PREMISE LIABILITY CASE LEGIONNAIRES’ DISEASE OUTBREAK AT SAN ANTONIO HOSPITAL JOHN GOMEZ, THOMAS DeCHANT, SUSAN TRIPP, RUTH EVANS, RUDY MARTINEZ, and JOHN E. SWANEY VS. NORTH CENTRAL BAPTIST HOSPITAL, RJ GRIFFIN & COMPANY, BRANDT ENGINNERRING, PRECISION BOILERS, INC., CENTRAL BACKHOE AND UTILITIES LTD., SOFT DIG UNDERGROUND SERVICES INC., TACO, INC., and HESCO INDUSTRIES, INC.
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Plaintiffs’ Counsel: RHODES & VELA, LLP From San Antonio, TX, By: Clem Lyons Plaintiffs’ Counsel: RHODES & VELA, LLP From San Antonio, TX, By: Mary Wilson Plaintiffs’ Counsel: RHODES & VELA, LLP From San Antonio, TX, By: J. Thomas Rhodes, III Plaintiffs’ Counsel: RHODES & VELA, LLP From San Antonio, TX, By: LoAn K. Vo Intervenors/Plaintiffs’ Counsel: THE LAW OFFICES OF L. BRENT FARNEY From San Antonio, TX, By: L. Brent Farney Defendant Counsel: PLUNKETT & GIBSON, INC. From San Antonio, TX, By: Richard N. Francis, Jr. – Counsel representing North Central Baptist Baptist Hospital Defendant Counsel: DLA PIPER US LLP. From Austin, TX, By: George B. Butts and Jennifer A. Lloyd – Counsel representing R.J. Griffin & Company
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Defendant Counsel: SPARR & BREWSTER, INC. From San Antonio, TX, By: Richard A. Sparr, Jr. and Gregory W. Geerdes –Counsel representing Brandt Engineering, Inc. Defendant Counsel: CHAMBERLAIN & McHANEY From Austin, TX, By: David E. Chamberlain and W. Richard Ellis, III – Counsel representing Precision Boilers, Inc. Defendant Counsel: DAW & RAY From San Antonio, TX, By: Willie Ben Daw, III and James K. Floyd – Counsel representing Central Backhoe and Utilities, Ltd. Defendant Counsel: GORDON & REES, LLP From Dallas, TX, By: Scott P. Hazen and Christina L. McCraken– Counsel representing Soft Dig Underground Services, Inc. (Soft Dig) Defendant Counsel: STRASBURGER & PRICE, LLP From San Antonio, TX, By: Judith Blakeway – Counsel representing Taco, Inc. Defendant Counsel: GONZALES, HOBLIT & FERGUSON From San Antonio, TX, By: Harvey Ferguson, Jr., and Courtney Floyd – Counsel representing Hesco Industries, Inc. FACTS On April 22, 2006, John Gomez was admitted to North Central Baptist Hospital’s new addition with a diagnosis of gastro intestinal bleed. Although he was treated appropriately his condition continued to deteriorate. On May 3, 2006, he was diagnosed as having contracted Legionnaires’ disease. Despite aggressive treatment for the disease, Mr. Gomez continued to deteriorate and died on May 7, 2006, leaving a wife and four adult sons. On May 1, 2006, Thomas D. DeChant, age 78, was admitted to North Central Baptist Hospital with a one week history of abdominal pain. Prior to his discharge, he was diagnosed with Legionnaires’ disease. He too, was treated aggressively for the disease but tragically died on June 12, 2006.
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On May 5, 2006, Susan Tripp was admitted to North Central Baptist Hospital with a diagnosis of bowel obstruction.
Soon after successful surgery she was diagnosed with
Legionnaires’ disease. After a long course of aggressive treatment, she returned home in a severely debilitated condition. Susan Tripp’s dear friend Ruth Evans visited Susan Tripp on two occasions. Approximately 1 week after her last hospital visit, Ruth Evans became acutely ill and was hospitalized. She too was diagnosed with Legionnaires’ disease. In spite of heroic efforts by her attending physicians she succumbed to the disease and died on May 22, 2006. On May 8, 2006, Alice Martinez was hospitalized at North Central Baptist Hospital for breast surgery. Her husband Rudy Martinez was her constant companion during her hospital confinement. Approximately 1 week after Mrs. Martinez was discharged from the hospital, Mr. Martinez became acutely ill and was taken to North Central Baptist Hospital where the diagnosis of Legionnaires’ disease was made. He too was treated aggressivelely and survived the disease. However, the disease has left him totally disabled and unable to care for his wife. Unfortunately, Mrs. Martinez died in September, 2008. On June 1, 2006, John E. Swaney accompanied his friend to North Central Baptist Hospital and visited her regularly for the next 3 days. On June 11th he became acutely ill and was admitted to North Central Baptist Hospital where the diagnosis Legionnaires’ disease was made. He was treated aggressively and survived his illness. However, he remains totally disabled in part as a result of this disease. In all 10 to 11 patients and visitors to the new facility at North Central Baptist Hospital were diagnosed with Legionella disease in a 30 day period.
