Sixth victim 'probably' contracted disease at Pittsburgh VA hospital

By SEAN D. HAMILL | Pittsburgh Post-Gazette | Published: February 24, 2014

PITTSBURGH — Pittsburgh Veterans Affairs officials recently told the family of a deceased Delmont veteran that they have changed the status of his Legionnaires' outbreak case from not hospital acquired, to "probably" hospital acquired, the daughter of the man and her attorney said this past week.

The move, which VA officials revealed to the family in a disclosure meeting on Feb. 6, follows the findings of a Pittsburgh Post-Gazette investigation last July that first found that Frank "Sonny" Calcagno, 85, had most likely contracted Legionnaires' disease at the Pittsburgh VA, not Forbes Regional Hospital where he died on Nov. 23, 2011.

"I already knew it, but I felt relieved that they admitted it," said Debbie Balawejder, 58, of Monroeville, Calcagno's daughter. "Because we all know, and have known, that that's where he got it."

But while that admission came from the Pittsburgh VA, which apparently did additional research to reach its conclusion, the federal agency that made the original analysis for Calcagno's case refuses to admit it made an error.

The federal Centers for Disease Control and Prevention said in an emailed statement Friday that, at the request of U.S. Sen. Bob Casey, D-Pa., last August, it had re-reviewed all of the original cases it found at the Pittsburgh VA, including Calcagno's case.

"We compared the case information, including disease onset dates, collected during the November 2012 investigation to what was described in CDC's investigation report. We did not find any discrepancies in our files from the original investigation that would change how cases were classified," the statement said in part.

How it did not find any discrepancies with Calcagno's case was because in its re-review, the CDC apparently did not seek additional information on any of the cases, including the information the Post-Gazette obtained last year, or information the Pittsburgh VA apparently obtained.

The Pittsburgh VA, which refused comment for this story, had previously conceded that five other veterans had probably or definitely contracted Legionnaires' disease during stays in VA buildings before they died in 2011 and 2012.

Those findings were based on the CDC's fall 2012 review of VA case data and documents of 32 veterans who were patients at the Pittsburgh VA in 2011 and 2012 and had tested positive at some point for Legionnaires', an often deadly disease that is transmitted by inhaling water or water vapor contaminated with the bacteria.

The CDC report found that, in all, 22 of the men (one was added after the original report) were probably or definitely sickened with the disease at the VA, and five of them died.

Calcagno was one of the 11 veterans whom the CDC classified in the report as not having contracted the disease at the Pittsburgh VA.

But the Post-Gazette's investigation found that CDC investigators made a crucial error in assessing Calcagno's case.

A case review document showed that investigators had considered the date of onset of Legionnaires' to be Nov. 5, 2011, when Calcagno was by then a patient at Forbes.

The CDC said as part of its statement Friday: "Per our classification scheme, the patient's date of diagnosis (November 5, 2011) was used as the disease onset date because no other date was recorded."

That may have been true, but the case review document clearly shows Nov. 5 was not the date of onset; it was the date that a positive Legionnaires' test was returned and Calcagno was diagnosed as having the disease.

It would be almost impossible for the date of onset, diagnosis and a positive test result to come back all on the same day, and it was likely that the date of onset was much earlier than Nov. 5.

That was important because under the CDC's analysis, it was counting backwards 14 days from the date of onset to see if a patient was in the Pittsburgh VA as a way to determine if he contracted the disease there.

Counting 14 days backwards from Nov. 5, 2011, only took Calcagno's case back to Oct. 22, 2011 — the second day after he was admitted to Forbes.

He was admitted to Forbes the same day he had been discharged from the Pittsburgh VA following a seven-week stay there for several medical issues. He had been home only about two hours on Oct. 21, 2011, before his daughter decided he was still so sick he had to be readmitted, and Forbes was closer.

A spokesman for Forbes last year insisted that the hospital was sure that Calcagno had not contracted Legionnaires' there, but he would provide no additional information about Calcagno's case.

But Forbes apparently provided additional information to the Pittsburgh VA.

During the disclosure meeting on Feb. 6 with Ms. Balawejder, the Pittsburgh VA's chief of staff, Ali Sonel, told her that her father's date of first testing for Legionnaires' was Nov. 2, 2011 — three days earlier than the CDC had listed it.

Counting backwards 14 days from Nov. 2 puts the earlier possible date of onset as Oct. 19, when Calcagno was a patient at the Pittsburgh VA.

John Zervanos, Ms. Balawejder's attorney in her family's civil lawsuit against the VA over her father's death, said he was not surprised the VA admitted the mistake "because I have the [medical] records and this guy had all the signs and symptoms of pneumonia or Legionnaires'."

What he was surprised by, he said, was the Pittsburgh VA's "candor in recognizing what was a case and what was not a case."

Mr. Casey, who asked for the re-review of all the Legionnaires' cases last August after the Post-Gazette's finding in Calcagno's case, said Friday said he too was pleased that the VA "has that kind of accountability."


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