Missing water tank reports at many NYC hospitals

One tank’s innards were rusty and discolored, and a dead pigeon lay nearby. A different tank had bird droppings on it and was missing its roof.

Both descriptions were included in inspection records for rooftop water tanks in New York City, which a recent City & State investigation found are poorly regulated, often neglected and potentially at risk of spreading disease.

What makes these reports different, however, is that they were submitted by city hospitals, where many of the sickest and most vulnerable people in New York City drink water stored in the tanks. These many thousands of hospitalized people with weakened immune systems are particularly susceptible to infection from viruses or bacteria that can proliferate in poorly-maintained water tanks, experts warn.

Even world-renowned health care facilities in New York City have their own water tanks tucked behind sleek glass exteriors, and some of them are made entirely of wood – which experts say also poses a risk. What’s more, many hospitalized patients at any of these facilities would have a hard time finding out how often hospital drinking water tanks are inspected or what inspectors find inside.

City records show many hospitals have not been filing timely water tank inspection reports, as the law requires, and those hospitals were reticent to follow public disclosure laws to show proof of inspections to City & State. The most detailed documentation obtained by City & State revealed worrisome signs of neglect in some tanks. City & State also learned several large hospitals employ wooden rooftop tanks that animals and insects could easily enter and contaminate if the tanks aren’t carefully maintained.

The tanks, if neglected, have proven to be vulnerable to animals and can be reservoirs of dangerous bacteria and viruses, health experts and EPA scientists previously told City & State. Citywide, current tank inspection requirements are inadequate and water testing practices are useless, experts said. Oversight is lax and some city agencies fail to follow the rules. The City & State investigation also showed that as many as two-thirds of all building owners with water tanks do not clean and maintain their tanks, according to city data. Even those who do file reports representing a clean bill of health often fail to mention the unsanitary conditions inspectors see.

Lawmakers have since begun proposing laws to solve the problem, with one city councilman triggering a formal inquiry by the Department of Investigation into the “the city’s failure both as a regulator and an owner.”

In a new City & State survey of 20 public and private New York City hospitals – encompassing 40 buildings – less than half had filed their water tank inspection reports with the city in 2017 as of late March. The same was true for 2016 and just over half filed for 2015, according to city data obtained by a Freedom of Information Law request. At least 13 of those hospital buildings had never filed at all, according to city records.

Generally, the city considers failure to file a report as evidence that no inspection was done. However, health care experts were careful to note that simply because the reports were not filed and documents were not made public, that does not mean the tank inspections and maintenance did not happen.

In addition to filing with the city, the water tank laws require the release of inspection results to any person who asks for them, within five business days. After City & State requested those documents from hospitals, some chose to quietly file online inspection forms with the city months or years after the deadline and then refused to provide inspection documents to City & State.

These hospitals said they do clean and inspect their water tanks, but they said they would not provide the proof within the five-day deadline as the law requires. Other hospitals never responded.

Of the 20 public and private hospitals surveyed by City & State, some gaps in the record remain. In the end, for 2015, six of the hospital campuses failed to file water tank inspection reports with the city or provide documentation to City & State. For 2016, seven hospitals failed to file or provide information. For 2017, one hospital failed to file or provide information.

Ultimately, just seven of 40 hospital buildings surveyed provided some proof of a water tank inspection – to the city or to City & State – for every one of the last five years, records city law requires buildings to keep. Several declined to provide all the documentation requested after they disagreed about which records the law requires them to release, but said they nevertheless cleaned and inspected their tanks annually.

Several hospitals say they go above and beyond the annual inspection and cleaning requirements. The most zealous appear to be hospitals that have previously experienced high-profile waterborne disease outbreaks in their own building drinking water systems.

“The wooden tanks are even more at risk of degraded water quality because they support the growth of these naturally occurring organisms some of which could be pathogens. And the risks of those kinds of organisms is greater in healthcare settings like hospitals.” - Mark Sobsey, adviser to the World Health Organization on drinking water issues

Some drinking water tank inspection records revealed that the hyper-clean environment New Yorkers might expect from their health care facilities clashed with the reality presented in the documents. Some New York City Health + Hospitals buildings, for example, included reports that showed steel tanks splattered with sediment and stained with rust.

Those city hospitals provided the most detailed inspection reports, which noted a host of defects, including rusty walls, heavy layers of muddy sediment, a missing roof, and evidence of animals around the tanks.

One of those hospitals, NYC Health + Hospitals Metropolitan, reported worrisome conditions in its 2016 inspection reports of its steel tanks. “Tank interior has large areas of rust on all walls including the ceiling,” read one inspection, which also noted “a dead pigeon was found in the same room as one of the tanks.”

Another city hospital, NYC Health + Hospitals/Kings County, reported a tank in 2016 that had “no roof,” “heavy sediment” and “some bird dropping on tank.” Photos showed black muck splattered on the walls. The hospital also shared reports from 2017 and 2018 from the same company, which appeared to show that the problems were resolved. A hospital spokesman did not provide any reports before 2016, saying that “earlier reports will take longer to retrieve from archives.”

