Congress Considers CDC Role in Recent Tuberculosis Case

Andrew Speaker, a man with extensively drug-resistant tuberculosis, on Wednesday told the Senate Appropriations Labor, HHS, Education and Related Agencies Subcommittee that CDC was aware of his drug-resistant TB infection before he left the U.S. and that health officials had informed him he was not contagious, the New York Times reports. Speaker traveled to Europe by airplane and re-entered the U.S. despite an advisory that called for his detainment by U.S. Customs and Border Patrol officers.

Speaker, testifying by telephone from a Denver hospital, said that he and his doctor met with CDC and Fulton County, Ga., health officials in late April to discuss his drug-resistant TB infection. At that time, the officials were aware of his upcoming wedding in Greece, Speaker said. Speaker said he met with officials again on May 10, when he was informed that his infection was multiple drug-resistant (Altman/Palank, New York Times, 6/7).

"CDC knew that I had (drug-resistant tuberculosis)," Speaker said, adding, "They were aware that I was going on my travels. I was clearly told, word for word, that I was not contagious; I was not a threat to anyone."

However, Steven Katkowsky, director of the Fulton County Health and Wellness Department, said that his office was concerned about the small risk that Speaker could infect others and contacted the county attorney for guidance on whether they could seek a court order prohibiting his travel.

Katkowsky said the attorney's response was that action could not be taken unless Speaker already had violated specific requests. "We found ourselves in a Catch-22," Katkowsky said (Deans, Atlanta Journal-Constitution, 6/7).

Speaker said that CDC contacted him during his honeymoon in Rome with news that he had XDR-TB and that he should admit himself to an Italian hospital. Speaker said he was told that no airplane was available to pick him up and that it would cost as much as $140,000 for him to return to the U.S. "I could be stuck indefinitely in an Italian hospital," Speaker said, adding, "I just wanted to get home" (Donnelly, Boston Globe, 6/7).

CDC Director Julie Gerberding, testifying before Speaker, said that the agency did not learn Speaker's identity until May 18, six days after his outbound flight.

According to the Washington Post, this "contradiction [with Speaker's comments] was partly explained" at the hearing when it became clear that Speaker primarily dealt with county health officials (Brown/Hsu, Washington Post, 6/7).

Gerberding said, "We gave the patient the benefit of the doubt and, in retrospect, we made a mistake" (Atlanta Journal-Constitution, 6/7). "We failed to take action to limit his movements," Gerberding said, adding, "I think we can do that faster. I think we should have done it faster. In retrospect, that was a mistake."

Subcommittee Chair Tom Harkin (D-Iowa) asked Gerberding why it took four days -- from May 18 to May 22 -- for the agency to alert the World Health Organization and the Department of Homeland Security about the Speaker case.

Gerberding said those days were spent confirming Speaker's diagnosis, determining the legality of releasing medical information and figuring out how to return him to the U.S. "We can't just call the world and say, 'There is an itinerant TB patient on the loose,'" Gerberding said (Washington Post, 6/7).

Discussing Speaker's decision to re-enter the U.S. on his own, Gerberding said, "I think the bottom line was the patient was fearful that he was going to be isolated out of his own country and made the personal decision to travel, as he put it, underground" (Berger, CQ HealthBeat, 6/6).

Harkin said, "I am dismayed and concerned that so many things went wrong in this case." Harkin added, "Clearly, there are gaps in planning on how to control the travel of persons with dangerous infectious diseases. It's as though the issue had not been raised before" (Boston Globe, 6/7). "It looks like there was some bureaucratic mismanagement here," Harkin said.

In addition, Harkin was critical of Gerberding's testimony that CDC jets were not used to fly Speaker back to the U.S. because they are not equipped for long-distance flights involving infectious patients. "This answer that I've heard doesn't hold a lot of water," Harkin said (Atlanta Journal-Constitution, 6/7).

Meanwhile on Wednesday, the House Homeland Security Committee held a hearing on the Speaker case, focusing on the failure of border officers to detain the patient.

DHS officials said that the border security system had worked except for a "single point of failure" -- the officer who allowed him to enter from Canada in a rental car (Washington Post, 6/7).

W. Ralph Basham, the U.S. Customs and Border Patrol commissioner, said that the on-duty officer "[a]pparently ... made the determination that the information was not accurate and determined that he did not look sick." Basham added, "The failure is inexcusable. This has resulted in an awakening that we need to do a better job" (Neuman/Havemann, Los Angeles Times, 6/7).

DHS officials said that they since have changed their system in order to prevent front-line officers from single-handedly waiving alerts on individuals' passports, and also have taken steps to back up the alerts (Washington Post, 6/7).

House lawmakers questioned why Speaker's flight to Canada from Europe had not been detected.

Jayson Ahern, assistant commissioner of the Customs Office of Field Operations, said that the system used by Customs and Border Protection to flag airline passengers cannot track completely new reservations with departures and destinations outside of the U.S. (New York Times, 6/7).

Rep. Ed Perlmutter (D-Colo.) said, "This was T-ball, and we still struck out. This was not a war on terror, but boy, we didn't do a very good job."

Rep. Bennie Thompson (D-Miss.) said, "We dodged a bullet. My question to the administration is, 'When are we going to stop dodging bullets and start protecting Americans?'" (Los Angeles Times, 6/7).

Rep. Jim Langevin (D-R.I.) said, "We need increased coordination among federal agencies ... as well as the ability to isolate and quarantine people who may pose a health risk to others, especially when they are uncooperative" (CQ HealthBeat, 6/6).

Several broadcast programs on Wednesday and Thursday reported on the hearing. Summaries appear below.

• ABC's "World News": The segment includes comments from Speaker, Gerberding and Nils Daulaire of WHO (Potter, "World News," ABC, 6/6). Video of Gerberding's comments is available online.
• CBS' "Evening News": The segment includes comments from Speaker, Gerberding and Katkowsky (Orr, "Evening News," CBS, 6/6). Video of the segment and expanded CBS News coverage are available online.
• CNN's "Larry King Live": The segment includes a discussion with Speaker and his wife (King, "Larry King Live," CNN, 6/6). A transcript of the segment is available online.
• NBC's "Nightly News": The segment includes comments from Speaker and Gerberding (Williams, "Nightly News," NBC, 6/6). Video of the segment is available online.
• NPR's "All Things Considered": The segment includes comments from Harkin, Speaker, Gerberding, Basham and Sen. Arlen Specter (R-Pa.) (Rovner, "All Things Considered," NPR, 6/6). Audio of the segment is available online.
• NPR's "Morning Edition": The segment includes comments from Specter, Speaker, Speaker's physician, Katkowsky, Speaker's parents and CDC official David Kim (Rovner, "Morning Edition," NPR, 6/7). Audio of the segment is available online.
• PBS' "NewsHour with Jim Lehrer": The segment includes comments from Gerberding, Speaker, Harkin and Deborah Spero, assistant commissioner of CBP (Holman, "NewsHour with Jim Lehrer," PBS, 6/6). Audio of the segment is available online. Video and a transcript will be available Thursday afternoon.
• WBUR's "Here & Now": The segment includes a discussion with Matthew Berger of Congressional Quarterly ("Here & Now," WBUR, 6/6). Audio of the segment is available online.