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County Orders Disease Notices

Health: Criticized for not disclosing Legionnaires' outbreak, officials vow to require hospital alerts.


Facing sharp criticism from the Los Angeles County Board of Supervisors, health officials said Tuesday that they will require Good Samaritan Hospital to alert all patients admitted since January about a recent Legionnaires' disease outbreak at the hospital.

And they vowed to mandate similar written notification in future outbreaks of that and other infectious diseases at all hospitals in the county.

County health officials have faced strong criticism for their decision not to promptly inform the public about the Legionnaires' outbreak at Good Samaritan, in which nine people became sick, two of whom died. Good Samaritan said the deaths--one in May, one in June--were not related to the hospital-acquired infections.

As the supervisors Tuesday expressed anger about the delayed disclosure, the county's health chief pledged to send inspectors into hospitals unannounced to ensure that they are reporting disease outbreaks as required by law. The names of hospitals cited for violations would be made public, said Dr. Thomas Garthwaite, director of the county Department of Health Services.

"It's important to make sure that we're looking aggressively at the infection control procedures in hospitals," Garthwaite told the supervisors. He said in an interview that he may need additional staff to conduct the surprise inspections, which are expected to begin within three months.

Good Samaritan, an independent nonprofit institution, said it will follow the county's order to notify patients, provide information about the symptoms of Legionnaires' and encourage people with questions to contact doctors. Those letters will be sent to patients admitted after Jan. 8 and continue with all new patients until testing and decontamination are completed. Previously, the hospital has held information sessions for physicians, employees and volunteers.

No new cases of hospital-acquired Legionnaires' have been reported since mid-June, leading the hospital and county to say that the outbreak has been contained.

However, Good Samaritan officials said Tuesday that they still are working to rid their water system of Legionella pneumophila bacteria, which causes the infection. The hospital is conducting a chlorine flush of its plumbing system this week after tests showed that an earlier superheated water flush did not eliminate traces of the bacteria in the system.

"We think we have gone beyond, even beyond the recommendations of the department of public health, to eliminate this bacteria," Good Samaritan Vice President Sammy Feuerlicht said.

As a precautionary measure, the hospital is serving some patients bottled water and giving them sponge baths, instead of letting them shower. The hospital is testing all incoming patients with pneumonia-like symptoms for Legionnaires' disease, and it has found some patients who acquired the infection outside the hospital.

Supervisor Gloria Molina focused her criticism on county employees, not the hospital.

"You have a real problem in public health," Molina said. "Heaven forbid that anthrax comes in to this community.... They're going to keep it in their shorts before they tell anyone else. That's inappropriate."

Garthwaite said his department acted quickly to discover the cause of the outbreak and respond to it, but he faulted the way he and the public were notified. Garthwaite said he did not learn of the outbreak until June 30, the day before The Times reported it.

According to a county-produced timeline, public health officials learned of the first case of Legionnaires' at Good Samaritan on Feb. 26.

"There has been a culture in the health department that they know better than the public," said Supervisor Zev Yaroslavsky, "that the public is just a bunch of boobs that aren't equipped to handle bad news."

John Schunhoff, chief of operations for county public health, said his agency needs to change. Local public health officials previously have been accused of withholding information on outbreaks, including contaminated strawberries that made children sick in the late 1990s.

"There's been a traditional tendency to err on the side of not disclosing, as opposed to disclosing," Schunhoff said. "We're going to change that culture."

Supervisors Molina and Mike Antonovich pressed Garthwaite for a written policy on how he will handle future disease outbreaks. They also asked him to report on corrective actions and discipline taken against employees who decided not to inform the public about the Legionnaires' outbreak.

"Keeping the outbreak from the public, the department raises suspicions of a cover-up," Antonovich said.

Since the Legionnaires' story broke, Garthwaite has required that public health officials tell him of all disease outbreaks so he can personally decide which ones to make public. So far, he has not released information on any of them.

"There's too much latitude [within the public health agency] to decide which infections they're investigating ought to be bumped up the chain," he said.

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