VA Facilities Now Must Follow State Rules on Reportable Diseases

By Sandra Basu

Rep. Mike Coffman (R-CO), chairman of the HOuse Committee on Veterans’ Affairs Subcommittee on Oversight and Investigations

WASHINGTON – As Congress considers legislation to require VA medical facilities to follow reportable infectious disease laws in the state or territory where they are located, VHA has issued a new mandate for that to be done immediately.

The VHA directive stops short of some of the proposed legislation, however, which calls for VAMCs to pay fines to states if they fail to comply with the reporting requirements.

In Congress, the call for legislation came after a Legionnaires’ Disease (LD) outbreak at the Pittsburgh VAMC, which resulted in five deaths and at least 16 other nonfatal cases in 2011-2012.

Currently, federal facilities do not have to follow the same rules as other public and private medical entities in reporting infectious diseases to state health officials. Lawmakers said the LD outbreak highlights the need for VA facilities to be held to the same standards.

“Based on investigations conducted by this subcommittee, as well as a hearing in February, it is clear that VA needs to be held to the same standard for infectious disease reporting as its healthcare counterparts in each state,” Rep. Mike Coffman (R-CO), chairman of the House Committee on Veterans’ Affairs Subcommittee on Oversight and Investigations, said at a hearing.

Coffman, sponsor of legislation addressing the issue in the House of Representatives, said during a subcommittee hearing that he found it “baffling” that the University of Pittsburgh Medical Center Hospital is required to report infectious diseases incidences to state health officials, while the nearby Pittsburgh VA Medical Center is not.

Specifically, Coffman’s bill would require VA to report each case of a reportable infectious disease that occurs at a VA medical facility in accordance with the laws of the state in which the facility is located. Data reported to the state would then be reported to the Centers for Disease Control and Prevention in Atlanta and used to monitor public health.

The bill also states that if the VA secretary fails to report a case of a reportable infectious disease to state authorities that VA would have to pay a fine to the state in the same way that a medical facility “not owned by the federal government that is located in the same state would pay as a penalty to such state for such failure.”

Introducing similar legislation in the Senate was Sen. Bob Casey (D-PA). His bill would require VISN directors to report a confirmed case of a notifiable infectious disease within 24 hours to a number of entities. The VA also would be required to notify the infected patient, next of kin and the patient’s primary care provider within 24 hours.

“During this outbreak of Legionnaires’ Disease in Pittsburgh, appropriate entities were not adequately informed,” Casey said in a written statement. “Changes are needed to ensure there is better notification in the future and that steps are being taken to ensure our veterans have access to high quality health care.”

A mandatory approach of requiring VA facilities to report infectious disease to state health authorities was favored by several outside groups.

During a hearing on the House bill, Timothy F. James, MD, president of the Council of State and Territorial Epidemiologists, testified that a change in law is needed because of “other examples of suboptimal coordination of disease reporting with VA institutions.”

“CSTE experts have reviewed many scenarios, including the Pennsylvania VA Legionnaires outbreak, and believe that if VA facilities comply with jurisdictional reporting laws, many facility-based outbreaks will be detected, investigated, and stopped earlier than they may be otherwise,” he said in written testimony.

Nick McCormick, legislative associate for the Iraq and Afghanistan Veterans of America, told lawmakers that his organization supports the bill and further suggested that the number of infected at the Pittsburgh VAMC could potentially have been far lower had the law been in effect at the time of the outbreak.

“Indeed, the CDC’s after-action report on this incident indicated that poor communication and procedural missteps in the VA Pittsburgh system were just as much to blame for the outbreak as the Legionella bacteria itself,” he said.

Mandatory Reporting

VHA Principal Deputy Under Secretary Robert L. Jesse, MD, told lawmakers that VA “absolutely supports that its facilities report infectious diseases to external health authorities in a manner comparable to reporting done” by other, non-federal facilities.”

Jesse further explained in written testimony, however, that VA would prefer a voluntary approach to reporting health data and believes that “more standardization and consistency in its practices” can be achieved without “new mandates in legislation.” If Congress moves forward with a mandatory approach, VA officials said they opposed requiring their medical facilities to pay a fine for failure to report in accordance with state law.

Although VA has said VHA facilities have already been encouraged to participate in their individual states’ reporting processes, days after the hearing a directive was released, establishing “a requirement for VHA health care facilities to report on the designated reportable diseases according to the laws, regulations, and policies of states and territories and to follow VHA Handbook 1605.1 and other applicable laws on release of information.”

The directive pointed out that “VHA’s policy on reporting of reportable diseases to local and/or State public health authorities has been limited.”

Now, the directive said that “it is VHA policy that VHA health care facilities will report diseases designated as reportable to the local, district, State, or territorial entities legally authorized to receive such reports.”

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