Officials Admit Errors in TB Case

Officials, Patient at Odds Over Travel Warnings

Medically Reviewed by Louise Chang, MD
From the WebMD Archives

June 6, 2007 -- Federal officials acknowledged mistakes Wednesday in their handling of an Atlanta man who traveled to and from Europe last month while infected with a highly drug-resistant form of tuberculosis.

Meanwhile, Andrew Speaker, the patient at the center of the incident, continued to contradict officials by maintaining they never told him his travel could endanger other people.

Officials said they should have acted more quickly to notify American border police and European health authorities once it became apparent Speaker had flown out of the United States.

But they were also quick to point out that their efforts were hampered by Speaker, who they say defied the advice of doctors and health officials when he flew to Europe for his wedding and when he flew back to North America.

That move in theory put hundreds of people who flew with Speaker at potential risk for contracting extensively drug-resistant tuberculosis, also known as XDR TB.

Could Have Moved Faster

Julie Gerberding, MD, director of the CDC, told members of a Senate committee that her agency could have acted faster between May 18, when they first became aware Speaker had drug-resistant TB, and May 24 when he was placed on a no-fly list and Italian health authorities were notified of their concerns.

“I think we can do that faster, I think we should have done it faster, and I think we’ll be able to accelerate this next time. In retrospect that was a mistake, and I wish we had done it differently.”

Lawmakers questioned why days elapsed between officials' receiving of Speaker's positive test results and notification of European authorities.

“It seems to me that this time frame should have been collapsed to just a few hours,” said Sen. Tom Harkin (D-Iowa), who chairs the appropriations subcommittee with jurisdiction over CDC.

But officials, doctors, and Speaker continued to give different accounts of what happened at a May 10 meeting between them.

Early Flight

Health officials have acknowledged that they were aware at the meeting that Speaker, a 31-year-old attorney from Atlanta, intended to fly to Greece four days later. Local officials approached a county prosecutor in Fulton County, Ga., to inquire about the steps that would be needed to bar Speaker from flying, said Steven Katkowsky, MD, the district health director of the Fulton County health department.

But Speaker abruptly moved up his travel date by two days. By the time a court order was drawn up, the patient had already left the country, Katkowsky said.

“The plan that we knew was for Mr. Speaker to travel outside the United States on May 14,” he said.

No Benefit of the Doubt

Though officials knew Speaker carried a drug-resistant TB strain, tests confirming he had an extensively drug-resistant -- and more dangerous -- form were not completed until May 22, they said.

Gerberding suggested officials hesitated to inform the World Health Organization and European governments until it was clear Speaker was positive for XDR TB. But she suggested that a bigger mistake was not moving more swiftly to detain Speaker in Europe when he had already traveled against medical advice and was likely to do so again.

“What we have learned is that when a patient is not willing to cooperate, we cannot give that person the benefit of the doubt any more,” Gerberding said.

Speaker, who testified by phone from quarantine at National Jewish Hospital in Denver, Colorado, maintained that doctors at the May 10 meeting did not tell him he could be a risk to others.

“None of us were wearing masks. I was repeatedly told I was not contagious. Not that I was partly contagious, but that I was not contagious,” he said.

Officials contradicted that claim. Katkowsky told lawmakers that Speaker's medical record and a follow-up letter issued the next day both indicate Speaker was told that he could be a danger to others.

Gerberding told lawmakers that the CDC became aware of Speaker’s drug-resistant diagnosis on May 18, and that tests confirming XDR TB were completed four days later.

Speaker suggested the agency knew about his drug-resistant status long before. Two doctors in the May 10 meeting were CDC employees, though neither was there in an official CDC capacity, Katkowsky confirmed. One was a CDC doctor working at the Fulton County clinic as a treating physician. The other was Speaker’s father-in-law, Robert Cooksey, a CDC microbiologist who specializes in tuberculosis.

Sen. Harkin said he would consider recalling Gerberding to testify again on when the agency was first aware of Speaker’s drug-resistant status.

Show Sources

SOURCES: Julie Gerberding, MD, MPH, director, CDC. Sen. Tom Harkin, (D-Iowa). Steven Katkowsky, MD, district health director, Fulton County Department of Health and Wellness, Georgia. Andrew Speaker, tuberculosis patient.

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