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September 8, 2017
Sharon Hall | VP Healthcare Risk Management, Risk Specialist
Legionnaires’ disease is a condition that our healthcare organizations do not frequently encounter, yet the Centers for Disease Control (CDC) estimates that between 8,000 – 18,000 people a year are hospitalized with this disease, and more than 10 percent of the cases are fatal (3). In their Vital Signs report issued on June 6, 2017, the CDC indicated that, while most cases of Legionnaires’ disease are not associated with healthcare facilities, 1 in 4 people who contract the infection while in a healthcare organization will die. Other relevant report statistics indicated that 80 percent of the cases were associated with long-term care facilities, 18 percent with hospitals, and two percent with both types of organizations (2). Recent news highlighting the suspected transmission of the Legionella bacteria to patients in a local hospital has reminded healthcare leaders of the importance of having a comprehensive risk management program.
According to the CDC, individuals may develop Legionellosis when they inhale water droplets that are contaminated with Legionella. Outbreaks are often traced back to the growth of this bacterium in buildings or structures that have complex water systems that are common in most healthcare organizations, including hospitals and long-term care facilities. The most likely sources of infection include potable water used for showering, cooling towers, decorative fountains, and hot tubs. The most vulnerable individuals include the elderly, current or former smokers, the immunocompromised, and those with chronic or underlying illnesses, such as diabetes, or kidney/liver failure. The potential condition that may result from exposure to the bacteria is a pneumonia referred to as Legionnaires’ disease, or a less serious infection called Pontiac fever.
Risk management strategies should be directed not only to prevention of the disease through creating, monitoring, and maintaining a safe building water system, but also for contingency plans to respond to any outbreaks. In 2015, ASHRAE published specific guidelines for Legionella water management programs (7). Generalized standards and surveyor guidance is included in a June 6, 2017, CMS Memorandum addressing Legionella infections for hospitals, critical access hospitals, and nursing homes4. Additionally, the CDC recently published a toolkit to aid organizations implementing industry standards (8).
Organizations should designate and assign accountability to a multidisciplinary team for the organization’s water management program. The team should also have the authority to develop and revise a written risk management plan to implement applicable standards, policies, and procedures in accordance with ASHRAE industry standards and the CDC. Key provisions include:
In addition, be sure to contractually transfer liability risk for new construction or renovations affecting the integrity of an organization’s water system to your contractors and subcontractors. It is also recommended that you be added to their environmental policy as an additional insured and confirm that coverage is in place.
Recent news highlighting the suspected
transmission of the Legionella bacteria
to patients in a local hospital has
reminded healthcare leaders of the
importance of having a comprehensive
risk management program.
Harm caused by the Legionnella bacteria may be difficult to prove, because the disease often affects individuals who have other chronic illnesses that compromise their immune systems. However, negligent maintenance of the facility’s water supply may be alleged when Legionnella bacteria is found in a facility’s water supply.
In addition to bodily injury, there can be financial loss associated with property (water equipment and systems), emergency response, remediation, relocation of patients, business interruption, regulatory compliance (fines and penalties), contractual obligations, and negative publicity.
Your insurance broker can assist you to review your existing insurance policies and identify coverage that may respond to claims and costs resulting from a Legionnaires’ outbreak. While most organizations often look to their directors and officers liability, professional and general liability, and property policies for coverage, a review may indicate exclusionary language for which no coverage is available. The insurance industry has developed pollution legal liability policies to address environmental risks often excluded from traditional policies that can be customized to an organization’s specific needs.
Adhering to requirements and implementing a water management program to reduce the growth and spread of Legionnella will also provide support to minimize allegations of negligence should an outbreak occur.
References and Resources:
The views and opinions expressed within are those of the author(s) and do not necessarily reflect the official policy or position of Parker, Smith & Feek. While every effort has been taken in compiling this information to ensure that its contents are totally accurate, neither the publisher nor the author can accept liability for any inaccuracies or changed circumstances of any information herein or for the consequences of any reliance placed upon it.