McLaren asks for administrative hearing on state order to improve Legionnaires' protection measures

McLaren Health Care Corp. is fighting back against a state order that it take further measures to reduce potential patient exposure to the bacteria that causes Legionnaires' disease.

McLaren, a 14-hospital not-for-profit system based in Grand Blanc, Mich., responded forcefully late Friday to an order by the state of Michigan that it take the additional measures at its 378-bed hospital in Flint by asking for a state administrative hearing on the issue and seeking to subpoena numerous state officials.

On Wednesday, the Michigan Department of Health and Human Services and the Department of Licensing and Regulatory Affairs ordered McLaren Flint to comply under the state's public health code with "water restrictions, patient notification, data requests, public health investigations and official recommendations."

The moves are part of an ongoing battle between the health system and the state over McLaren's responsibility for Legionnaires' cases in Genesee County.

MDHHS and LARA said McLaren Flint has not taken enough steps to "resolve Legionella issues that impair its ability to deliver an acceptable level of care for the health and safety of the public," LARA Director Orlene Hawks said in the Wednesday release. "Our order requires the hospital to take additional measures to protect Michiganders and ensure compliance with the Public Health Code."

But McLaren contends it has invested more than $2 million to improve its water management program and taken all the steps its consultants have recommended. "Yet, despite these efforts, we continue to feel the effects of our community's legionella issues," the hospital said in May.

In its request to LARA for an administrative hearing in Lansing, McLaren denied all of the state's allegations in the order "for they are untrue" and also "denies the existence of any violation of the regulations cited as a basis for the order," according to J. Brian McDonald, attorney for McLaren Flint with Cline, Cline & Griffin in Flint.

McLaren also is asking that subpoenas be issued for 13 state, county and federal officials to compel their testimony at the hearing. The state officials are Hawks, Kim Gaedke, LARA chief deputy director; Larry Horvath, LARA director of community health systems; Robert Gordon, MDHHS director; Joneigh Khaldun, MDHHS chief medical executive; Sarah Lyon-Callo, state epidemiologist; Jim Collins, MDHHS communicable disease division director; Shannon Johnson, section manager of MDHHS communicable disease division.

The county officials are John McKellar, health officer of Genesee County Health Department; Jim Henry, environmental health director with Genesee County. Federal officials are Laura Cooley, medical epidemiologist of the Centers for Disease Control and Prevention; Jasen Kunz, CDC environmental health officer; and Jevon McFadden, CDC medical epidemiologist.

An officials MDHHS told Crain's that LARA will provide for the hearing based on rights under the state public health code.

MDHHS has asked McLaren to take several additional steps based on CDC recommendations to ensure its water supply is safe. Steps include to impose water restrictions on patients impacted by the monochloromine unit at F Tower, floors four and higher; advise patients discharged after April 1 of potential exposure and what to do; evaluate trends in water quality and testing measures; continue to identify and remediate underlying issues.

McLaren officials have previously said the Flint hospital has complied with at least 90 percent of the recommendations. But several CDC recommendations "run contrary to what is considered best practice by independent water experts," said a McLaren official, who asked not to be named. McLaren also conducts regular sampling and analysis of the bacteria in the building's water systems, and the hospital routinely shares those findings with state and county regulators.

During the deadly 2014-15 Legionnaires' outbreak in Genesee County, when 12 of 91 people, or 13%, affected by Legionnaires' died, the MDHHS claimed McLaren Flint hospital was the source of some of the infections, a charge the hospital has always vehemently denied.

A Crain's analysis has found that Legionnaires' disease cases rose in 2018 in Michigan with 633 confirmed, a 67% increase from 2017, with no single obvious explanation. Of those, there were 32 confirmed Legionnaires' disease deaths, a 14% increase from 28 in 2017. But mortality rates declined to 5% last year from 7% in 2017 because of faster detection of symptoms and use of newer antibiotics.

In early May, the MDHHS launched an investigation into the female patient at McLaren who developed the severe form of pneumonia. That investigation stemmed from a review of several Legionnaires' cases reported in 2018 and 2019 with exposure histories that include the hospital, Crain's reported.

"Our hospital treats sick people, including people that come to our facility with Legionnaires' Disease contracted from community sources," the hospital said in a statement emailed to Crain's in May. "Despite considerable evidence to the contrary, including a 100 percent increase in Legionnaires' disease cases in Genesee County last year, the state continually attributes those cases to our facility."

So far this year, the hospital has been tied to two additional cases involving the disease, one of which the state agency said is a "definite health care-associated case" as the patient spent 10 days at the hospital during the disease's incubation period.

MDHHS said the investigation is part of an ongoing review of several Legionnaires' cases reported in 2018 and 2019 with exposure histories that involve the hospital. There were 26 cases of Legionnaires' in Genesee County in 2018, compared with 13 in 2017, and eight so far this year, the state said.

The Genesee County Health Department also has investigated other hospitals, nursing homes and health care facilities for similar alleged problems.

In mid-May, health officials announced they are looking into multiple possible cases of Legionnaires' disease at two other hospitals besides McLaren Flint in Genesee County and one hospital in Washtenaw County.

One case of Legionnaires' has been confirmed as having a definite healthcare association with St. Joseph Mercy Ann Arbor Hospital, although the hospital says it has not been proven that it was the source of the disease.

"McLaren asks for administrative hearing on state order to improve Legionnaires' protection measures" originally appeared in Crain's Detroit Business.