By Ashley Lopez
Florida Center for Investigative Reporting
State health officials are on the defensive.
They are flatly refuting a recent story in The Palm Beach Post that claimed the state was hiding a serious tuberculosis outbreak in Duval County.
The reporter that broke the story pointed to a report published by the Centers for Disease Control that noted the outbreak was the worst the agency had investigated in 20 years. During the time the report came out, the state was reorganizing its health department and its tuberculosis hospital was shutting down.
Both moves put state officials under some harsh scrutiny by public health officials.
The Florida Times-Union reported:
Steven Harris, deputy secretary for health for the Florida Department of Health, said the agency didn’t hide from the public a recent increase of tuberculosis in Duval County, as reported by the Palm Beach Post and published in the Times-Union and on Jacksonville.com.
“We’ve been in contact with members of the public since 2008 when this cluster of cases first emerged,” Harris said.
Harris said the state health department notified people who were in direct contact with the segment of the infected population, which he called an adequate response. The general public is told, he said, only if their help is needed in identifying people at risk.
Brian Burgess, a spokesman for Gov. Rick Scott’s office, sent a statement to The Tampa Bay Times:
[T]he secrecy allegation is absurd, and is proven so by the fact that numerous community stakeholders were engaged in the effort to contain the disease.
State and county health officials alerted the Jacksonville Community Tuberculosis Coalition which was composed of members from the Mayor’s office, the City of Jacksonville, local officials, local hospitals, the Sheriff’s office and homeless shelters. The very purpose of the coalition was to protect the homeless population, make sure the cluster was contained, and inform the local community that was affected. The coalition had monthly meetings and the county health department issued a press release in coordination with the first meeting.
In response to all this, the Post has announced it is standing by its story.
While state officials dispute whether there was a cover-up afoot, there are some indisputable facts here that warrant a hard look.
Alex Seitz-Wald and Kent Sepkowitz at Salon both pointed to a lack of state funding for government functions — and specifically public health — as the real culprit. In the case of Scott, a refusal to receive federal health funds that could help stave off some of the cuts is also not helping.
The case underscores the real human consequences of austerity budgeting and conservatives’ drive to slash government whenever possible. Since austerity came into vogue with the Tea Party beginning in 2009 and was then put in place nationally after the Republican wave in 2010, there have been countless examples where cuts or attempted cuts impact preparedness. After the the Japanese tsunami, it was noted that Republican budget cuts targeted the agency responsible for tsunami warnings. The same was true about earthquake monitoring after a temblor struck the eastern seaboard (though funding was restored). House Majority Leader Eric Cantor also tried to hold up disaster funding for tornado and earthquake cleanup, demanding it be offset with cuts elsewhere. Republicans’ proposed budget last year would have cut funds for the CDC and food safety monitoring. Meanwhile, Louisiana Gov. Bobby Jindal spoiled his big national debut in 2009 when he gave the GOP rebuttal to President Obama’s first state of the union address in which he attacked supposedly wasteful spending on volcano monitoring in Alaska. Just a month and a half later, a volcano erupted in Alaska that threatened Anchorage.
Sepkowitz, an infectious-disease specialist, wrote:
But the current Jacksonville outbreak didn’t start because AG Holley was closed. It started in Florida and countless other states in the late 1990s when TB cases nationally began to fall. Unable to resist the urge to tinker, a series of numbskull state leaders began to undo various states’ TB programs, including Florida’s. Somehow, bean counters always see any public health endeavor as ripe for cutting. The predictable cycle is this: Any good public health program fights hard to reduce the disease it sets out to control; but sure enough, each and every time success is met with a big thank you and a series of pink slips …
So, while the closing of AG Holley itself has nothing to do with the current outbreak, the austerity-loving attitude toward AG Holley and its ilk surely is at the heart of the matter. The specifics of this outbreak, published, oddly, in the American Journal of Psychiatry are the same as every other outbreak: A patient, in this case a homeless African-American man, has a cough. His cough is mostly ignored because people cough all the time and the clinicians are focused on his schizophrenia. Eventually, someone gets an X-ray (In Jacksonville it was eight months into the illness), TB is diagnosed and then public health workers scramble to locate the hundreds of people he might have exposed. In an adequately funded and sane healthcare system, information from previous visits, including old chest X-rays, might have been available; so too any relevant information about his TB status; perhaps an X-ray would have been easier to obtain (outpatient mental health facilities don’t often have the equipment) – all aspects of the “medical home” at the center of the ACA. Which is why it’s so distressing to see governors like Scott turn away additional Medicaid funding in order to make a political stance against President Obama.