By Ashley Lopez
Florida Center for Investigative Reporting
Diagnosis: another case of bad timing.
The state Department of Health (DOH) faces a massive reorganization during a bonafide public health crisis. Jacksonville is gripping with the worst tuberculosis outbreak in 20 years — and the contagious bacterial infection is spreading beyond the city.
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.
The DOH reorganization bill had met little resistance from members of the Legislature and had fulfilled a goal among lawmakers to close down A.G. Holley State Hospital in Lantana. A.G. Holley, the state’s only tuberculosis hospital, had been seeing relatively few patients, as TB was on the decline statewide.
While it is probably unfair to claim the TB outbreak was kept secret to prevent political fallout from the closing of A.G. Holley, it is probably fair to say it was a bad idea to restructure during a TB outbreak the one agency charged with handling that serious public health problem.
There is also currently no policy in place that requires the state or even local health departments to warn residents that there is a TB outbreak in their area. This is left up to the discretion of local health officials, who commonly do not want to frighten people while they investigate an outbreak. Agencies such as the CDC and state and county health departments look into outbreaks of diseases all the time and their officials typically find it more valuable to not issue a press release about their inquiries.
Either way, the timing of this outbreak could not have come at a worst time. Even though local and state officials knew there was a serious TB cluster in Jacksonville, it wasn’t until April that the CDC had told them it was one of the worst they had investigated in decades.
During that time, the DOH was in turmoil. There had been a flush of top-level employees around that time, and years of ideological differences among officials had come to a head. This was not the best environment for DOH officials to work — and certainly not the best one for solving difficult public health problems.