Este artigo foi traduzido para o Português pelo Google Translate. Para ler a versão em Português, clique aqui.
While the world reacts to the epidemic of ebola in Western Africa, a record outbreak of over 300 Legionnaires Disease victims is straining the health care resources of the small town of Vila Franca de Xira, Portugal, a small town north of Lisbon.
In addition to the people that have been infected, at least five people have died. It is a terrible situation, and one that is comparable to the original outbreak in 1976 at the Legionnaires’ convention on which the disease was named. The outbreak in Portugal; however, is an incredible number.
Marta Reis of the online news magazine “I-Online” has reported that the Portugal outbreak is the world’s third largest Legionnaires outbreak ever.
The World Health Organization has termed the Portugal Legionnaires outbreak to be a “Major Public Health Emergency” and the number of exposures to be “unusual and unexpected.”
The Investigation and Identifying the Source
Media reports, including the following by Marta Reis of iOnline, have identified the location of the legionella bacteria to cooling towers at a fertilizer plant as the likely cause: The Fertilizer Company: ADP Fertilizantes, Adubos de Portugal.
Officials hope to have today until midnight test results that could confirm the source of the outbreak of Legionella:
The first analysis revealed Legionella in cooling towers of fertilizers Portugal, Central Beer and Solvay but experts Environmental Inspectorate point to a more significant problem in ADP. The expected today analyzes should determine whether the samples collected in the factories are linked at the molecular level with the isolated bacteria in patients. The director general of health explained that it is not entirely certain that the analyzes come today because the multiplication of bacteria in the laboratory is not fully controllable. Francis George said that there is a chance the results are not conclusive. Once the towers were closed suspicions 10th, should no longer be new cases 20 days, George said. [Translated with Google Translate]
In the United States the process of discovering the source is typically the responsibility of our Government by an agency called the Center for Disease Control (CDC). Once the case is diagnosed, the CDC pursues these cases through a detailed investigation. If the victim hires an attorney, then the case is filed in a court, and the attorney can use subpoena power to discover information that can assist in determining the origination of the exposure and the causal connection to the victim.
Portugal’s Environment Minister has confirmed that all cooling towers in the affected area have been shut down pending the investigation.
What is interesting in the Portugal outbreak, the major focus of enforcement comes in the form of “Environmental Crimes” that will be prosecuted by the Environmental Minister. The recovery of medical treatment and damages is, at least for the present time, apparently being handled by local legal advocacy organizations.
One other issue involves the important “documents.” The most important documents are those that the company should maintain on the treatment of their water. In the United States, water service companies generally handle the treatment of cooling towers and pools and similar water containers. The treatment logs and the company water testing logs should be the first thing that the government should be securing. That is where the answer to the question of “how did this happen” will be located. Unfortunately these documents are not accessible to the victims unless they have some type of subpoena power, or other authority that can protect, secure, and obtain these corporate documents.
Watch for the company to say, “we have the strictest processes for the safety and protection of the public” but at the same time will not be able to completely provide their corporate logs on the maintenance of the cooling towers and the water treatment procedures. The company explanation on those logs always seems to be either “misplaced” or “the person in charge of the logs was not qualified, and he has been terminated.”
If there is one thing that I could wish to put my hands on it would be those cooling tower maintenance logs. Forgive the religious metaphor, but that is where they will find the “Holy Grail” of documents. And like the search for the “Holy Grail,” the search will go on and on, never-ending.
Pursuing a Legionnaires Claim
The families should be making sure that they have their medical records available, both before and after the event. It is very likely that the company will suggest that the medical problems suffered by the victims are because of prior medical problems. This defense is used in most cases of medical causation, where the offending party claims, “well we may have had some problems, but the victim had some serious medical problems, so we are not totally to blame.” So the families should be ready for that argument with medical records or some statement from their physicians that the person was a healthy individual prior to the exposure.
Each victim should be seeking treatment from qualified physicians that have knowledge of legionnaires disease or sometimes referred to as Pontiac Fever. Most cases of Legionnaires are diagnosed as pneumonia, so it is important that the medical experts diagnose the condition properly. Some of the symptoms, the secondary medical conditions that follow, and the proper testing are listed here on my website as well.