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WHAT IS LEGIONNAIRES’ DISEASE Legionnaires’ disease is the common name for an illness caused by Legionella type of bacteria. It is a lung infection and is a form of pneumonia. It is called Legionnaires’ disease because it was first identified as the cause of the outbreak of pneumonia that caused thirty-four deaths at 1976 American Legion Convention in Philadelphia, Pennsylvania. The Legionnaires’ bacteria are common warm water microorganism.
However, the
levels found in nature are so low that it is unlikely individuals will contract the disease from common water sources. The risk of exposure increases when high concentrations of the organism grow in water systems. Legionnella will live, reproduce and survive within free-living microscopic animals called protozoa. While living within these animals, Legionella bacteria are not only better able to grow, but often become more virulent– meaning better able to produce disease. Legionnella can cause disease only when it is able to increase in population density, present certain virulent factors, and gain transmission into the lungs of susceptible human beings. When a virulent strain of Legionnella is present in sufficient quantities to cause infection, a susceptible human being who inhales or aspirates water containing these bacteria is at high risk of contracting Legionnaires’ disease. Therefore, important factors that promote the growth, colonization and proliferation of Legionnella include: I.
Stagnation of water such as occurring during building construction when water systems are turned off and on.
II.
Warm water temperatures between 68 to 122 degrees Fahrenheit. Optimal growth temperatures are between 95 to 113 degrees Fahrenheit.
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HISTORY OF LEGIONNAIRES’ DISEASE IN SAN ANTONIO In 1996 San Antonio recorded sixteen Legionnaires’ cases, which was considerably higher than prior years. Therefore, State and Federal experts tested twelve of our largest hospitals. Legionnella was found in eleven of the twelve hospitals. Some of the researchers concluded that residents in San Antonio were at a higher risk to contract the disease than people living in other areas. RISK FACTORS I.
Where Legionnella is found to proliferate such as the city of San Antonio;
II.
People who are elderly, lung compromised, have compromised immune systems, or weakened by disease, are at high risk to contract Legionnaires’ disease. Such patients are found in hospitals;
III.
Where the water in the hot water system is not heated above 122 degrees Fahrenheit; and
IV.
Where the building water system has been disrupted.
CONDITIONS EXISTING AT NORTH CENTRAL BAPTIST HOSPITAL IN MAY 2006 I.
San Antonio has been found to have more Legionnella bacilli than most cities;
II.
North Central Baptist Hospital treats patients who are elderly, lung compromised, compromised immune systems, have been weakened by disease and, therefore, are at a high risk. This is true of most major hospitals.
III.
North Central Baptist Hospital was delivering hot water into the hospital water system at temperatures well below 122 degrees Fahrenheit.
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IV.
In April 2006, just weeks before the Legionnella outbreak, there were two disruptions to the building water system. This occurred in relationship to a major building expansion at North Central Baptist Hospital that more than doubled the size of the hospital.
WHY WAS THERE AN OUTBREAK OF LEGIONNAIRES’ DISEASE AT NORTH CENTRAL BAPTIST HOSPITAL, MAY 2006 I.
North Central Baptist Hospital intended that its hot water system would heat the water that was provided to the hospital to temperatures in the 140 degree range. At these temperatures, Legionnella bacilli are rapidly killed. However, the hot water system failed in that the water within the tank were
not
being
properly
circulated and were not being properly heated. The water in the tank was well below 140 degrees Fahrenheit, and was in the range that encouraged the growth, colonization, and proliferation of Legionnella bacilli. II.
In April 2006, there were two disruptions of the building water system. This permitted the introduction of large colonies of the Legionella bacilli into the hot water system.
III.
When the outbreak of Legionnaires’ disease was identified, an inspection of the hot water system was commenced. The system contains two tanks capable of holding 1500 gallons of water. Steam is delivered via a closed system within the tanks causing the water to rise in temperature high enough to kill bacteria such as Legionnella bacilli. The hot water system included a motor and pump on each tank. The pumps were intended to circulate the water within the tank. An investigation and evaluation of the pumps after the outbreak, determined that
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neither pump was working. Therefore, the water contained in the tank was not circulating and the temperatures of the water within the tank were not in the desired range of 140 degrees Fahrenheit. Instead, the water was in the dangerous range of between 95 and 115 degrees Fahrenheit, the optimal condition for growth and proliferation of the Legionnella bacilli. NEGLIGENCE OF DEFENDANTS I.