When asked about the signs of neglect and disrepair, a city health department spokesperson said that water tanks at both hospitals “show compliance with inspection and maintenance requirements.” But the spokesperson added, “A lack of inspection by the building owner and maintenance over an extended period of time is a concern for the agency.”

According to a search of city records, Metropolitan and Kings County hospitals had never submitted inspection reports to the Department of Health and Mental Hygiene, which also means there was likely no city record that these buildings even had water tanks before City & State requested the primary documents.

It is impossible to say whether these poor conditions were typical or unusual in hospitals citywide, because the documentation that tank inspectors provide varies wildly. While one company will create a report with pages of records, photographs and scanned-in contemporaneous handwritten notes on conditions inside the tanks, another will simply issue a single-sheet “certificate of compliance.” Online filings do not provide much detail either; they amount to a basic checklist with no written comments or pictures of sanitary defects. Of course, nothing can be learned from hospitals who declined to provide any records at all.

According to a search of city records,SUNY Downstate - University Hospital Brooklyn, a state entity, has never filed inspection reports with the city, although a facilities management employee confirmed the facility uses at least one wooden water tank for drinking water. Records officers refused to turn over inspection records within the five-business-day timeframe alloted for in city law, instead treating it as a Freedom of Information Law request. “As a state agency, SUNY Downstate follows the city code on a case by case basis,” a records officer wrote. “To the extent that it is feasible, SUNY Downstate makes good faith efforts to comply with the spirit of the New York City requirements whenever possible.” A spokesperson later said that “SUNY Downstate does clean and inspect its drinking water tanks.”

Wooden tanks are inherently vulnerable to contamination, including the ease with which animals could get inside and pollute the drinking water supply, experts say. Several hospitals who care for fragile patients, however, use wooden rooftop tanks for their drinking water supply, including Memorial Sloan Kettering Cancer Center (which reported seven wood tanks) and the Mount Sinai Hospital complex (which reported 10 wood tanks).

“I would be very concerned about them and I'd do what I can do get them replaced with more durable structures,” an EPA drinking water toxicologist said of wooden water tanks on hospitals, noting that sick people are particularly susceptible to tainted water. “It's a huge vulnerability.”

The EPA scientist spoke on condition of anonymity because the tanks are not within his jurisdiction.

Building managers, the EPA toxicologist said, “need to be diligent about their inspections and making repairs when they need them,” suggesting that tanks should be examined every few weeks.

Mark Sobsey, a leading expert on public health microbiology and environmental virology who advises the World Health Organization on drinking water issues, echoed those concerns.

“The wooden tanks are even more at risk of degraded water quality because they support the growth of these naturally occurring organisms some of which could be pathogens. And the risks of those kinds of organisms is greater in healthcare settings like hospitals,” Sobsey said. “You have variety of threats to stored water that need to be controlled.”

A spokesperson for Mount Sinai hospital, which has five wood tanks alone on its towering Annenberg Building, said, “Our tanks are appropriately cleaned, maintained and certified by an independent inspector meeting all the city’s requirements. In addition to the rigorous cleaning and maintenance, we treat ALL water with secondary disinfectants which is over and above the city’s requirements. The tanks are made of materials used during the period of their construction.”

Two hospital epidemiologists said using wooden rooftop tanks is not necessarily problematic.

“In my mind the wooden tanks themselves may not be an issue,” said Dr. Brooke Decker, who has done extensive research on waterborne disease outbreaks in hospital drinking water systems and is director of infection prevention for the VA Pittsburgh Healthcare System, which had a Legionnaires’ outbreak before she came on. “It’s more about how they are managed and how that safety is validated.”

While there are no hospital-specific federal or city regulations for maintaining drinking water tanks and internal plumbing systems, New York state health authorities have implemented rules to limit Legionnaires’ disease outbreaks in health care facilities by requiring annual, and in some cases quarterly, water testing. In addition, a set of building system standards calls for a water safety committee to create a water safety plan. An independent nonprofit, The Joint Commission, also audits hospital practices every three years as part of its widely-accepted accreditation process. Several hospitals also said they follow guidelines and have rigorous testing procedures. Other hospitals explained that they have additional safety measures designed to further disinfect the water in their buildings.

“It's a huge vulnerability.” - EPA toxicologist

Even some of the newest hospital buildings employ wooden rooftop water tanks, including one of the most revered cancer hospitals in the world.

“We just built a brand new building and put a water tank on the top,” said John Letson, vice president of plant operations at Memorial Sloan Kettering Cancer Center, during a policy discussion hosted by City & State last year. “It’s still wood.” Letson sees no problem with using the barrel-like tanks.

Memorial Sloan Kettering has been vocal in its support for more active monitoring and maintenance of health care water supplies. The hospital tests its wooden rooftop water tanks four times a year, and cleans them annually, examining the water for more than just the city-mandated samples for E. coli and coliform bacteria contamination.

