Jan
19
2015
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An article posted last week in the NY Sun discussed the CDC’s errors in recent public health issues including its response to Ebola.  The article calls Ebola a “wake-up call, because the CDC has been fumbling its most important jobs for several years. ”

The article goes on to discuss  multiple public health topics in the US including domestic preparedness, lab safety, the dangers of inaction regarding Legionella, hospital superbugs, and the CDC’s confusion in its mission.

“Deadly inaction on Legionella: The CDC has chosen to ignore Legionnaire’s Disease, rather than control or prevent it. It’s a type of pneumonia you can only get from water in contaminated pipes. Europeans routinely test their pipes for the bug, which is easily eradicated. The CDC, in contrast, opposes testing until tragedy strikes, like the 2012 outbreak at the Pittsburgh VA that killed five. As a result, the problem has more than quadrupled in the last decade. Amazingly, the CDC doesn’t even have current data on Legionnaire’s Disease, though Paul Edelstein of the University of Pennsylvania estimates that it infects more Americans each year than HIV.”

To read the entire article, please click here.

Posted by jzacher">jzacher at 5:47 pm
Jan
15
2015
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coopcity_areial bronxAn outbreak of at least eight Legionnaires’ disease cases occurred at Co-op City, an apartment complex in the Bronx, last month December 2014.

The health department held a meeting at Co-op City on Tuesday to discuss the issue with residents.

Brenda Hines, whose son contracted Legionnaires’ disease said “I was shocked, horrified, because he was in the ICU with it forever, at least nine days with it.  So it was very, very scary.”

According to Jeff Buss, general counsel for Co-op City, the health department contacted Co-op City in order to conduct an investigation and test for Legionella.  Testing revealed that Legionella was present in the cooling tower.

Co-op City was ordered to decontaminate the towers and shut them down.

Co-op City has experienced cases of Legionnaires’ disease in past years as well, which leaves residents concerned about their health.

To read more about this story, please click here.

Legionnaires’ disease is a form of pneumonia that is contracted when a person inhales tiny water droplets contaminated with the bacteria.  It is not commonly contracted through drinking water.  The first incidences of Legionnaires’ disease were identified in 1976 in Philadelphia at the Bellevue-Stratford Hotel during a Legionnaires’ convention due to a contaminated water cooling tower.  During this convention, a total of 221 people contracted the illness, 34 of whom died.

Posted by jzacher">jzacher at 5:40 pm
Jan
06
2015
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The Hong Kong Centre for Health Protection (CHP) of the Department of Health is investigating a case of a 67-year-old man who contracted Legionnaires’ disease.

The man was admitted to Tuen Mun Hospital on January 1, 2015 after experiencing fever, tiredness, and shortness of breath on December 29, 2014.  The patient was first diagnosed with pneumonia; further testing showed that he had Legionella pneumonia.

The investigation has revealed so far that his case of Legionnaires’ disease may be travel-associated as he was visiting Guangdong Province from December 21-23, 2014.

To read more about this case, please click here.

Posted by jzacher">jzacher at 3:57 pm
Dec
15
2014
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Hotel Exterior

Legionella bacteria were discovered in the water system of the four-star Tel Aviv Hilton Hotel after three patients were diagnosed with Legionnaires’ disease.

According to the Israeli daily Haaretz, all three patients were reported to have used the showers and bathroom of the lower floors of the Hilton Hotel.  It appears that the lower floors of the hotel have a separate water system than the system associated with the hotel rooms.  The Health Ministry has since urged the hotel to address the issue of the bacteria’s presence.

To read more about this story, please click here.

Posted by jzacher">jzacher at 2:23 pm
Dec
12
2014
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According to investigators at the Texas Department of State Health Services, an infant in Texas died a few weeks after being born due to a Legionella bacteria infection.  The bacteria are commonly found in warm water in hot tubs and water systems.

The baby was born in a heated birthing pool at home and taken to the hospital six days later due to breathing problems and other signs of an infection.   The infant ultimately died in January 2014 after being hospitalized for 19 days.

In July 2014 there were reports of Legionella found in birthing pools in the UK; public health alerts and advisories were issued after one baby died as a result of exposure to the waterborne bacteria.

According to Elyse Fritschel, an epidemiologist at the Texas Department of State Health Services, “[infants] are in a higher risk category because of their underdeveloped immune system, and their developing physiology.”

Public health investigators in Texas reviewed the disinfection process used by the midwifery center that provided the family with the birthing pool.  Investigators also tested the pool and water used to fill the tub for bacteria.

Unfortunately, by the time public health investigators were able to inspect, the birthing tub was already disinfected and placed back into storage, and so Legionella was not detected.  Legionella was not detected in the water either, however, “current testing techniques don’t detect this bacterium 100 percent of the time.”

“Because Legionella is pretty ubiquitous in the environment, it’s not a big stretch to imagine that it would be in the water system, and there were no other exposures that were identified,” said Fritschel.

According to the American Academy of Pediatrics and the American College of Obstetricians and Gynecologists, giving birth using a birthing pool is generally not recommended because there are no proven benefits and there are a number of potential health risks for the baby including waterborne pathogens.

