Kanes fight $260,000 federal fine over Legionella contamination

Allegheny County officials are appealing a $260,000 federal fine for problems related to Legionella bacteria contamination at the county’s Kane Regional Center-McKeesport nursing home, which has had three patients test positive for the infection since October.

The Centers for Medicare & Medicaid Services imposed the fine last month as a result of an inspection of the Kane-McKeesport facility by the Pennsylvania Department of Health in late October that identified numerous deficiencies. Some of those related to infection control, and particularly to the Oct. 20 hospitalization of a patient who was diagnosed with Legionella pneumonia.

The state separately fined the facility $9,750 based on the inspection findings. Among various problems cited, the report faulted Kane-McKeesport for failing to retest its water supply after a private company’s annual Legionella test in July found levels of bacteria that required cleaning water system components such as faucets and shower heads to protect patients’ health.

The federal CMS agency relies on state inspectors to evaluate nursing homes to ensure they are following government regulations, but it independently decides on any penalties for facilities risking the health and safety

of patients by non-compliance. It is common for state and federal regulators to impose different penalty amounts, and even to disagree on whether any penalty is warranted, but the federal fine in this case is unusually higher than the state’s.

Dennis Biondo, executive director of the four Kane Regional Centers, said during an interview Tuesday that the county would be paying the state fine but has challenged the federal one as unjustified. He has been with the Kanes since 2004, and he said no prior federal penalty has approached the new one in scale.

CMS officials were unavailable Tuesday to discuss the fine.

Legionella bacteria can result in a waterborne respiratory illness with pneumonia-like symptoms. It is potentially fatal, particularly with vulnerable elderly individuals. It was responsible for six deaths in Pittsburgh Veterans Affairs hospitals in 2011-12, and the term Legionnaires’ disease came from a 1976 Philadelphia hotel outbreak that killed some two dozen American Legion conventioneers.

None of the three recent cases has been fatal at Kane-McKeesport, Mr. Biondo said. The state’s annual inspection occurred before the latest two cases. Pennsylvania Health Department spokeswoman April Hutcheson said she was not permitted to comment on whether those have been under investigation, but Mr. Biondo said he is unaware of any such inquiry.

He said patient confidentiality restrictions prevent him from going into detail about the cases, but that they consist of: the patient hospitalized in October who was referred to in the state inspection report; a resident who first tested positive at the nursing home itself in December but tested negative in a subsequent urine sample and never required hospitalization; and a third case in March involving a man who was at the nursing home a few days before being hospitalized and testing positive.

“We think it’s something he brought in with him,” Mr. Biondo said of the latest case, stating that in none of the cases has it been proved that infection took place at the nursing home instead of elsewhere. Many facilities’ water systems can contain the Legionella bacteria, and the question is whether the levels are high enough to be harmful.

“The science is very muddled” on the best procedures health care facilities can and should use to avoid contamination and illness, Mr. Biondo said. He said environmental and infection control staff at the nursing home last summer used recommendations from the Allegheny County Health Department in cleaning the facility in response to the Legionella testing, and those recommendations did not call for the kind of retesting the state says should have been done.

Since then, as a result of the cases that have been diagnosed, county officials have reported taking numerous steps such as new testing, cleaning and replacement of various water system components and installation of special treatment systems at all of the Kanes.

For a long-term solution, the Kanes have hired Garratt-Callahan, a private firm based in California, to evaluate the entire system and develop a plan specific to Legionella control. Representatives of the firm, which advertises itself as the largest privately owned water treatment company in America, are in the middle of developing that plan with county officials, Mr. Biondo said.