A publication of the Kentucky Center for Public Service Journalism

Keven Moore: Legionnaires’ Disease is rampant and deadly; businesses need insurance

Imagine for a minute you and your co-workers are sent to a 3-day work conference in Orlando, Fla. You return home and the next day you have a headache, chills, muscle pains and a high fever. After a couple of days your fever spikes to dangerous levels so you are rushed to the hospital.

You wake up eight days later after going into a coma to find yourself on a ventilator fighting for your life. You remain in the hospital for additional 45 days and then discover that four other co-workers were hospitalized with the same symptoms. One died.

Is this work related? Yes. Is it a workers compensation claim? Yes. You later learned that you contracted Legionnaires Disease at the resort when you walked by the water fountain in the lobby or when you used the Jacuzzi with the shower in your bathroom.

Legionnaire outbreaks happen more often than people realize.

Just this week, Disneyland in Anaheim, Calif., announced it shut down cooling towers after three dozen visitors contracted Legionnaires’ Disease.

This past September a 62-year-old Kentucky woman was sickened by Legionnaires’ disease after staying at a hotel near Graceland, the home of Elvis Presley. She was one of nine people who contracted the disease after staying at The Guest House at Graceland. Officials in Tennessee say the outbreak was apparently linked to the hotel’s hot tub and pool.

That same month five guests and one employee of the Springhill Suites Austin, Texas, were diagnosed with Legionnaires’ disease. Then in Maple Grove, Minn. that same month two residents in an assisted living facility were diagnosed with the same disease after local officials investigated the building water systems. They closed the pools and advised residents to not shower or use tap water for drinking or brushing teeth.

This bacterium was named after an outbreak in 1976, when many people who went to a Philadelphia convention of the American Legion got sick with pneumonia. More than 221 people were hospitalized and 34 people died.

Legionnaires Disease is on the rise in the U.S. and continues to go unchecked and undiagnosed despite all the local headlines. According to a Washington Post article last year, cases of Legionnaires’ disease nearly quadrupled in the United States over a 15-year period, and almost all might have been prevented with the proper use of disinfectant, the right water temperature and other control measures.

The disease can affect just about anybody exposed to it. People can get Legionnaires’ disease when they breathe in mist (small droplets of water in the air) containing the bacteria from air-conditioning units, cooling towers, hot water tanks, water fountains, hot tubs, air conditioning systems, and water systems for large buildings.

Adults over the age of 50 and people with weak immune systems, underlying medical conditions, chronic lung disease, or are heavy tobacco use are most at risk; but it does not spread from person to person. It’s important to note that home and car air-conditioning units do not use water to cool the air; so they are not a risk for Legionella growth.

Outbreaks related to water systems

Outbreaks are most commonly associated with buildings or structures that have complex water systems, like hotels, resorts, hospitals, long-term care facilities, gyms and cruise ships.

Legionnaires Disease is a form of pneumonia. Nearly 6,000 cases are reported annually in the United States but it is under-diagnosed.

It is difficult to distinguish this disease from other forms of pneumonia. It’s been estimated that over 25,000 cases of the illness occur each year and cause more than 4,000 deaths. About one out of every 10 people who get sick from Legionnaires’ disease will die.

The legal exposure associated with Legionnaires’ disease can be substantial to business owners, corporations and property owners. A single outbreak can affect dozens or even hundreds of people at a given time. Many of those infected who do survive still spend weeks, if not months, in the hospital and are often left with severe permanent impairment and six-figure medical bills.

According to an article in TheCLM.org reports of settlements are rare as most agreements include stipulations that payout amounts remain confidential. But some reports indicate single claim settlements and jury awards have ranged from $255,000 to $5.2 million.

In November, 2010, a Calhoun County, Alabama, a jury awarded a combined $4.5 million judgment in a case stemming from a hotel hot tub contaminated with Legionella bacteria. Two hotel guests were staying at the Wingate Inn and both of them developed Legionnaires’ disease and had to be hospitalized. The trial lasted four days and the jury took only 50 minutes to return a guilty verdict against DEVI, LLC, the owner of the hotel.

As tragic and costly as this preventable Legionnaires Disease is, in my 25-plus years as a safety and risk management professional working with health clubs, hotels, nursing homes, hospitals, etc. I have had only one client request that I provide risk control counter measures to control Legionnaires Disease.

Perhaps business owners are unaware of how great the exposure is or they get a false sense of security because they outsource the preventative measures to a third party. Either way many businesses and corporations are in great financial risk.

Keeping Legionella out of water systems is key to preventing infection. Legionnaires Disease can easily be deterred by regularly and conscientiously maintaining man-made water systems. Legionella grows best in warm water, like the water temperatures used in hot tubs. However, warm temperatures also make it hard to keep disinfectants, such as chlorine, at the levels needed to kill germs like Legionella. Disinfectant and other chemical levels in hot tubs should be checked regularly and hot tubs should be cleaned as recommended by the manufacturer.

Establish a risk program

Business owners, corporations and property owners should establish a Legionella Risk Management Program. Where they establishing a formal written water management plan which identifies the exposure and control methods. They should then implement these control measures to control the risk exposures. For a well maintained facility, implementing the plan will not cost much because many Legionella control measures are simply good maintenance and part of manufacturer recommendations.

The plan must be validated to show its effectiveness in controlling Legionella bacteria. Testing water systems for Legionella is not mandatory for validation but provides the most direct and reliable feedback on the control program.

The plan should then call for correcting the identified problems. Some facilities will require no remediation—zero cost. Some will need to make only minor adjustments in the maintenance or operation of the water systems. For others, the remediation cost will depend on the size of the problem and the proposed solution, but still only a small fraction of a cost of a Legionnaires Disease outbreak.

Currently there aren’t federal, state, or local codes, statutes or regulations that actually establish a “standard of care” specific to the control of Legionella for any structure or industry outside of healthcare. And while several government agencies, such as the CDC, EPA, OSHA, VA and several professional associations have published guidelines relating to Legionella control and prevention, they are merely advisory in nature.

However, the American Society of Heating, Refrigeration and Air Conditioning Engineers (ASHRAE) drafted a new standard of Legionnaires’ disease control and prevention – Legionellosis: Risk Management for Building Water Systems, better known as “Standard 188.” It applies equally to new and existing facilities, fundamentally altering the obligations of designers, owners, builders, contractors, operators, and property managers responsible for water systems, cooling towers, and other water features in buildings they design, build and maintain.

If “Standard 188” is adopted by a cities, counties or state building codes, it will have the force of law. That means that under the new standard, organizations and individuals are much more likely to be found negligent if a simple analysis can prove that proper preventative measures, as specified in the standard, were not taken. And even if it isn’t incorporated into statutory codes, Standard 188 is likely to be considered by a court whenever a judge is asked to determine an applicable “standard” In the United States.

The fact is that every year people and organizations suffer from the lack of proper water handling measures and necessary insurance. That’s why many businesses, such as hotels, health care facilities, and office buildings need additional coverage beyond that of their standard GL policy.

Next week I will address these coverages.

Be Safe My Friend


Keven Moore works in risk management services. He has a bachelor’s degree from University of Kentucky, a master’s from Eastern Kentucky University and 25-plus years of experience in the safety and insurance profession. He lives in Lexington with his family and works out of both the Lexington and Northern Kentucky offices. Keven can be reached at kmoore@roeding.com.

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