To read more about this story, please click here.

Posted by jzacher">jzacher at 10:32 am
Dec
11
2014
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kathmandu_tour

The Epidemiology and Disease Control Division (EDCD)  under the Department of Health Services in Nepal reported last week that two cases of Legionnaires’ disease were discovered in Kathmandu over the period of one month.

No personal details are known about these patients, but both were treated and discharged from Vayodha Hospital in Balkhu.

“The patients have fully recovered and are under our surveillance.  We are further testing and conducting research regarding their condition,” said Dr. Baburam Marasini, Director at EDCD.

To read more about this story, please click here.

 

Posted by jzacher">jzacher at 5:36 pm
Dec
10
2014
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VA Black Hills Health Care Systems

The VA Black Hills Health Care Systems (VA BHHCS) located in Hot Springs, South Dakota has tested positive for Legionella in its water system during routine testing.

Legionella were discovered in several sink and shower fixtures, but it is believed that health risks to employees and Veterans is minimal so far; further, there have been no reported cases of Legionnaires’ disease associated with this VA location.

Prompt actions were taken to disinfect the water.

To read more about this story, please click here.

Posted by jzacher">jzacher at 11:24 am
Dec
01
2014
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Olympic Games in Rio de Janeiro Raises Legal and Public Health Questions regarding water quality liability and Legionella bacteria

 By: Jules Zacher, JD MA; Tawny Vu, MPH

1. Introduction

Rio de Janeiro will be the host city for the Games of the XXXI Olympiad in 2016.  Athletes and tourists from all over the world will come to this beautiful city by the sea.  While the infrastructure for the Games is being completed, many hotels, hospitals and even the Olympic Village should consider their legal exposure to these guests for contracting such diseases as Legionnaires’ disease.  The purpose of this paper will be to discuss what, if any, legal liability Brazilian entities face from Americans who contract the disease in Brazil

2. Dangers Associated with Legionnaires’ disease for Travelers

Legionnaires’ disease is an uncommon form of pneumonia that occurs when a person is infected with Legionella bacteria typically by aspirating or inhaling aerosolized water containing Legionella bacteria.  Bacteria accumulate in potable water systems when building operators do not properly maintain their water and can be eliminated from the system through various disinfection and preventive methods.  This is more frequently an issue in larger facilities with complex water systems, such as hotels, hospitals, etc.

Failure to maintain the appropriate biocide levels and/or temperatures may result in the propagation of the bacteria within a building’s potable water system.  What should be pointed out here is that water coming in off the municipal main (although having been treated by chlorine and other disinfectants) can have Legionella bacteria.  Once the water reaches the building, however, the bacteria can multiply if the temperature and/or biocide levels are not adequate enough to kill them.

Many building owners, even in the United States, are unaware of the dangers associated with Legionnaires’ disease.  The disease, although entirely preventable, can be lethal or, at the very least, debilitating if contracted.  Individuals who contract the potentially deadly illness often require extensive stays at the hospital with a rigorous antibiotic regimen.

Travel-associated Legionnaires’ disease is especially problematic since many outbreaks of the illness occur in large facilities with complex water systems such as hotels.  According to the CDC, “More than 20% of Legionnaires’ disease cases reported to the CDC are travel-associated” (CDC 2014).  Travel-associated cases of this disease can be difficult to track and ultimately report because individuals typically do not begin to display symptoms until 2-14 days after their exposure to the bacteria.  By the time the incubation period has passed, the person has returned home and must retrace their steps to pinpoint the places they may have been infected with the bacteria.  Further, the European Centre for Disease Prevention and Control (ECDC) reports that “Legionnaires’ disease is still underascertained in most European countries since specific testing for Legionella in patients with pneumonia is not a routine procedure” (ECDC Surveillance Report 2009).

3. History of Litigation in the US

The U.S. legal system is very different from that of Brazil regarding potential claims for someone contracting Legionnaires’ disease. The U.S. legal system is based on tort or civil law rather than criminal law. This means that a Brazilian hotel, hospital, or even the Olympic Village (potential defendants) could be liable to an American citizen in an American court room for damages caused by the negligence of the defendant. A negligent act can be one of omission, I.e. where the defendant performs an act such as maintenance of the potable water system in an improper manner, or one of omission, where the defendant should have performed an act such as not having a water management plan but did not do so.

Juries are requested after finding that a defendant was negligent to award damages.  Damages include medical bills, lost wages, and most importantly, pain and suffering. Awards for Legionnaires’ disease cases can be in the hundreds of thousands of dollars, and indeed, millions of dollars. One case that my office is involved in is seeking punitive damages, whereby the victims of the defendant’s negligence are seeking a monetary award that will punish the defendant for its behavior.

Clients in the US are represented through a contingent fee agreement.  This means that a potential client only pays his or her lawyer if the lawyer is successful in obtaining monies for the client.  The lawyer also fronts any file costs, which could be extensive.

