Florida rushes closure of its only TB hospital in Lantana
By Stacey Singer
By Stacey Singer
Palm Beach Post Staff Writer
JACKSONVILLE —
The CDC officer had a serious warning for Florida health officials in April: A tuberculosis outbreak in Jacksonville was one of the worst his group had investigated in 20 years. Linked to 13 deaths and 99 illnesses, including six children, it would require concerted action to stop.
That report had been penned on April 5, exactly nine days after Florida Gov. Rick Scott signed the bill that shrank the Department of Health and required the closure of the A.G. Holley State Hospital in Lantana, where tough tuberculosis cases have been treated for more than 60 years.
As health officials in Tallahassee turned their focus to restructuring, Dr. Robert Luo’s 25-page report describing Jacksonville’s outbreak — and the measures needed to contain it – went unseen by key decision makers around the state. At the health agency, an order went out that the TB hospital must be closed six months ahead of schedule.
Had they seen the letter, decision makers would have learned that 3,000 people in the past two years may have had close contact with contagious people at Jacksonville’s homeless shelters, an outpatient mental health clinic and area jails. Yet only 253 people had been found and evaluated for TB infection, meaning Florida’s outbreak was, and is, far from contained.
The public was not to learn anything until early June, even though the same strain was appearing in other parts of the state, including Miami.
Tuberculosis is a lung disease more associated with the 18th century than the 21st, referred to as “consumption” in Dickensian times because its victims would grow gaunt and wan as their lungs disintigrated and they slowly died. The CDC investigator described a similar fate for 10 of the 13 people who died in Jacksonville.
They wasted away before ever getting treatment, or were too far gone by the time it began. Most of the sick were poor black men.
“The high number of deaths in this outbreak emphasizes the need for vigilant active case finding, improved education about TB, and ongoing screening at all sites with outbreak cases,” Luo’s report states.
Today, three months after it was sent to Tallahassee, the CDC report still has not been widely circulated.
Backer of closing hospital didn’t know
Meanwhile the champion of the health agency consolidation, Rep. Matt Hudson, R-Naples, said he had not been informed of the Jacksonville outbreak and the CDC’s role as of Friday.
Told the details, the chairman of the House Health Care Appropriations Committee vowed that there would be money for TB treatment.
“There is every bit of understanding that we cannot not take care of people who have a difficult case of TB,” Hudson said.
The governor’s office asked a reporter to foward a copy of the CDC letter on Saturday, but did not comment by press time.
Treatment for TB can be an ordeal. A person with an uncomplicated, active case of TB must take a cocktail of three to four antibiotics — dozens of pills a day — for six months or more. The drugs can cause serious side effects — stomach and liver problems chief among them. But failure to stay on the drugs for the entire treatment period can and often does cause drug resistance.
At that point, a disease that can cost $500 to overcome grows exponentially more costly. The average cost to treat a drug-resistant strain is more than $275,000, requiring up to two years on medications. For this reason, the state pays for public health nurses to go to the home of a person with TB every day to observe them taking their medications.
However, the itinerant homeless, drug-addicted, mentally ill people at the core of the Jacksonville TB cluster are almost impossible to keep on their medications. Last year, Duval County sent 11 patients to A.G. Holley under court order. Last week, with A.G. Holley now closed, one was sent to Jackson Memorial Hospital in Miami. The ones who will stay put in Jacksonville are being put up in motels, to make it easier for public health nurses to find them, Duval County health officials said.
They spoke about CDC’s report Friday, only after weeks of records requests from The Palm Beach Post. The report was released late last week only after a reporter traveled to Tallahassee to demand records in person. The records should be open to inspection to anyone upon request under Florida Statute 119, known as the Government in the Sunshine law.
That report had been penned on April 5, exactly nine days after Florida Gov. Rick Scott signed the bill that shrank the Department of Health and required the closure of the A.G. Holley State Hospital in Lantana, where tough tuberculosis cases have been treated for more than 60 years.
As health officials in Tallahassee turned their focus to restructuring, Dr. Robert Luo’s 25-page report describing Jacksonville’s outbreak — and the measures needed to contain it – went unseen by key decision makers around the state. At the health agency, an order went out that the TB hospital must be closed six months ahead of schedule.
Had they seen the letter, decision makers would have learned that 3,000 people in the past two years may have had close contact with contagious people at Jacksonville’s homeless shelters, an outpatient mental health clinic and area jails. Yet only 253 people had been found and evaluated for TB infection, meaning Florida’s outbreak was, and is, far from contained.
The public was not to learn anything until early June, even though the same strain was appearing in other parts of the state, including Miami.
Tuberculosis is a lung disease more associated with the 18th century than the 21st, referred to as “consumption” in Dickensian times because its victims would grow gaunt and wan as their lungs disintigrated and they slowly died. The CDC investigator described a similar fate for 10 of the 13 people who died in Jacksonville.
They wasted away before ever getting treatment, or were too far gone by the time it began. Most of the sick were poor black men.
“The high number of deaths in this outbreak emphasizes the need for vigilant active case finding, improved education about TB, and ongoing screening at all sites with outbreak cases,” Luo’s report states.
Today, three months after it was sent to Tallahassee, the CDC report still has not been widely circulated.
Backer of closing hospital didn’t know
Meanwhile the champion of the health agency consolidation, Rep. Matt Hudson, R-Naples, said he had not been informed of the Jacksonville outbreak and the CDC’s role as of Friday.
Told the details, the chairman of the House Health Care Appropriations Committee vowed that there would be money for TB treatment.
“There is every bit of understanding that we cannot not take care of people who have a difficult case of TB,” Hudson said.
The governor’s office asked a reporter to foward a copy of the CDC letter on Saturday, but did not comment by press time.
Treatment for TB can be an ordeal. A person with an uncomplicated, active case of TB must take a cocktail of three to four antibiotics — dozens of pills a day — for six months or more. The drugs can cause serious side effects — stomach and liver problems chief among them. But failure to stay on the drugs for the entire treatment period can and often does cause drug resistance.
At that point, a disease that can cost $500 to overcome grows exponentially more costly. The average cost to treat a drug-resistant strain is more than $275,000, requiring up to two years on medications. For this reason, the state pays for public health nurses to go to the home of a person with TB every day to observe them taking their medications.
However, the itinerant homeless, drug-addicted, mentally ill people at the core of the Jacksonville TB cluster are almost impossible to keep on their medications. Last year, Duval County sent 11 patients to A.G. Holley under court order. Last week, with A.G. Holley now closed, one was sent to Jackson Memorial Hospital in Miami. The ones who will stay put in Jacksonville are being put up in motels, to make it easier for public health nurses to find them, Duval County health officials said.
They spoke about CDC’s report Friday, only after weeks of records requests from The Palm Beach Post. The report was released late last week only after a reporter traveled to Tallahassee to demand records in person. The records should be open to inspection to anyone upon request under Florida Statute 119, known as the Government in the Sunshine law.