RJ Griffin & Company was the general contractor on the expansion project at North Central Baptist Hospital. As such they are ultimate responsible for providing a safe hot water system.
II.
Brandt Engineering, Inc. was the plumbing subcontractor responsible for the installation of the hot water system. Plaintiffs allege Brandt’s employees installed two hot water tanks improperly which resulted in stagnation and stratification of water within the two hot water tanks, thereby causing the growth, colonization and proliferation of the Legionella bacilli within the hot water tanks.
III.
Precision Boilers, Inc. was the manufacturer of the hot water tanks in question. Plaintiffs allege that the tanks as manufactured were defective and that the inlet lines for domestic water and recirculating water were improperly labeled, thereby misleading the Brandt employees in there installation of the tanks. Further, Plaintiffs allege there was a “dead leg” in the drainage line of the tank, thereby providing an ideal location for the proliferation of Legionella bacilli. Additionally, Plaintiffs were prepared to prove that the heating elements within the hot water tanks were too short, thereby creating a “dead
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zone� of inadequately heated water in the back of the tanks.
IV.
Taco, Inc. manufactured the pumps that were designed to circulate water within the hot water tanks. After the outbreak of Legionella was identified, it was discovered the Taco pumps on each hot water tank were frozen and were not functioning. Plaintiffs allege the pumps manufactured by Defendant Taco failed due to a design defect in the pump itself, as well as providing pumps that were defectively manufactured.
V.
Soft Dig Underground Utility Services, Inc. were retained to identify underground utilities between the street and the hospital. Plaintiffs believe and allege that Soft Dig negligently and erroneously identified the main water line in a location where it did not exist. This information was given to Central Backhoe and Utilities who were responsible for digging a trench and laying a fire line from the main water line to the hospital.
VI.
Central Backhoe and Utilities, Ltd. relying on the information provided it by Soft Dig began digging in the parking lot in preparation for the laying of the fire line. On April 4, 2006 Central Backhoe employees transected and breached the main water line to the hospital. The line was immediately repaired and digging recommenced. On April 6, 2006, Central Backhoe again transected the main water line to the hospital. It is the Plaintiffs information and belief that as a result of the negligence of both Soft Dig Underground Services, Inc., and Central Backhoe Utilities, Ltd. the water lines were cut on two separate occasions which interrupted water service provided to the hospital and permitted the introduction of bacteria into the water system of the hospital. These
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interruptions contributed to cause the proliferation and growth of bacteria, including Legionella bacilli, in the water system which resulted in the Legionella outbreak at North Central Baptist Hospital.
VII.
North Central Baptist Hospital had recently undertaken a vast expansion project whereby they increased the size of the hospital by more than two-fold. It is common knowledge within the hospital industry, that when hospitals undertake major expansion there is an anticipated increased risk in the proliferation of Legionella bacilli within the hospital system. Further, it is well known that when there is an interruption of the water delivery system, Legionella bacilli tends to multiply and proliferate. When the main water line was breached on two occasions in early April 2006, it was the shared responsibility of North Central Baptist Hospital to do a thorough evaluation and sampling of the system. Further, the hospital should have promoted appropriate action to eliminate or minimize the risk to patients and visitors and their hospital to assure the public, their visitors and patients, that their water system was free from bacteria such as Legionella.
All parties agreed to a mediation which was held on August 13, 2008 through August 15, 2008. The mediator was Karl Bayer of Austin, Texas.
On October 13, 2008, all Plaintiffs and all Defendants agreed to a settlement of all Plaintiffs’ claims as to all Defendants for a total sum of $5.2 million dollars.
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PLAINTIFFS’ EXPERTS 1.
Paul Edelstein, M.D. 1608 Waverly Road Gladwyne, Pennsylvania 19035 Internal Medicine, Infectious Disease and Legionnaires’ Disease Expert
2.
Linden E. Witherell, P.E.,M.P.H.,J.D.,D.E.E. Environmental Health Services 777 South Prospect Street Burlington, Vermont 05401-3512 Environmental Engineering Expert
3.
Jennifer Clancy, Ph.D. Clancy Environmental Consultants, Inc. P.O. Box 314 St. Albans, VT 05478 Microbiologist
4.
Tom Green, P.E. 3701 Executive Center Drive, Suite 258 Austin, Texas 78731 Mechanical Engineer
5.
Gilbert Kissling 418 E. Huisache San Antonio, Texas 78212 Water Supply Production Specialist Journeyman Plumber DEFENDANTS’ EXPERTS The Defendant’s were not required to designate their experts prior to the settlement.
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