GUILDERLAND — A hearing scheduled for Nov. 15, in which the state Department of Health was to lay out its case for why Promenade at University Place should not be allowed to admit any new residents until it has reduced the amount of the bacteria that causes Legionnaires’ disease in its water supply, was abruptly adjourned. 

Promenade, an assisted-living facility for seniors, had two cases of Legionnaires' disease in February; one resident died. In September, the health department said it was investigating another case of Legionnaires' from Promenade although the facility says it has had no cases since February.

What is clear is the health department banned Promenade from admitting new residents, which Promenade argued against at the first session of the hearing on Oct. 28.

The woman who opened the door at the DOH Bureau of Adjudication at 150 Broadway in Menands Friday morning said that the hearing was probably not going to happen, and that the matter would likely move toward a settlement. 

Promenade requested the adjournment, Erin Silk, a spokeswoman for the state department of health, told The Enterprise later on Friday. The hearing will not be continuing, she added, and next steps are to be determined.  

However, Promenade said in a Friday email answering Enterprise questions: “The hearing originally scheduled for today with the NYS Department of Health and Promenade Senior Living has been adjourned. A new date has not yet been scheduled at this time. Promenade continues to keep its residents' safety as the top priority as this process continues.” That message came in an email from Leanne Ricchiuti of Overit, a public-relations firm representing Promenade. 

Ricchiuti did indicate, contrary to what Silk had said, that the hearing would go on at a later date. She wrote in a second email on Nov. 15, responding to questions about the discrepancy, “I appreciate your concern, but at this time, all I can say is that there was an adjournment that is being rescheduled. We have no further comment at this time.” 

DOH spokesman Gary Holmes told The Enterprise on Friday evening that one of two courses could unfold: The hearing could continue at a later date, or Promenade and the health department could agree on a compromise.

Meanwhile, the ban on new residents remains in place, said Holmes.

Background 

Promenade at University Place opened in December 2018, after converting the former Best Western Sovereign Hotel to an assisted-living facility. 

The Best Western had an outbreak of Legionnaires’ disease in 2012, when six people across the state became ill and the only connection among them was a stay at the Best Western. They all recovered. At the time, the hotel completed a process of “super-chlorinating” its shower heads and installed a new hot-water tank. 

After the 2012 outbreak, the hotel was required to have regular testing done, said Mary Rozak, spokeswoman for Albany County, in February. Testing continued until the hotel closed, she said. 

State health department spokeswoman Jill Montag told The Enterprise in February that the state DOH required Promenade to conduct water testing by a certified lab in October 2018, because of the hotel's history, and that the testing was negative for legionella. 

But in February 2019, just months after opening, the facility had an outbreak of Legionnaires’ disease. Two residents became ill, and one of them died. 

Before it had opened, as part of its conversion of the hotel, Promenade had done “an extensive renovation that replaced every single fixture in the building, faucets as well as the hot-water heater,” Paul Belitsis, Promenade’s chief operating officer told The Enterprise at the time of the February outbreak. He said the facility replaced almost all of the piping in the building. 

Promenade took a number of mitigation measures after the February outbreak, which The Enterprise learned about in a hearing at the state DOH Bureau of Adjudication on Oct. 28. At the hearing, Promenade was fighting the state DOH order to stop admitting new residents. 

The mitigation measures it had taken after the February outbreak include: 

— Telling residents and their families about the outbreaks and about all the mitigation measures underway as well as about symptoms of Legionnaires’, and urging them to tell staff if they experience any symptoms of illness; 

— Using point-of-use filters on all showers and faucets in occupied rooms and on all outlets in common areas that are accessible to residents; 

— Placing signs reading “Do not drink the water” at each sink; 

— Providing as much bottled water as residents need or want, for drinking and for personal hygiene such as tooth brushing; and 

— Having caregivers check every day to make sure signs and filters are in place, and that filters are not clogged; clogging would not increase risk of disease but would lower water pressure. 

In March, the facility installed a copper-silver ionization system to try to address the level of legionella bacteria in the water supply, but switched at the end of August to a monochloramine system after finding that the original system did not work as well as expected. 

