Family not told about disease

Legionnaires' traced to water tank

hospital explains its handling

July 10, 1999|By Lisa Respers and Dan Thanh Dang | Lisa Respers and Dan Thanh Dang,SUN STAFF

Even as Harford Memorial Hospital officials said they acted properly in handling four cases of Legionnaires' disease, family members of a woman who died of the disease complained yesterday that the hospital delayed telling them about the infection.

Evelyn Blakely, daughter of Elizabeth M. Cox, 79, said the family was not notified when Cox was diagnosed with Legionnaires' disease July 2. They were not told that she had the disease until Thursday -- two days after she died from the disease, Blakely said.

"We're very upset we weren't told that it was in the hospital," said Blakely, 52, of White Hall. "If we had known there was a problem, we could have taken her to another hospital. You would think they would tell us that she was diagnosed with Legionnaires' disease."

Preliminary tests released yesterday confirmed that the hospital's hot water tank was the source of the Legionnella bacterium for three of four cases at the hospital. A spokeswoman for the hospital, when asked who was responsible for notifying the families, said the administration did its part by informing them as soon as test results of the water system were available.

"Communication between a physician and a patient is a complicated system that has many factors, and it would be totally inappropriate for us to speculate on how that communication worked in this case," said Debbie Egerland, a spokeswoman for Upper Chesapeake Health Systems Inc., which runs the hospital. "But as soon as we discovered the test results, we felt it was our responsibility to let her family know the part our water tank played in her illness."

The name of the physician was not available yesterday from the hospital or the family.

Legionellosis is a bacterial infection that can cause a very mild respiratory illness or severe pneumonia that can lead to death. Symptoms include a dry cough, high fever, chills, muscle aches, diarrhea, fatigue, headache and abdominal pain. The disease is spread by water droplets in the air and can develop in air conditioners, whirlpools, spas and showers. It does not appear to be spread by personal contact.

During a news conference yesterday, hospital and state health officials discussed the preliminary tests confirming the bacterium's presence at the hospital's water system and the Legionnaires' disease that killed two patients, including Cox.

Tests are continuing to determine whether a fourth patient, who was also diagnosed with the disease, contracted it at the hospital.

Hospital officials are on the alert for other cases of Legionnaires' disease but said yesterday there was no evidence of other infections.

State health officials yesterday said the hospital followed proper procedures in handling and investigating the four cases.

"As soon as the second case was diagnosed, the hospital worked closely with the [county and state] health departments to implement the recommendations on water culturing and treatment," said Dr. Diane Dwyer, chief epidemiologist for the Maryland Department of Health and Mental Hygiene.

The first case involved a patient who had been treated for an undisclosed illness and released. That patient was readmitted four days later, June 4, with pneumonia, said Dr. Peggy Vaughan, Harford Memorial's medical director.

When that patient did not respond well to antibiotics, the attending physician conducted a series of tests -- including one for the Legionella bacterium. Those tests led to a diagnosis of Legionnaires' disease June 8. The patient was treated with the antibiotic erythromycin and released.

Harford County health officials were notified. On June 25, a second patient was diagnosed with the disease. That patient, who also had been treated at the hospital earlier and released, died June 26, a day after being readmitted.

Officials have declined to release the names of the patients, citing state law regarding patient confidentiality.

Because the two patients had been discharged earlier, Dwyer said, hospital officials had no reason to suspect that the facility was the source of the infection until Cox and another unidentified patient were diagnosed there with the disease July 2.

"There were exposures to other sources of water. Therefore, it was not clear that the exposure came from the hospital itself," Dwyer said, referring to the first two patients. "On single cases that have multiple exposures, generally the Health Department does not do a full water investigation."

Between the first death and the third and fourth diagnoses on July 2, hospital authorities had begun to suspect a problem and notified county and state health officials.

On July 1, the state health department took cultures of the hospital's water. Two days later, the water system was heated to 150 degrees, and water outlets were flushed and chlorinated -- a precautionary procedure recommended by the state health department.

That day, the hospital said, nurses went to each room and explained to patients why the procedures were being done. The hospital also began using bottled water as a precaution.

But Blakely said her family was not alerted.

Cox originally was admitted to Harford Memorial on June 18 after she fell and needed stitches. But she returned to the hospital June 23 for blood tests for undisclosed reasons. Hospital officials informed family members that Cox developed pneumonia during her second stay.

Cox and a fourth patient, a woman in her 80s who was admitted June 28 from a Havre de Grace nursing home, were diagnosed with Legionnaires' disease July 2.

Sun staff writer Laura Cadiz contributed to this article.

Pub Date: 7/10/99

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