4. Jurisdiction

This part of the paper will address the question of jurisdiction, I.e. where a claim can be brought by an American citizen, by using three scenarios.  The first is the potential liability of American-owned corporations to American citizens.  The second is the liability of Brazilian corporations, including Brazilian subsidiaries of American corporations, to American citizens.  The third is the liability of Brazilian entities such as the Brazilian Olympic Organizing Committee to American citizens.

The case of Reid-Walden v. Hanson, 933F2d 1390 is instructive regarding the first scenario.  In that case, both the defendant and plaintiff were American citizens.  The plaintiff contended she was injured while vacationing at a hotel in Jamaica owned by the American defendant.  The U.S. Circuit Court held under these set of facts that the case should be tried in the United States and not Jamaica.

Another possibility would be an American travel agent being sued by an American (see Desiry v. Unique Vacations Inc. 2014 U.S. Dist Lexis 8826).  In that case, an American citizen was suing a Saint Lucien company and the travel agent who set up the trip.  The Court dismissed the Saint Lucien defendant, but required the American travel agent to stand trial.

As far as the last two scenarios are concerned, American case law would seem to indicate a Brazilian entity would not be accountable under most circumstances to an American citizen (see Daimler AG v. Bauman, 134 S. CT. 746).  This invariably would apply not just to Brazilian companies owned by Brazilians, but also to Brazilian subsidiaries of American companies.

5. Conclusion

The above discussion of potential liability of Brazilian entities to American citizens is at best a brief survey of American case law. By no means is this paper meant to be dispositive as to whether a Brazilian entity could be made to stand trial in an American court room for damages claimed by an American citizen for contracting Legionnaires’ disease in Brazil. The best way to prevent even the possibility of such an occurrence is to prevent the propagation of Legionella in the first place.

 

 

References

  1. Centers for Disease Control and Prevention. 2014. “Identify and Report Travel-Associated Legionnaires’ disease.” http://www.cdc.gov/legionella/health-depts/travel-identify-report.html
  2. ECDC Surveillance Report. 2009. “Legionnaires’ disease in Europe 2009.” http://ecdc.europa.eu/en/publications/publications/1109_sr_legionnaires’%20disease_europe_2009.pdf
  3. 2010. “Travel-associated Legionnaires’ disease in Europe, 2010.” http://www.eurosurveillance.org/ViewArticle.aspx?ArticleId=20498

 

 

About the Authors

Jules Zacher, Esquire has been engaged in the practice of law since 1974.  He currently represents victims of Legionnaires’ disease in federal and state courts across the country.  Mr. Zacher received his law degree and Master of Arts in Economics from Temple University.  He is a member of the American Association of Justice.

As of October 2012, he serves on the Board of Directors of the Council for a Livable World, the Advisory Board of the Center for Ethics and the Rule of Law at the University of Pennsylvania Law School, and is a member of various committees at the Philadelphia Racquet Club.  He is an avid reader of non-fiction, has lived and worked in Paris, France and Budapest, Hungary, and plays court tennis.  He was born in 1942 in Philadelphia, Pennsylvania.

Tawny Vu has a research, biology, and health policy background.  She received her Master of Public Health degree at Drexel University and Bachelor of Science in Biological Sciences at the University of California, Irvine.

Posted by jzacher">jzacher at 1:28 pm
Nov
20
2014
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Working Title: Olympic Games in Rio de Janeiro Raises Legal and Public Health Questions regarding water quality liability and Legionella bacteria

By: Jules Zacher, JD MA; Tawny Vu, MPH

Outline

  1. Introduction – importance/significance of XXXI Olympiad
    1. Guests and athletes of the games will travel from all over the world and all could be exposed to bacteria
  2. Dangers associated with Legionella for travelers
    1. False sense of security in hotels (water coming in from water company is not necessarily safe)
    2. Lack of knowledge about water system maintenance within large facilities
    3. LD can be debilitating or even lethal
    4. LD is under-diagnosed
    5. Cases of LD are under-reported
  • History of litigation in U.S.
    1. American legal system
    2. Causes of Action
    3. Jules Zacher’s cases
      1. German citizen who contracted LD at a hotel in New York while traveling for work
      2. Las Vegas hotel LD outbreaks
      3. Spa-associated LD at hotel in Maryland
  1. Liability of corporations
    1. Liability of American-owned corporations to American citizens
    2. Liability of Brazilian corporations, including Brazilian subsidiaries, to American citizens
  2. Liability of Brazilian entities, such as the Brazilian Olympic Organizing Committee
  3. Conclusion
    1. Legionnaires’ disease is dangerous and it has international concerns
    2. There is liability
    3. Prevention is key

 

Outline – LD Brasil

Posted by jzacher">jzacher at 9:23 am
Nov
11
2014
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Vila Franca de Xira - Portugal

The Health Ministry in Portugal is now saying that 160 people have been diagnosed with Legionnaires’ disease.  So far, at least four people have died and two dozen of those diagnosed are in intensive care.

The greatest concentration of Legionnaires’ disease cases were at four parishes in the district of Vila Franca de Xira, which is approximately 16 miles northeast of Lisbon.

An investigation is still underway to determine the source of the outbreak.

To learn more about this story, please click here.

Posted by jzacher">jzacher at 1:34 pm