In September 2019, the state health department had issued a statement saying, “The Department is investigating a case of Legionnaires disease associated with a resident at Promenade and we are analyzing for both clinical and environmental samples.”

At that time, the state DOH ordered Promenade to stop admitting new residents until the facility could show that it had had three successive months in which unfiltered water from at least 70 percent of its outlets tested were free of the legionella bacteria. Legionella is the bacteria that causes Legionnaires’ disease. 

On Oct. 28, Promenade made its case in a day-long hearing at the Bureau of Adjudication. 

The DOH was scheduled to present its case the following day, Oct. 29, but that was adjourned to Nov. 15. 

On Nov. 1, Ricchuiti of Overit sent The Enterprise a letter Promenade had given to its residents and their families. 

The letter said, in part: “The Department of Health has opened an investigation into a resident at the Promenade who was ill with a respiratory matter. The resident was treated for the respiratory matter. Subsequently, the NYS Department of Health did further testing to see if that resident showed a presence of the same legionella bacterial strain that has been found in our building. According to the information provided to us by the Department of Health, that bacterial strain was not detected.” 

The letter to Promenade residents continued: “What does this mean for you? It means that the remedies we have employed, based upon advice from our consultants and consistent with the guidance of the NYS Department of Health, are effective. The filters, procedures and precautions we implemented in February, and modified as needed, are working. As far as we are aware, no one has contracted Legionnaires’ disease from our facility since the filters were installed.” 

Holmes of the state DOH declined to comment on the Promenade statement, saying on Nov. 1, “... [T]he facility has the ability to challenge the order, and to do so in court. That has to be the forum where I’m comfortable with this playing out.” 

The Enterprise subsequently wrote an editorial, asking the health department to clarify whether there had been a case of Legionnaires' at the Promenade in September, as it had stated, or not, as Promenade claimed, and what the DOH tests had shown [“Is the health department filtering the truth?” Nov. 14, 2019].

Holmes said this week that he couldn’t answer those questions because “it is within the window of due process.”

Expert’s view 

The Enterprise spoke with Dr. Leonard Mermel, a doctor of osteopathy and a professor of medicine at Brown University’s medical school and the medical director of the Department of Epidemiology and Infection Control at Rhode Island Hospital. 

When the health department had first announced it was investigating, in September, Paul Fahey of the PR company Overit told The Enterprise, ““We are not sure of the source.” He emphasized that Promenade has been following department-of-health guidelines on water quality and filtration systems, and said that the resident who had gotten sick sometimes leaves the facility and goes shopping or on vacation. 

If someone who lives at Promenade and spends most of his or her time there contracts Legionnaires’, Mermel said, Promenade is the most likely source.

There are 15 serogroups of Legionella bacteria; serogroup 1 is the most common. According to Oct. 28 hearing testimony, serogroup 1 is the only one present at Promenade.

“Even if that’s the only one they found, it doesn’t mean it’s the only one that’s there,” said Mermel. “How well did they look?” he asked rhetorically.

The incubation period is from two to 10 days, Mermel said. He would anticipate that the state DOH would have investigated whether the resident had gone anywhere outside the facility during the period from two to 10 days before becoming sick; if the resident had gone somewhere, he would think the DOH would investigate whether there had been any cases associated with that location. 

The department of health has yet to clarify any of these points. 

Mermel said that point-of-use filters should be effective in keeping legionella bacteria from residents, and said that infections have sometimes been traced to air-conditioning units or fountains. 

He mentioned an incident from North Carolina in October, in which more than 100 people who had walked past a hot tub display at a state fair in became ill with Legionnaires’ disease. 

Mermel also questioned the state DOH order to have Promenade reduce its bacteria to the point that at least 70 percent of the unfiltered water coming from the showers or faucets tested are free of bacteria. 

While 30 percent is a common benchmark used by the Centers for Disease Control and Prevention, Mermel said, his hospital would take action if any legionella bacteria were found. “In my hospital, we basically do something if we find anything,” he said. 

He cited a paper on an outbreak of Legionnaires’ at a Pennsylvania hospital with a Legionella disinfection system. The paper concludes, “Until more precise tests are available, any detectable level at even a single site should be considered a hazard.”