State orders McLaren to fix conditions on Legionella

Karen Bouffard and Jim Lynch
The Detroit News

State health officials on Tuesday ordered McLaren Flint Hospital for the second time in a little more than a month to “correct conditions” to reduce the presence of bacteria that causes Legionnaires’ disease.

The Michigan Department of Health and Human Services said McLaren Flint has “consistently failed to provide sufficient information” to verify it has implemented and complied with U.S. Centers for Disease Control and Prevention recommendations. The state said it would conduct independent testing and asked for extensive amount of documents back to Jan. 1, 2016.

“McLaren Flint’s response has been insufficient to demonstrate that the threat of healthcare-associated Legionella within its facility has been addressed,” HHS Director Nick Lyon said in the order.

There is reasonable belief that the hospital’s water system “is a nuisance, unsanitary condition or cause of illness,” Lyon said.

McLaren said it has already provided “much – it not all – of the information outlined in the order” and plans to carry out the state’s request.

“Despite the fact that dozens of Legionnaires’ Disease cases have been reported in patients that have had absolutely no contact with our facilities, and despite the growing consensus among public health and infectious disease specialists that the City’s use of the Flint River as a water source is the prime contributor to our community’s Legionnaires’ Disease epidemic, the State refuses to broaden its perspective and hold itself and others accountable for the inaction of prior years,” the medical center said in a statement.

Ninety-one people in the Flint area were sickened by Legionnaires’ disease during the summers of 2014 and 2015, including 12 who died.

The sparring happened as the state released along with its order a Dec. 23, 2014, letter in which a consulting firm told McLaren Flint that the city’s water system was “not contributing” to Legionella problems at the medical center. The Dec. 5-19, 2014, testing found no Legionella at detectable levels.

“It seems that the supply water coming from the city of Flint is not contributing to the Legionella issues at McLaren and that any issues are likely internal to the hospital system,” Environmental Testing & Consulting Vice President Jeremy Wescott wrote in the letter.

Several prominent scientists — including Virginia Tech Professor Marc Edwards, who uncovered lead in the city’s water system — have blamed changes in Flint’s city water system for the Legionnaires’ outbreak.

Wescott would not comment Tuesday on the firm’s work for McLaren.

Legionnaires’ disease most often strikes in warm weather months that help foster the growth of Legionella bacteria in large water systems and other water sources.

Consultant’s letter released

State health officials said they were not aware McLaren had contracted an outside consultant in 2014 until last month. And they didn’t learn about it from the hospital. It’s the second piece of evidence state health officials have presented so far to bolster their contention that McLaren was the source of the Legionnaires’ outbreak.

The Department of Health and Human Services in January announced that one of the 91 cases had positively linked to McLaren through genetic testing.

A University of Pittsburgh expert specializing in Legionnaires’ disease hired by McLaren said last year the hospital’s issues with the respiratory disease likely were caused by the city’s water supply after it switched to the Flint River from the Detroit water system as its source in April 2014. Legionnaires’ cases began emerging that June.

Edwards said the corrosive nature of the Flint River depleted bacteria-fighting chlorine residuals in the water. It also ate away at the pipes, filling the water with iron and rust, nutrients that Legionella fed on. At the same time, the temperature of water in the system increased slightly because the Flint River is warmer than the city's previous source, Lake Huron.

McLaren said it shared all of its water testing results with Genesee County officials for the past three years.

“McLaren has provided hundreds of testing results to the State in that time, yet this one result is the focus of their attention after three years,” a hospital spokeswoman said.

The letter reflects 15 days of municipal water samples — “a snapshot in time and does not reflect conditions at any other time period, including from warmer months,” McLaren’s representative said.

The state didn’t alert the public to the Flint area Legionnaires’ outbreak until Gov. Rick Snyder did so in January 2016. State officials told at least six Environmental Protection Agency officials in late March 2015 that the public would be alerted about the Legionnaires’ outbreak, according to state-provided emails, but a Michigan health official told the CDC two months later that “the outbreak is over.”

The email outlining the testing and its findings was included among hundreds of pages turned over to HHS by the Genesee County Health Department in January, said Health and Human Services spokeswoman Angela Minicuci.

“Our biggest concern relating to the letter is that ETC had given McLaren an indication at the end of 2014 that there was an issue with exposure to Legionella internal to their water system,” Minicuci said in a Tuesday email to The News. “That combined with the increasing number of cases associated (with) their facility in 2014 and 2015 show an ongoing risk to residents at their hospital that may have resulted in cases as recently as November 2016.”

According to state epidemiologic studies, McLaren Flint was associated with 21 Legionella cases in 2014, 29 cases in 2015, and two cases in 2016. They say the facility accounted for 52 out of 54 hospital health care-associated Legionella cases in Genesee County over this period, including 45 out of 46 inpatient cases.

In addition, 10 of the 12 deaths in the 2014-15 Legionella outbreak were associated with the McLaren Flint hospital, according to the state.

State focuses on McLaren

“It's difficult to say how knowing about ETC’s testing at McLaren would have impacted the overall outbreak, especially since we continue to request additional data and testing information from McLaren at this time,” Minicuci said.

“That said, given that more than half of all cases and the majority of health care-associated cases during the outbreak were associated with their facility, this further underscores the ongoing concerns we have relating to protecting residents from potential exposure to Legionella at McLaren Flint.”

The department in January ordered McLaren Flint hospital and the Genesee County Health Department to take “immediate action” to reduce the risk of Legionnaires’ disease at McLaren, prompting a backlash from the hospital and county health officials.

The Genesee County Health Department was not included in Tuesday’s order and did not immediately respond to an email seeking comment.