Illinois Public Health Director Defends Response To Legionnaires’ Outbreak

At least two Illinois lawmakers have called for the director of the state’s public health department to step down, following the deaths of 13 residents from Legionnaires’ disease at a veterans’ home in Quincy since 2015.

Speaking on The 21st on Wednesday, Dr. Nirav Shah said he thinks he still has the public’s trust and intends to continue in his role.

Shah said his agency’s role during an outbreak is to figure out who’s at risk, identify the source, and make recommendations to facilities on how to keep people safe. Within 27 minutes of learning of the second Legionnaire’s death at the Quincy veterans home in 2015, Shah said “we were on the phone with the facility to let them know of what was going on and giving them recommendations that they could put into place.” After that point, he said it was the responsibility of the facility—not his agency—to notify staff and families.

Here are some important highlights from Dr. Shah’s discussion with 21st host Niala Boodhoo:

On notifying the veterans' home and families about the Legionnaires' outbreak

Niala Boodhoo: Can you remind us the timing of this? There was a six day period in 2015 when families and staff at the facility were not notified about what was going on, from the time that you all found out about it.

Dr. Nirav Shah: That’s a great question, Niala. And one really important point here is that the Department of Public Health notifies and works with facilities. Family notification, staff notification, are left to the facility itself. The Department of Public Health, in this situation, on August 21st, in the late afternoon—we were notified of a second case. And that’s what kicks us into action.

And within 27 minutes—literally, 27 minutes—we were on the phone with the facility to let them know what was going on, and giving them recommendations that they could put into place to help keep people safe.

It then comes to the facility, and we trust the facility in those instances, to notify staff, family, etc. As you’ve probably heard, Veterans’ Affairs Director Erica Jeffries discuss, they did do those things. But the obligation and the role of the Department of Public Health is to notify, first and foremost, the facility.

Do you think it was a mistake to trust the facility? Because they didn’t notify families.

Well, there, you’d have to check in with Director Jeffries at the Department of Veterans’ Affairs. But we trust facilities to make those notifications, to inform staff, to inform residents of what’s going on. Our role is to provide them with public health recommendations such as turning off the water, looking at testing to see if a cooling tower is implicated. Those are the scientific sets of recommendations that we work on. Issues of notification are the ones that the facility always handles.
 

On whether the current standards for notifying families are sufficient

It says on IDPH's website that one of the roles is "to set standards for nursing homes." In this case, it's a state-run nursing home. Do you feel like the standards were sufficient there in 2015, in terms of notifying people and in the way everything happened and unfolded?

Well, there are no set standards in any statute, or rule, or regulation as to when families need to be notified. Again, we trust facilities to do that on the schedule that they have set forth. And again, Director Jeffries can discuss the nuances at the mechanics of those notifications. But in this situation, we did immediately alert the facility of what was going on, we provided them—

—right, and you’ve said that. You’ve made that really clear. I think I’m asking just a more general question about whether you’re responsible for standards at nursing homes, if you feel that standards were followed in this instance. Do you feel comfortable that standards were followed?

I do. And there no specific standards in terms of when a facility needs to notify somebody of something—

Do you think there should be? I mean, when people are dying—and this case, we can get into some specifics here…families are being notified two hours before a parent passes away, that this is the disease that they had. Is that sufficient?

Well, I can’t comment on any specific case. The department doesn’t get involved with direct patient care.
 

On IDPH's communications response to the outbreak

Dr. Shah, there’s one family in particular I wanted to ask you about from the 2015 outbreak, and that's the family of Eugene Miller. For our audience who’s not aware, he was 86 years old and lived in the Quincy facility. He was gravely ill and expressed a desire not to have any extraordinary efforts made to prolong his life. During that time, the Veterans Home contacted members of Miller’s family for permission to test him for Legionnaires' disease. They approved that, and then had to wait two days to find out he was sick. The test was positive. Email communication obtained by WBEZ later revealed that you all knew for nearly a week that you were dealing with an epidemic. And Eugene Miller’s son revealed on Facebook that he felt a lack of communication killed his father. When did you first become aware?

I believe it was in late August in 2015.

The day after that Facebook post circulated, a spokesperson with the state veterans affairs department forwarded a newspaper article from the Quincy Herald Whig. It was headlined, “Residents, family laud Illinois Vets Home staff as Legionnaires [sic] disease cases climb.” You responded, “Great story. Helps rebut the FB message we saw yesterday. Thank you!” And forwarded it to the governor’s office. Again, this is WBEZ Chicago’s reporting. Dr. Shah, at a moment of crisis when you know that five people have already dead, eight people are sick—

No one had died yet.

