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Lawsuits expose more problems at Quincy veterans’ home

Friday, Dec 15, 2017

* Matt Hopf at the Quincy Herald-Whig

Two of 10 lawsuits filed against the state of Illinois claim the Illinois Veterans Home knew of the presence of the water-borne bacteria Legionella in its facility by July 2015 and did not notify the residents or their families about the issues.

They also claim that when two residents became ill and exhibited fevers, they never were tested for Legionella by medical personnel at the facility.

The Herald-Whig obtained the lawsuits from the Illinois Court of Claims through a Freedom of Information Act request. An 11th lawsuit is expected to be filed. […]

In the lawsuit filed on behalf of the family of Melvin Tucker, who died Aug. 31, 2015, at the age of 88 from a Legionella pneumophilia infection, the family claims that daily nursing logs in July 2015 showed Tucker was doing well. But the family claims that on Aug. 21, 2015, Tucker told the staff that “he did not feel well and was concerned that he was sick.” The family claims further logs noted that Tucker had a fever and issues with his lungs. He reportedly was given Tylenol, but the suit says no further action was taken.

By August 27, 2015, Mr. Tucker was very anxious about his health and it is noted that he informed his priest that he was fearful he was going to die,” an exhibit from the lawsuit said. “Finally, on this date, the staff took a urine sample and confirmed that he was in fact positive for Legionella.”

August 27th is highlighted for a reason.

Consult the timeline we talked about yesterday. Veterans Affairs Director Erica Jeffries claims that the remediation cleanup started on August 21st. Since I posted that timeline yesterday, IDPH Director Nirav Shah has told me that his agency was informed by the county health department on August 5th about the first case and was notified about the second case on August 21st (individual cases are pretty common everywhere, but when a second case is found, it’s more cause for alarm). On August 23rd, the CDC was formally notified of five confirmed cases. The governor’s office was notified on August 24th.

And yet, it wasn’t until August 27th that Tucker was finally tested even though he was exhibiting classic symptoms?

* Oh, and by the way, in the midst of all this, on August 25th, Gov. Rauner and IDVA Director Erica Jeffries did a photo op in Springfield with some veterans…



Two days later, IDVA and IDPH announced the outbreak to the public.

The lawsuits are here.

* Rep. Jil Tracy, who represents the Quincy area, told me today that she would “not hesitate about putting my father into the veterans’ home.”

It does appear that the veterans’ home has upped its game since then. They’ve had a couple of outbreaks since 2015 and they’ve both been contained. “It’s a great place for anyone to live,” Tracy insisted.

* I think one thing that local leaders are really worried about is the potential for closure. From WBEZ’s report...

Sen. Durbin tells WBEZ far more dramatic steps are necessary in light of the most recent legionellosis cases in October and November.

He said the state must move the Quincy home’s nearly 400 veterans and their spouses to a safe place until its century-old plumbing system is fully free of the waterborne bacteria that killed residents. If that isn’t possible, the state should build a new home, Durbin said. […]

“I want an admission by the governor that we have failed these veterans, and we need to do something immediately on an emergency basis to protect those who are there to make sure this never happens again and, if necessary, to replace this facility,” said Durbin, who along with fellow Democratic U.S. Sen. Tammy Duckworth, has endorsed candidate J.B. Pritzker to be their party’s nominee to challenge Rauner as the potential GOP candidate in the 2018 gubernatorial election.

“What we have now lurching from year to year is a situation that’s embarrassing, and it’s an insult to these veterans and their families,” Durbin said.

* Pritzker campaign…

“Allegations of failure to notify families and test residents are appalling and more evidence of Bruce Rauner’s gross mismanagement and neglect,” said Pritzker campaign spokeswoman Jordan Abudayyeh. “Sadly, this is only the tip of the iceberg as many more details remain unknown, which is why Bruce Rauner must immediately release all communication about the Legionnaires outbreaks in Quincy.”

…Adding… DGA…

Two new reports out today added more questions about Governor Bruce Rauner’s administration’s response to the tragic Legionnaires’ disease outbreak at the Quincy Veterans’ Home. Ultimately, 13 people died in 2015. The Herald-Whig obtained lawsuits that detail how residents were not tested or treated in a timely fashion, despite showing symptoms of the disease. Why did the Rauner administration not take more aggressive steps to ensure everyone was tested and cared for knowing the deadliness of the disease?

