Bungling public health agencies don't inspire trust

June 04, 2007|By CYNTHIA TUCKER

ATLANTA -- Public health authorities were confronted with one patient - just one - with a deadly infectious disease, but they failed to control his movements. They weren't dealing with a plague affecting thousands of patients. They weren't confronted with the chaos of a pandemic.

Yet they dithered over court orders and rules and regulations, unable to make a quick decision that would have kept the patient, 31-year-old Andrew Speaker, from leaving the country. As a result, the Centers for Disease Control and Prevention was left desperately trying to track down passengers who sat near him on two trans-Atlantic flights last month.

The Atlanta-based CDC and Georgia public health agencies have no good excuse for losing track of one man with a deadly, drug-resistant strain of tuberculosis, especially since, by all accounts, he was relatively compliant.

In recounting the transcontinental chase that led to Mr. Speaker's forced quarantine under armed guard at Atlanta's Grady Memorial Hospital, Atlanta Journal-Constitution reporter Alison Young provides a glimpse of a multi-agency bureaucracy with lots of knowledge but little judgment. It is a tale of public health agencies that remain indecisive and inept despite years of planning for crises.

In defending their actions, CDC spokesmen and Georgia health officials have tended to blame Mr. Speaker, and he certainly shares some of the responsibility. An Atlanta-area resident, Mr. Speaker was advised by Georgia health officials that they "preferred" that he not travel for his long-planned wedding in Greece and an extended European honeymoon.

But Mr. Speaker told Ms. Young that authorities did not tell him explicitly not to go. He says he feels well and has no symptoms. He had complied with his treatment regimen, but the drugs he was given didn't work. He had agreed to go to a Denver hospital for cutting-edge treatment after his honeymoon. Given that, it seems likely that he would have complied with an order not to travel.

And public health authorities knew he intended to leave. Isn't that what no-fly orders are meant for? Instead, the CDC and Georgia officials spent two days discussing whether to issue an order restricting his movements, Ms. Young reported. By the time they attempted to serve the order, Mr. Speaker was gone.

Public health authorities have also pointed out that Mr. Speaker fled when he was ordered to turn himself in to Italian health authorities, who would have detained him indefinitely for treatment.

But Mr. Speaker told Ms. Young he was frightened at the prospect of failed treatment in Italy. Instead, he asked the CDC to send the agency's private jet to take him to Denver to start his treatment. According to Mr. Speaker, he was told that there was no money in the budget to pay for such a trip.

The CDC has a different story: The agency was considering sending the plane when Mr. Speaker and his bride fled to Prague. It's too bad the private plane wasn't immediately available, since Dr. Julie L. Gerberding, the CDC's director, has defended the agency's lease of the aircraft as necessary for public health emergencies.

As it turned out, Mr. Speaker was able to evade the no-fly order authorities issued when he left Italy, as well as passport warnings that should have stopped him at international borders. He flew from Prague to Montreal, then drove back into the United States, where he was allowed to cross even after a routine check of his passport set off a computerized alert. Had he not turned himself in when he arrived in New York, the CDC might still be looking for him. (Late last week, he was transferred to Denver.)

The U.S. House Homeland Security Committee has scheduled a hearing this month to sort through another example of bureaucratic bungling in the face of an emergency. Here we go again.

Cynthia Tucker is editorial page editor for The Atlanta Journal-Constitution. Her column usually appears Mondays in The Sun. Her e-mail is cynthia@ajc.com.

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