No one had died yet?

Yes, that’s correct.*

In [this] moment, why are you forwarding emails about positive press coverage to your boss, the governor? Was that your focus?

Let me first say, Niala, that we are tremendously, tremendously mournful for the loss of Mr. Miller and our hearts go out to his family. We certainly understand their sadness and the frustration with what’s going on here.

As to your particular question, one of the aspects of navigating an outbreak is communications. Communication is, indeed, the thread that goes through the entire agency. Now, my particular email that you read was insenstitive. And that’s not something that I am proud of, and not something I should have communicated in that fashion. That being said, communication is a big part of how we manage an outbreak. We have to make sure we are communicating and conveying what the facts are. In order to do that, we have to have the facts. In that situation, what I wanted to make sure is that if we had a situation that someone did not feel that they had all the facts, how can we check that? Is there a way we can determine whether that sentiment is widespread, or is it something that requires more immediate intervention on the part of the facility?

And did you do that? Did that set off an alarm bell, when you saw that Facebook post, thinking—we notified the facility but it doesn't seem like the facility is talking to these people?

It did.

What did you do?

We wanted to make sure that any communication that we are giving to the facility about what we know is being accurately transmitted back to families.

But from that Facebook post, it doesn’t seem like it was.

That’s why it was concerning, that's why claims by families that they do not have all the facts are things that are concerning. From what I understand, there are additional facts, that I'm not—because of some litigation that's going on—that I don't believe we're able to discuss. And so I can’t go into the specifics, but again, IDPH doesn’t have direct patient involvement in this situation.

So, you didn’t feel like you needed to reach out to Tim Miller or his family and discuss this situation.

That’s a question we get a lot. And in this situation, and in any facility outbreak situation, that’s the role of the facility, of the doctors that are managing the patients. Public health’s role in this situation is to take a look at the dynamics of the outbreak and see what steps we can put into place to stop that outbreak situation.
 

On whether Dr. Shah thinks IDPH still has the public's trust

A lot of our conversation has focused on the role that IDPH plays. And I think when one looks at public health it’s very clear that trust is an important part of this. People need to trust their public health department. We don't even feel that way about politicians sometimes, but I think when we think about public health, we don't think it should be political, we think we should trust our public health officials. 

I want to ask you about something else your department—and you, directly, have also come under criticism for, and that’s the implementation of screening for Krabbe disease. There are babies who have died in Illinois—at least three of them—because screening for the disease, which mandated by law, took 10 years to be implemented by your department. This also first came up in 2015. And it wasn’t until this past December 11 that you notified hospitals that IDPH would begin testing.

I bring this up because one foundation of a public health department is that the public trusts you. You told lawmakers on Monday that IDPH's singular goal is to protect health and improve lives throughout the state. But I don't think you can do that if the public doesn’t trust you. So I wanted to ask you: given the multiple deaths—more than a dozen people in Illinois, babies, veterans and their families, that have died while you have been director of the department of public health...do you think you still have the public’s trust?

I think I do, I hope I do. And if I don't, I need to work to earn it. What I will say in regards to Krabbe is that wa a law that was passed far too long ago, in 2010. When we came in January of 2015, we realized that implementation of that law was not where it needed to be. Our laboratory team picked up the ball at our direction and started running with it as quickly as possible. It was far too late, it should've been done years and years earlier, but it was something that we felt needed to happen, even if it was years delayed at that point. And we were able to get testing online. Again, that’s cold comfort to the families who waited far too long.

And whose children died.

Exactly. It should’ve been done years and years before. But it was a top priority. And we were able to bring it online a few months ago.

With respect to trust generally, you’re absolutely right. Trust is vital to the work that any state agency does, but perhaps most critically with respect to health. The department is effectively charged with keeping everyone in the state safe. And we do that by erecting this invisible forcefield around our lives. And I like to tell people if you went to a restaurant at any point in the last day, if you drove down a street, if you played somewhere in a park and didn’t get sick, that’s because public health was there keeping you safe.

Do you think the public still deserves to trust you after all these things have happened?

I do think so. The reason is because we’re focused looking back at where we may have fallen down on the job, and always looking toward continuous improvement in that regard.

Even though bipartisan groups of lawmakers have also called for you to resign, you still think—I’m going to stay in this job, the public’s going to trust me?

I disagree with those calls, and I have every intention of continuing the work at the agency.

*Note: According to reporting by WBEZ, "By Aug. 29, 2015, the day Miller sent his Facebook message, at least three other residents had already died of Legionnaires’ and nearly three dozen people had gotten sick, according to a later report by the Centers for Disease Control and Prevention."