Sunshine law helps reporter expose major TB outbreak in Florida

Posted by Liz Borkowski on July 12, 2012

I wrote last week about the importance of the Freedom of Information Act, and Stacey Singer of The Palm Beach Post has just published a piece that shows how important sunshine laws can be for public health. Singer revealed that Florida is in the midst of tuberculosis outbreak that’s claimed 13 lives and sickened at least 99 people, six of them children. Another 3,000 people may have been exposed to the bacterium through close contact with contagious sufferers. “Fortunately, only a few of the cases have developed drug resistance so far,” Singer reports.

State health officials explained that they had not alerted the public to the outbreak because the disease was largely limited to the homeless population. But Singer reports that “only two-thirds of the active cases could be traced to people and places in Jacksonville where the homeless and mentally ill had congregated,” suggesting the bacteria had spread from this population into the general population. Such findings came from a CDC report that reached Duval County health officials in April.

Meanwhile, state health officials faced with budget pressures sped up the closure of A.G. Holley State Hospital, which had cared for some of the hardest-to-treat TB cases in the state for decades. (It closed its doors last week, sending to Jackson Memorial Hospital 16 TB patients who courts had ordered to be confined for treatment because they were unlikely to adhere to treatment otherwise.) The lawmaker who’d pushed for the health agency consolidation that led to the hospital’s closure said he hadn’t been aware of the outbreak. The Duval County Health Director conceded to Singer that “in retrospect, it would have been better to inform the general population” in 2008, when the outbreak began.

You can (and should) read the whole article here. What caught my attention in particular was Singer’s description of how the newspaper obtained the CHC report from the state:

[Duvall County health officials] 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.

Without the state’s sunshine law, Singer might never have gotten access to the CDC report that details the Florida tuberculosis outbreak. Her reporting performs two services: First, it alerts people who may need to get tested for TB — in particular, people who are homeless or are in frequent contact with homeless people. Second, it helps move TB up the priority list of lawmakers and executives who are making decisions about where to direct their limited resources.

Speaking of limited resources, this TB outbreak gives yet another example of how “saving” money by cutting public health can end up costing far more in the long term, in terms of both dollars and health. Singer writes (emphasis added):

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.

… Harmon said the Duval County Health Department will need more resources if it is to contain the current TB outbreak. In 2008, when the TB outbreak hit, his department employed 946 staff with revenues of $61 million. “Now we’re down to 700 staff and revenue is down to $46 million,” Harmon said. “It has affected most areas of the organization.”

If he can raise at least $300,000, he will use the money to hire teams of experts — epidemiologists, nurses, outreach workers, to look under bridges, in fields — in all the places where Jacksonville’s estimated 4,000 homeless congregate, to track down the people who may still be infected unknowingly.

The county and state could have saved money by preventing the initial 2008 outbreak from going on to become much more extensive in 2012. (Officials told Singer that they’d initially thought they’d contained the outbreak; only recently did several new cases emerge and turn out to be from the same strain, dubbed FL 046.) Perhaps the problem would be getting worse, though, if lawmakers and the public had remained unaware of the tuberculosis outbreak for another year. Thanks to Stacey Singer, The Palm Beach Post, and Florida’s sunshine law, all eyes are now on Duvall County and Florida health officials.

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