Secondly, Capitol Fax reported Governor Bruce Rauner attended a veterans’ honor flight with his Veterans’ Affairs Director after the Governor’s office was informed of the outbreak, but before the public was alerted. This meeting calls into question Rauner’s role in the then-unfolding situation at the Quincy Veterans’ Home. Was Rauner briefed by his Veterans’ Affairs Director during this meeting? Did Rauner and the Director talk about when the public should be informed?

So far, Rauner’s administration has done nothing to address the questions raised by WBEZ’s heartbreaking account from Wednesday. As new information leaks out, those questions will only grow.

“Bruce Rauner’s administration already failed veterans at the Quincy home, and now he is refusing to be transparent about what happened,” said DGA Illinois Communications Director Sam Salustro. “The families of the deceased should not need to find out what happened to their loved ones through press reports. Rauner needs to come clean about what he knew when, and what he did about it. This is not the time for Rauner to simply duck accountability for his administration’s failures like he always does.”

- Posted by Rich Miller        

33 Comments
  1. - Gettysburgaddress - Friday, Dec 15, 17 @ 10:42 am:

    13 dead veterans/spouses. Maybe someone should ask the EOIG what she thinks. Oh wait, she might be too busy interviewing disgruntled spouses and Thompson Center employees….
    What did Governor Rauner know and when did he know it?


  2. - WasAnon - Friday, Dec 15, 17 @ 10:43 am:

    Whoa. Back off. Didn’t you see Rauner greeting Veterans?
    He’s doing all he expects himself to do for our Veterans./s


  3. - cdog - Friday, Dec 15, 17 @ 10:46 am:

    Great reporting going on here and from around Illinois. Transparency is the best disinfectant, right?

    And, inquiring minds want to know, does Senator Durbin think that new plumbing system will cost $500million?

    A little research shows this is a ridiculous price per foot. (ILVHQuincy is 1m sq ft, therefore $500/ft)


  4. - Lester Holt’s Mustache - Friday, Dec 15, 17 @ 10:58 am:

    cdog, was it Durbin who threw out the $500 million number? I don’t think it was. Regardless, this would be a moot argument if Bruce hadn’t stopped the finishing work on the new Veterans home. What’s going to be cheaper going forward, finishing the new facility or completely redoing the existing one? That’s what they have to figure out next.

    To the post, in any another administration I’d think heads would roll over this, but I’m not sure if anyone is going to lose their jobs or not. Gov can be fickle about throwing people under the bus. He doesn’t seem to have a problem doing it to Radogno or Barickman but has stood behind his agency heads in the past.


  5. - A guy - Friday, Dec 15, 17 @ 11:00 am:

    ==It does appear that the veterans’ home has upped its game since then. They’ve had a couple of outbreaks since 2015 and they’ve both been contained. “It’s a great place for anyone to live,” Tracy insisted.==

    I wish everyone would stop politicizing these things this much. Obviously, this is serious, as is any virus that goes around a Senior Living facility or a Cruise ship, for that matter.

    There aren’t nearly enough places for people who need elder care, veterans or not, and containing everything is hard to do. It’s a real challenge every flu season and every winter. It’s even more difficult with elderly patients who have more trouble taking precautions on their own.

    The people who work in these facilities are angels on Earth. The criticism is warranted, but cut them a little slack.


  6. - We'll See - Friday, Dec 15, 17 @ 11:02 am:

    - cdog -
    Quincy is a community within a community and the plumbing system includes water mains, a water tower, pumps and boiler systems, etc. I’m guessing the cost to replace would be very high.

    What I would like to know is how many vets at the facility are from the Chicago metro area. Plans to build a new Vets Home in the Chicago area have been long stalled.


  7. - annonin' - Friday, Dec 15, 17 @ 11:02 am:

    “What did Governor Rauner know and when did he know it?”
    We think everyone knows that from time he emrged from BigVinny’s nest GovJunk’s general rule was to know as little as possible at all times. In this case he went to Quincy about once a month during his reign of terror, hit the vets home once and declared everything A-OK.
    So let’s check elsewhere and get some subpoenas


  8. - annonin' - Friday, Dec 15, 17 @ 11:07 am:

    Speakin’ of what did GovJunk know check this little tidbit from taxpayer’s twitter feed

    “Starting my day with a donuts from Schnickelfritz Bakery in Red Bud. These sisters sure do know how to bake a great business.”
    this hit at 9:31 so GovJunk was not off to a fast start this a.m.


  9. - Langhorne - Friday, Dec 15, 17 @ 11:10 am:

    IANIC, but lets not let that interfere w all messagin’ all the time. And photo ops.