From a civil claim standpoint there should be some effort to find a qualified expert in epidemiology to give opinions on the victims condition to that of legionnaires disease. This expert can contradict the likely opinions of the company that the level of legionella was not high enough for the sickness of certain victims. Relying on the government to establish these medical causation issues is not a good idea. The victims need to protect themselves and advance their own claims with solid medical and expert support. More on the importance of experts.
Not immediately, but at some point there will be a need to have the victims also evaluated by a pulmonologist to determine lung strength. This is the condition that could remain permanent, but it is important to have the victims checked at certain times to determine the improvement of the lung capacity of the person over time after they make a general recovery.
One other thing that will likely occur. Because of the large number of persons that have been infected, there will likely be some “phantom victims” that claims that they are affected and ill, but will be shown not to have contracted the disease. These people will be the ones that the company will use to show that the problem is not legionnaires at all but people trying to falsely make a claim. Even though it may be only one person that claims the disease but is not infected, the company will make that person the main focus to diminish the claims of the worthy persons.
One would think that with the incredibly high number of persons affected the company would have no defense, but I can promise you there will be a defense, and right now these companies are likely making a long term plan for their financial protection.
For questions regarding a criminal complaint, I would assume that any criminal process would be prosecuted by some government agency and with limited input by the victims or their representatives. This is good and it is bad. Government agencies are generally good at doing much while doing nothing. While the government will investigate the cause and the source, their general methods of investigation do not go into too much depth about the problem or to the cause of the individual victims’ injuries. While the criminal prosecution seems good, the end result will likely be less than what the families are needing for their individual claims.
If the Portuguese legal system allows for financial compensation, then the issues that will be involved will be similar to those in the United States – Legionella experts needed for proof, causation experts and medical experts, as well as investigating the factual cause of the Legionnaires’ outbreak.
In the United States the principle parts of the compensation system are:
- Medical expenses
- Lost wages
- Mental anguish
Some jurisdictions allow for punitive damages (compensation in the form of punishment against the offending company). In the overwhelming number of case the victims do get compensation, but the amount generally depends on the degree of the injury, or in the worse case – death. Most of the cases in the United States are settled outside of a court hearing, and the amounts are generally kept secret by agreement of the victim and the company. Again the amounts of compensation vary with the injury, but recoveries have been awarded in trial in the United States for over a Million Dollars.
In Louisiana our laws are also based on Codal Law similar to that of most of Europe, so I would imagine that there would be some basis for some type of compensation for the victims in Portugal.
Can a Portuguese citizen be allowed to prosecute a case in the United States from an exposure that occurred in Portugal? That may be possible if the companies that are found to be responsible have contacts or some connection to the United States. That is a simple explanation, but it is possible to bring a lawsuit in the United States under certain set of facts.
My experience are that cases in the United States are most commonly caused by swimming pools and hot tubs exposure. The last case that I handled involved a Hotel’s hot tub that exposed the customers to Legionella. Their symptoms did not manifest until a few days later (which is common), and once the CDC had done its investigation, the location of the hotel and the Legionella was determined. Unfortunately by the time the victim had recovered and then sought legal advice it was some months later. By a coincidence that same hotel had been found to have legionella in its hot tub a few months before my client’s arrival, and we were able to piece together facts that the same hotel had the bacteria before my clients exposure.
Most hotels in the United States that have pools and hot tubs have contracts with water service companies that maintain the water at safe levels for swimming in the pool and tub. Either the service company failed to properly service the pool and hot tub, or the hotel failed to follow the procedures requested of the service company. Either way the condition of high levels of legionella are preventable.
In the most recent case we retained experts to determine the source of the bacteria, another to determine the causal connection to the hotel bacteria, and the medical doctors that treated the victim were also used by us to give opinions on the injury, the significance of the condition, and to determine the future complications of the disease. Many times the victim may recover from the most problematic of their symptoms, but the disease causes future problems to the lungs and sometimes to the nervous system. These future complications are many times permanent.
In most cases the claims of the victims are resolved a settlement after a suit is filed. The terms and the amount of the settlements are generally made confidential by the parties. Although in some cases there could be some type of criminal complaint made, the vast majority of the cases in the United States are cases of civil liability.