“Any time that we’ve had a rain event of substantial quantity, two inches or more, we’ve noticed a plume of Legionella in the domestic water tanks, and that’s reflected by the testing,” Letson said at the panel discussion last October. He later told City & State that the hospital did not detect legionella in hospital rooms at the same time and that the elevated levels were not “inordinately” high – between 10 and 50 colony forming units per milliliter. Recently, the hospital has taken to immediately disinfecting its wooden tanks after the rain stops.

“Personally, my greatest concern is for the bone-marrow transplant patients,” Letson said at the event. Such cancer patients are extremely susceptible to infections and they increasingly receive treatment while staying outside the hospital and therefore drink water from buildings that do not keep a wary eye on their water supply. “Those apartments actually pose a tremendous risk to our patients,” Letson said.

In 2015, a Memorial Sloan Kettering cancer patient who was staying at Hope Lodge,an American Cancer Society building that provides free housing to people undergoing treatment,contracted Legionnaires’ disease that was linked to Hope’s water supply system. The patient had to halt cancer treatment and died. The family is suing Hope Lodge for not doing more to protect the water supply.

“My mantra is: As long as you’re at Sloan Kettering, you’re safe,” Letson said. Then, referring broadly to New York apartment buildings, he added,“You go home to your own water system, it’s another story.”

Outbreaks in hospital drinking water systems pose “a serious threat to high-risk patients,” including the critically-ill and those with weakened immune systems, recent research shows. Because of that, some hospitals add disinfectants like chlorine to their water supply or use other novel techniques to kill microbes and keep water safe for patients to drink, however, not all do.

“The more contaminated the tank is, the harder it is to fix it before it comes out of the tap,” said Dr. David Weber, medical director of UNC Hospitals’ department of hospital epidemiology. “To the degree that you don’t properly maintain the water in the tank – and you get lots of sediment, lots of microbes – that impairs the system, anything between the tank and the tap, to decrease the level of microbes and decrease the risk.”

An outbreak of Legionnaires’ disease at the Pittsburgh VA hospital led to increased data gathering and on-site chlorination of the water system that has radically reduced the incidence of positive legionella tests, said Dr. Decker, who heads water safety efforts at the hospital. They also clean their water tank regularly, she said.

There have been several outbreaks in New York City hospital drinking water supplies of legionella bacteria, which causes Legionnaires’ disease. Dr. Victor Yu, a legionella expert who defined the clinical syndrome of Legionnaires' disease in 1982, noted in a letter to city health officials that several drinking-water-linked legionella outbreaks were documented over a decade ago in New York City hospitals.

However, city health officials have repeatedly said that no illness or outbreak has ever been traced back to a rooftop drinking water tank. It is true that no case of Legionnaires’ disease has been associated with a New York City water tank, although EPA research shows that water tank sediments can provide a rich breeding ground for legionella bacteria and other pathogenic organisms.

Still, health officials have said they would not check water tanks for legionella bacteria during an outbreak, because they believe the tanks are safe. In fact, during the 2015 Legionnaires’ outbreak in the Bronx, city officials said they did not test and did not need to test the drinking water inside the buildings. At the time, Dr. Yu and other experts disagreed with those decisions. Dr. Michael Skelly, a Bronx infectious disease specialist who did test his patients’ drinking water during the outbreak, found legionella in several of their homes, although he was fired by the hospital shortly afterwards and has since sued the city over his firing. The case is ongoing.

The city ultimately ruled that the 2015 Bronx outbreak was attributable to cooling tower mist.

"Absence of information is not information of absence, meaning just because you don’t know it, doesn’t mean they’re not doing it right.” - Dr. David Weber, medical director of UNC Hospitals’ department of hospital epidemiology

Scientists stressed the importance of gathering information about New Yorkers’ water. Little is known about the city’s water tanks or the quality of the drinking water inside them. Even in the most carefully scrutinized building water systems that serve the most vulnerable people – those inside hospitals – the city knows virtually nothing about how often the rooftop reservoirs are cared for or what condition they are in.

A spokesperson for the New York City Department of Health and Mental Hygiene did not answer questions about whether the agency was concerned by the lack of information or compliance from city hospitals, instead noting that “100 percent compliance is the goal” and that neglected water tanks are a concern. The department said that it is creating “a system that generates summonses automatically for those buildings that are likely to have a water tank but have not submitted an annual inspection report.” The new system should be in place sometime this year.

The fact that large hospital operators, including New York-Presbyterian and New York University, failed to provide copies of inspection results to City & State and that several others declined to provide years of records does not necessarily mean water tanks are being neglected. In fact, both operators filed a flurry of online inspection reports after City & State requested the documents.

“Absence of information is not information of absence, meaning just because you don’t know it, doesn’t mean they’re not doing it right,” said Dr. Weber, the hospital outbreak specialist. “That said and done, my rules for practicing medicine are be compulsive and trust nobody for nothing.”

City & State’s previous reporting showed that even sterling inspection reports are not always reliable records of well-maintained water tanks. One city agency’s spotless inspection reports completely contradicted years of visible decay and neglect in a drinking water tank atop city sanitation offices.

“I’m not a real trusting person when it comes to health and safety,” Weber said. “Everything should be documented.”