  10. - DuPage Bard - Friday, Dec 15, 17 @ 11:11 am:

    Politicizing? Too late- Darlene Senger- we should blame this on Tammy Duckworth.
    There is no desire by, failed Governor Rauner, to handle this problem straight forward. As with everything the failed Governor has done he talks out of both sides of his mouth until he gets caught. Then blames other people.
    I’d love to hear in some debates with Ives his desire and care for the veterans compared to her West Point pedigree.


  11. - Henry Francis - Friday, Dec 15, 17 @ 11:13 am:

    So the Guv’s office was notified of the outbreak on August 24th. And what was his response? The very next day he went to take pictures with vets returning from an Honor Flight.

    Campaignin > Governin


  12. - NoGifts - Friday, Dec 15, 17 @ 11:14 am:

    Once you found out that legionella bacteria were around the place, wouldn’t you freak out and call a doctor every time someone sneezed. I really don’t understand the attitude of giving tylenol under those conditions.


  13. - Gettysburgaddress - Friday, Dec 15, 17 @ 11:18 am:

    What did Governor Rauner know and when did he know it? Governor Rauner last year “We’re really on top of the situation.”

    http://www.wgem.com/story/32552477/2016/07/Wednesday/illinois-governor-visits-veterans-home-in-quincy


  14. - Claude Peppers - Friday, Dec 15, 17 @ 11:21 am:

    Rep. Jil Tracy, who represents the Quincy would not hesitate to put her father in the home, but would she put her father-in-law in it?


  15. - Henry Francis - Friday, Dec 15, 17 @ 11:21 am:

    ==“Starting my day with a donuts from Schnickelfritz Bakery in Red Bud. These sisters sure do know how to bake a great business.”
    this hit at 9:31 so GovJunk was not off to a fast start this a.m.==

    So is the Guv gonna even pretend to “work”? Or is is all ridin around campaignin’ and tweetin’

    I’m starting to miss Rod jogging during working hours.


  16. - Anon221 - Friday, Dec 15, 17 @ 11:26 am:

    NoGifts- I wondered the same thing yesterday about the Tylenol, but after doing some Googling, that is the recommended course of action. That said, however, the entire administration at the VA home should have made it clear to staff that the discovery of Legionnaires disease should be of great concern, and patients should be closely monitored for any signs/symptoms. The resident shouldn’t have had to insist that something was wrong or insist that he needed to go to the hospital. The 104 temperature alone should have been a trigger that something was amiss, and tests needed to be done to figure out if it was Legionnaires.


  17. - Sugar Corn - Friday, Dec 15, 17 @ 11:29 am:

    ==cut them a little slack==

    “We’re really on top of the situation” said Rauner on July 27.

    So no. People died because this situation was mismanaged.

    It isn’t low-level staff at the Home that are being criticized here Guy.

    It’s Mr. “I’ve been successful at everything I’ve ever done” and his team of Superstars.


  18. - Alternative Logic - Friday, Dec 15, 17 @ 11:33 am:

    There are clear protocols to be followed as to how to identify at-risk persons.
    There are established diagnostic criteria and treatment plans, which have a very high success rate.
    This is a cringe-inducing failure.
    Perhaps it’s time to reconsider the $100K damage cap at the Court of Claims.
    http://www.idsociety.org/uploadedFiles/IDSA/Guidelines-Patient_Care/PDF_Library/CAP%20in%20Adults.pdf


  19. - dbk - Friday, Dec 15, 17 @ 11:35 am:

    Re: who estimated the cost of replacing the 1 million feet of pipes at $500 mn: according to the WBEZ article, it was Erica Jeffries,ILDVA Director, who “ballparked” the cost. But as sb noted upthread, the system consists of a lot more than pipes.

    Re: the (unbuilt, delayed, postponed) Chicago veterans’ home: its total capacity will only be 200, half of that of the Quincy facility. Even if it were completed–and it won’t be, for years–it couldn’t accommodate those in the Quincy facility.

    Senator Durbin suggested that the home be closed and its residents moved to other facilities, but how would he envision that working? Four hundred residents - that’s a very big facility; would ILDVA lease/rent a number of other new/new-ish facilities for x-amount of time? Somebody should ask him directly about this.

    It sounds from the past few days of comments as if there are a number of negatives in play here: the state of the 132-year-old building (and its pipes) itself: possible/probable chronic under-staffing due to under-funding; a desire to avoid political fall-out (thus, delaying public announcement of cases), etc.

    It’s a complex crisis that’s been long in the making; everyone wants our vets to be well cared-for, but is everyone equally willing to pay for their care at the level they deserve?

