had
had Legionnaires’ disease. Only last month, when Gov. Rick Snyder’s
administration informed the public of the outbreak, did she request her
medical records and find that she had tested positive for Legionella
during her hospital stay, she said.
Ms. Taylor said she would require the dialysis treatments for the rest
of her life, unless she qualifies for a kidney transplant.
“This was something I didn’t have to go through,” she said, “and it’s
changed my life tremendously.”
Months Without Warning
No public announcement of an outbreak — or even a countywide warning to
medical providers — was issued in 2014 or 2015, an omission that several
infectious disease experts described as bewildering and highly unusual
given the number of cases.
In New York City last summer, health officials warned the public within
weeks about an outbreak of Legionnaires’ disease in the Bronx that ended
up being the largest in the city’s history. They also provided frequent
updates on the outbreak, which they traced to a hotel cooling tower
after matching Legionella samples collected from the tower and from
patients’ sputum.
In the Michigan outbreak, the state laboratory tested sputum samples
from only 11 of the 87 cases, Ms. Eisner said, adding that hospitals,
not the state, were responsible for collecting and sending them for
testing. She also said it was the county’s job to inform health
providers about the outbreak, a contention county officials have disputed.
Laurie Prochazka, a spokeswoman for McLaren, declined to answer specific
questions about the Legionnaires’ outbreak, citing the lawsuit. But in a
statement, she said that the hospital had “consistently followed all
statutory regulations and notification requirements” and that its water
“meets safety and quality standards.”
The hospital, which hired Dr. Stout as a consultant last summer,
recently announced steps it had taken to “safeguard and reinforce the
quality” of its water system, including installing five secondary water
disinfection systems at a cost of $300,000.
In state and county government offices, emails show mounting concern
over the outbreak, but bureaucratic inertia even as people like Ms.
Taylor were fighting for their lives.
As she was recuperating in October 2014, the Genesee County Health
Department was starting to ask officials in Flint and at the State
Department of Environmental Quality for help determining the source of
the outbreak, emails show.
Around the same time, the state health department appeared concerned
that the county’s investigation was falling short and that the state’s
efforts were being rebuffed. The department had “tried to offer our
services to Genesee and thus far have gotten very little information
and/or willingness to receive assistance,” a state epidemiologist wrote
in an Oct. 13 email.
Similarly, Genesee County officials were complaining about the response
of local officials. In March 2015, emails from county health officials
showed rising frustration about their unsuccessful attempts to get
information from Flint about its water. In an email in January 2015 that
had accompanied a public records request — and that was also forwarded
to the state — Jim Henry, the county’s environmental health supervisor,
said the increase in Legionnaires’ cases “closely corresponds with the
time frame of the switch to Flint River water.”
Forwarding the email to several high-level state officials, Brad Wurfel,
a spokesman for the State Department of Environmental Protection, called
it “beyond irresponsible” for Mr. Henry to suggest a connection.
On June 4, a state health official wrote in a memo that “the outbreak is
over,” angering county officials, emails from Mr. Henry show. In the
months after that pronouncement, 39 more Legionnaires’ cases were reported.
The state was angry that the county officials had bypassed it to request
help from the Centers for Disease Control and Prevention, including with
collecting and testing respiratory cultures from Legionnaires’ patients.
“I believe that C.D.C. is in agreement that their involvement really
should be at the request of the State, rather than the local health
department,” wrote Jim Collins, director of the state health
department’s communicable disease division, on June 8. He added that the
state had “not seen any information that would rise to the level of
warranting” such a request.
An Outbreak Advances
Kristen Nordlund, a spokeswoman for the C.D.C., said in a statement that
while the agency had provided “technical assistance via phone and email”
starting in February 2015, the state did not invite its experts to
Michigan until last month.
During the crucial months of 2014, the outbreak steadily advanced: five
cases were reported in Genesee County in June 2014, five in July and 10
in August. In all, 42 were reported from June through December 2014,
state reports show.
Debra Kidd of Burton, adjacent to Flint, came down at the end of July
with what seemed to be a migraine headache. Her son took her to the
emergency room at McLaren on July 25, and after a few hours of
observation and an injection to treat Ms. Kidd’s headache, they left.
But Ms. Kidd deteriorated over the weekend, said her son, Troy Kidd.
When she went to her own doctor on Monday, he sent her to a different
hospital, Genesys Regional Medical Center in nearby Grand Blanc.
There, Ms. Kidd, barely able to breathe, was put on a ventilator and
into a medically induced coma, Mr. Kidd said. Her illness was diagnosed
as Legionnaires’ disease the next day, and she died on Aug. 2, after her
family decided to take her off the ventilator. She was 58 and had been
in good health, Mr. Kidd said.
Mr. Kidd said he thought to connect her death with the Flint water only
after the state announced the outbreak last month. He now believes his
mother was exposed to Legionella bacteria in the McLaren emergency room
on July 25.
“Accountability has to be laid on somebody’s lap,” he said. “I want
answers; I want to know why.”
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