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State officials deny cover-up on TB outbreak

DOH's Harris said in the video that CDC has assigned an employee to the Duval health department to help with screening, joining several from the state office. He did not say how much of the backlog has been cleared up.State officials are defending the Department of Health from accusations that it covered up a serious TB outbreak in Jacksonville in order to proceed with downsizing of the state's largest agency.

DOH's press office released a statementfrom Dr. Steven Harris, deputy secretary, that called the accusations inaccurate and "outrageous." Harris said that as soon as health officials noted a spike in Duval County TB cases, they asked for help from the Centers for Disease Control (CDC) and organized a  coalition to address the issue.

"Contacting these local government officials, community organizations and hospitals is a clear sign that these actions were conducted with the utmost level of transparency," Harris wrote.

Harris also said in a video interviewthat he thinks the outbreak is contained to the homeless community in Jacksonville and doesn't present a threat to the general population -- a statement that appears at odds with a report from the CDC. Harris said that since there was no general threat, there was no need to issue a public warning, and in fact DOH usually doesn't make its disease investigations public, he said.

Meanwhile, House health budget chief Matt Hudson said that "the Department of Health acted responsibly" in dealing with the outbreak and that the Legislature's reorganization of DOH did not impair the agency's ability to act.

The funding for tuberculosis programs remained the same, Hudson said. "We didn't cut a single dime for that program."

Harris and Hudson were reacting to Monday's publication of a Palm Beach Post articleby Stacey Singer about a TB outbreak among the homeless in Jacksonville that caused 99 illnesses and 13 deaths.

An April 5 letter by Dr. Robert Luo of the CDC called the outbreak the worst he had seen in 20 years and indicated that the danger wasn't over, despite DOH statements saying the caseload was trending down.

Singer's story said Luo's 25-page report, dated April 5, came to light after it was mentioned in a psychiatry journal. The reporter wrote that she tried for weeks to get the report from CDC and DOH but ended up having to drive to Tallahassee from West Palm Beach to get it.  Florida's Sunshine Law requires agencies to turn over such records to the public, including the media, upon request.

DOH press secretary Jessica Hammond said Tuesday that Singer's account does not dovetail with her understanding of events; she said she would check with DOH general counsel's office to see whether she could elaborate.

The most potentially damaging aspect of Singer's article is its suggestion that the agency downplayed the outbreak for political reasons. Luo's letter, addressed to the acting state health director at the time, Dr. Richard Hopkins, was dated only a few days after Gov. Rick Scott signed a bill that shrank DOH and ordered the closing of the state's long-time tuberculosis hospital, A.G. Holley in Lantana.

 Singer's story quoted a spokesman for the Duval Health Department explaining that officials there didn't publicize their request to CDC for help because they didn't want to give the public yet another reason to demonize the homeless. "It's a judgment call," said Duval County Health Director Dr. Bob Harmon, who noted that when outbreaks involved a school, the public is alerted.

CDC gave Duval a $275,000 grant to track contacts of the original case identified in 2008-09, Singer reported, but when that money ran out the effort was cut back.

“We thought after 2008 that we had it contained,” Harmon told the Post. “It was not contained. In retrospect, it would have been better to inform the general population then.”

Holley, built in the 1950s as a long-term-care hospital for tough-to-treat cases of TB, had been ordered closed because it was seen as outdated. Most cases of TB can now be treated on an outpatient basis; if inpatient care is needed, hospitals have the capability of isolating patients in negative-pressure rooms that keep air flow going in, not out.

However, hospitals have not rushed to embrace TB patients, especially those who have a strain that is resistant to antibiotics. Most of the patients have no health insurance, they say, and Medicaid has not come close to covering the expense.

Both the reorganization and hospital closing, part of HB 1263 by Rep. Hudson, were contentious issues, opposed by many in the public health community.

The closing of Holley, originally set for later this year, was speeded up by six months, and patients were moved out to Jackson Memorial in Miami and Shands Hospital in Jacksonville in May and June. DOH sent out a press release on July 2 announcing it had completed the goal of transferring out all patients (the link to that press release appeared not to be working on the DOH website today).

Hudson, in a phone interview today, said the hospital was an expensive and delapidated structure overdue for shuttering and that the TB outbreak was not related. "One does not have anything to do with the other," he said.

Forty-six other states take care of TB patients without a state-supported sanitarium, noted Hudson, R-Naples. "Clearly it can be taken care of efficiently and compassionately without a hospital."

Luo's report, which summarizes an investigation that began in February of this year after Duval County requested help from CDC, says the genotype of the bacterium isolated in the new cases is the same as the index case from 2008, a homeless man who had schizophrenia. While TB cases overall in the state had been trending down, the report said, cases related to that genotype were spiking up in 2011 and continuing at that rate in early 2012.

If that rate continues, Luo wrote,  it suggests "this outbreak has yet to show signs of abating."

He commended Florida for boosting its genotyping, which had lagged in the early years of the outbreak, and for instituting the practice of documenting stays at homeless shelters so that epidemiologists were able to track the spread of disease. The CDC team identified a jail, homeless shelter and mental-health outpatient treatment center as sites where the disease was spread.

Luo identified two factors that contributed to the size and complexity of the outbreak: 1) the lack of tuberculosis screening and education programs at most of the homeless shelters and other transmission sites; and 2) the state's failure to contact and screen the vast majority of people identified as close contacts to infected patients.

Of 3,222 close contacts to infected persons identified since 2010, Luo wrote, only 253 had been screened and evaluated at the time of the CDC visit.

DOH's Harris said in the video that CDC has assigned an employee to the Duval health department to help with screening, joining several from the state office. He did not say how much of the backlog has been cleared up.

--Health News Florida is an independent online publication dedicated to journalism in the public interest. Contact Editor Carol Gentry at 727-410-3266 or by e-mail.



Carol Gentry, founder and special correspondent of Health News Florida, has four decades of experience covering health finance and policy, with an emphasis on consumer education and protection.