    Modest proposal: one U.S. Senator to spend Christmas Day in Edgewood; one in Cairo, and the Gov to dine with the residents of the Quincy Veterans Home. /s


  20. - Moe Berg - Friday, Dec 15, 17 @ 11:37 am:

    It’s problematic if the OEIG, Maggie Hickey, is involved in these investigations. Rauner was pushing for her to be the US Attorney for the northern district, so there’s a political patron relationship there. Further, she and Rauner are issuing press releases about their crime-fightin’together:

    https://www2.illinois.gov/Pages/news-item.aspx?ReleaseID=15184

    To have any confidence in investigating the Quincy situation or the Murashko matter, there really needs to be a special counsel to look into it.


  21. - Sigh - Friday, Dec 15, 17 @ 11:38 am:

    Interesting that on Aug 27, 2015 IDPH issued a press release which “announced eight confirmed cases of Legionnaires’ disease in residents at the Illinois Veterans’ Home - Quincy. There have been no known deaths related to this outbreak.”
    And “Test results are currently pending for other residents.”
    http://www.dph.illinois.gov/news/respiratory-illness-illinois-veterans’-home-quincy

    I know bc of confidentiality we will not know the 8 individuals who tested positive and where they resided in relation to Mr. Tucker. However, I’m sure the law firms involved have this information or will be getting it. What I don’t understand is on Aug 27th IDPH issued a press release- the same day that Mr. Tucker was tested. If there was an outbreak and 8 people were confirmed and others were tested, WHY wasn’t Mr. Tucker tested when he first indicated he did not feel well?

    More excerpts from that same press release:

    Legionella bacteria grow in areas of warm water. In order to be infected with the bacteria, a person must inhale contaminated water vapor. Legionnaires’ disease cannot be transmitted person-to-person. Common water sources include decorative fountains, hot tubs, shower areas, and cooling towers.

    “Legionnaires’ disease can be a dangerous illness, especially in older adults who have weaker immune systems,” said IDPH Director Nirav D. Shah, M.D., J.D. “While there can be numerous causes of respiratory illness, we will continue to work with our public health partners and local healthcare providers to quickly identify residents who may have Legionnaires’ disease and get them treatment as soon as possible.”

    Again, if this cannot be transmitted person to person, then where did the 8 people reside and where did Mr. Tucker reside? Since Director Shah, M.D., J.D. admits ”Legionnaires’ disease can be a dangerous illness” then how was it determined who was tested and at any point did Dr. Shah suggest that the entire facility be tested? Doesn’t Shah have a background on investigating and managing disease outbreaks? Why wasn’t the report to IDPH on Aug 5th taken more seriously since it can be a dangerous illness? When was Director Shah (M.D.,J.D.) actually notified of this situation?

    Who notified the Governor’s office on the 24th- IDPH or IDVA? I find it hard to believe that IDVA has an outbreak at a state facility and they did not immediately notify their assigned point person in the Governor’s office.


  22. - Sugar Corn - Friday, Dec 15, 17 @ 11:46 am:

    MOe Berg, you’re suggesting Maggie Hickey is conflicted in all of her work as OEIG because Rauner supported her? That’s a major claim.


  23. - Anonymous - Friday, Dec 15, 17 @ 11:53 am:

    Yeah Jill, like that’s going to happen.

    Why don’t you spend a couple weeks living there, drinking the water, etc.? Anything stopping you?


  24. - Claude Peppers - Friday, Dec 15, 17 @ 11:55 am:

    Ask inspector general Dean Bower how something like this can be a problem.


  25. - @misterjayem - Friday, Dec 15, 17 @ 11:59 am:

    “Once you found out that legionella bacteria were around the place, wouldn’t you freak out and call a doctor every time someone sneezed.”

    The CDC currently recommends a Legionella investigation in a healthcare setting in two scenarios:

    1) If even a single case is definitely healthcare-associated, i.e. the patient had continuous exposure to the hospital or long-term care facility for the entire 10 days preceding onset, or
    2) If two or more cases are possibly linked to a facility within 12 months of each other.

    As you can probably surmise a Legionella investigation was first triggered on August 5th (first case in a long-term care facility).

    Unfortunately, by Veterans Affairs Director Erica Jeffries own account, the remediation cleanup only began on August 21st (after the second case in a facility within a year).

    What if Veterans Affairs hadn’t WAITED OVER TWO WEEKS and instead addressed the problem on August 5th? How many lives might have been saved if the Quincy veterans home had promptly treated the Legionella outbreak with the seriousness that the CDC recommends for long-term care facilities?

