Michigan considers new water testing rules for hospitals

Michigan, seeking to prevent another oversight fiasco after lead poisoning in Flint and a deadly Legionnaires' disease outbreak in the area, is considering new water testing rules for hospitals and possible changes to how large facilities manage their water systems that could include new monitoring requirements.

State officials are analyzing Michigan's public health code in terms of "the requirement and enforcement of water testing in hospitals and other facilities," Jason Moon, a spokesman for the Department of Licensing and Regulatory Affairs, told the Associated Press.

The Legionnaires' outbreak killed nine people and sickened at least 78. Water testing found Legionella bacteria in at least one Flint hospital.

In addition, officials are looking at updated guidelines for building operators to mirror the standards developed by a national industry group that require building owners and managers to conduct annual surveys to look out for Legionella bacteria risks and develop plans to control it.

Both are part of the response by Gov. Rick Snyder's administration to the surge in Legionnaires' cases after Flint switched its water source in 2014 from the Detroit water system to the Flint River water that wasn't properly treated. The move, while the city was under emergency state financial management, allowed lead to leach from old pipes into Flint homes and businesses. Tests later showed high lead levels in some Flint children.

Moon did not give details of the testing requirements, so it's difficult to say whether any changes would put Michigan at the forefront of building water systems safety. One expert told The AP that no state requires any advance or preventative testing for Legionella in building water systems, and another notes that the drawback to the standards developed by the American Society of Heating, Refrigerating and Air Conditioning Engineers is that they are voluntary.

"To get teeth, it needs to be adopted into plumbing, regulatory codes," said Janet Stout, president of Pittsburgh-based Special Pathogens Laboratory, who has researched links between Legionella bacteria and public water supplies. "The only way" to prevent it "is to test before somebody gets sick."

Health officials in Genesee County, which includes Flint, raised questions early on about a possible connection between the increase in Legionnaires' cases and the water.

County Public Health Supervisor Suzanne Cupal told The AP that county and state health officials met with representatives from the federal Centers for Disease Control and Prevention and from the Environmental Protection Agency earlier this month to discuss the ASHRAE standards for Legionella testing in water systems.

Stout believes the Flint River caused an increase in Genesee County of Legionnaires' disease, a type of pneumonia caused by bacteria that infect the lungs. There were 45 confirmed cases from June 2014 to March 2015, and about 42 cases between May 2015 and November 2015. Records show only 21 cases reported in Genesee County in all of 2012 and 2013.

The surge in cases wasn't announced until last month by Snyder, but emails obtained this month through public records requests show county health officials were questioning earlier whether there was a connection.

"We have investigated a hospital as a potential source for the disease, but have expanded our investigation to include the city water supply," Genesee County health department epidemiologist Shurooq Hasan wrote on Feb. 10, 2015, to a CDC epidemiologist.

State agencies were aware of the cases, according to other emails.

"The increase of the illnesses closely corresponds with the timeframe of the switch to the Flint River water. The majority of the cases reside or have an association with the city," Jim Henry, Genesee County's environmental health supervisor, wrote on March 10, 2015, to Flint leaders, the city's state-appointed emergency financial manager and the state Department of Environmental Quality.

"This situation has been explicitly explained to MDEQ and many of the city's officials," Henry said in the email that was forwarded by the DEQ to a Snyder aide three days later. "I want to make sure in writing that there are no misunderstandings regarding this significant and urgent public health issue."

Genesee County's health department is now promoting the ASHRAE standards, while local hospitals, colleges and universities are also working on the guidelines, Cupal said.

But compliance with those standards is voluntary and no state requires any advance or preventative testing for Legionella in building water systems, said Robert Homeyer, president of the Boston-based water advisory firm Homeyer Consulting Services.

"No one requires anything until there is an outbreak," he said.

Another part of the problem, according to Stout, is the CDC does not tell hospitals to test for Legionella as a preventative measure.

"Our group ... has been saying that's backward and they should be making sure health care facilities should be testing," she said.



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