    I don’t know. But I’ll bet we find out.

    – MrJM

    Sources: https://www.cdc.gov/stltpublichealth/townhall/2017/downloads/06-jun-presentation.pdf
    http://www.hospitalsafetycenter.com/details.cfm?content_id=330291&topic=WS_HSC_BHS


  26. - Sigh - Friday, Dec 15, 17 @ 12:13 pm:

    For some reason the link to the press release in my earlier post goes to a different press release. Hopefully this one works:
    http://www.dph.illinois.gov/news/respiratory-illness-illinois-veterans’-home-quincy


  27. - Anonymous - Friday, Dec 15, 17 @ 12:22 pm:

    Any word from Z or Goldberg about why this took a backseat to pressing issues like local RTW zones, taunting legislators, handouts to Exelon, etc.?


  28. - Moe Berg - Friday, Dec 15, 17 @ 12:51 pm:

    Sugar Corn: I’d say the same thing if it were a Democratic governor. It’s problematic to have the person who’s supposed to investigate wrongdoing be appointed by the person who may have been involved in the wrongdoing. It’s a structural problem, that perhaps lacks an easy solution. However, it’s not wrong to raise the concern, especially in a situation where people have died. Maybe that argues for the local state’s attorney to look into it. Or, the FBI. This is a facility that receives federal funds.


  29. - Sigh - Friday, Dec 15, 17 @ 1:34 pm:

    Moe Berg and Sugar Corn- I believe the OEIG has a 5yr term. If an EIG leaves then the Governor appoints a person to serve the rest of the previous EIG’s term. Keep in mind the EIG’s go through the Senate Confirmation process. I will agree that a joint press release (Governor’s office and OEIG) is not the best way for the OEIG to argue independence. However, I know individuals that work at OEIG, they are not political and the frontline and senior staff take their jobs serious. I do not know Maggie Hickey, so until she does something that causes me to question her ability to be independent, then I cannot question her ability to be the Executive Inspector General for the Agencies under the Governor. Keep in mind, OEIG cannot confirm or deny a complaint or investigation. In regards to the Veterans Home, Ms. Hickey could already be investigating. If her staff uncovers any criminal activity, then the OEIG has a duty to refer the case to the proper law enforcement agency.


  30. - Lester Holt’s Mustache - Friday, Dec 15, 17 @ 1:45 pm:

    ==Re: who estimated the cost of replacing the 1 million feet of pipes at $500 mn: according to the WBEZ article, it was Erica Jeffries,ILDVA Director, who “ballparked” the cost.==

    dbk, thanks for the info. I didn’t think it was Durbin, but about once every two months cdog gets his facts right so I can never tell when he’ll slip in something that’s actually true.

    ==I wish everyone would stop politicizing these things this much.==

    Guy, thanks to Darlene Senger it’s far too late for that to happen. The only thing rauner admin could have done that’s worse than trying to blame the individual workers is to try to blame someone who left VA 6 years before this started, but she didn’t hesitate to try to find a non-Raunerite they could blame. Mendoza is going to beat Senger over the head with this one, and rightfully so.


  31. - cdog - Friday, Dec 15, 17 @ 2:01 pm:

    I knew it wasn’t Durbin.
    My jab is at waste and abuse in government and I consider Durbin a premium fossilized artifact of the political class that has gotten away with over-charging for projects for decades.


  32. - Rich Miller - Friday, Dec 15, 17 @ 2:04 pm:

    === gotten away with over-charging for projects===

    Huh? He’s not an executive or a contractor.


  33. - wordslinger - Friday, Dec 15, 17 @ 2:51 pm:

    –Obviously, this is serious, as is any virus that goes around a Senior Living facility or a Cruise ship, for that matter. –

    It’s not a virus. Legionella bacteria. You appear to be putting your confidence in the political hacks in Rauner’s office who put this out in a release two days ago:

    –“Legionella is a virus that is a growing concern in the U.S., not just in Illinois. That it has arisen in a place where our bravest and most cherished defenders reside is a tragedy, and we intend to keep working with the CDC at our side to protect our residents.–

    I’d have a lot more confidence that Rauner has been “on it” since the summer of 2015 if his office knew the basics of what the heck it was talking about two days ago.

    Plus, the dude has quite a track record in the private sector running nursing homes.

    I’d suggest it’s “on” all of us to ensure that this administration take a little interest in its executive management duties.

    Thoughts and prayers, sad country songs, and stadium flyovers ain’t good enough. The vets deserve an engaged public holding the executive branch accountable.


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