The Miami Herald

Jackson Health System becomes center for tuberculosis cases

With the closing of Florida’s only hospital dedicated to tuberculosis, Jackson Memorial has taken all of the state’s TB patients that health officials believe need hospitalization — a mere 21.

Jackson and county health officials say the transition has gone smoothly, despite reports of a virulent strain of TB in Jacksonville that has received intense publicity.

“I can’t tell you how proud I am of Jackson,” said Lillian Rivera, administrator of the Miami-Dade Department of Health, a state agency. “They have the expertise and are providing excellent care.”

She said the state is temporarily paying for several employees from the closed TB hospital to help train the Jackson staff.

A.G. Holley State Hospital, which had been treating tuberculosis patients for a half-century, was closed earlier this month in a cost-cutting move passed by the Legislature and signed into law by Gov. Rick Scott. On a 140-acre campus in Lantana, the facility had a capacity for 500 beds, one of several large TB state hospitals. As the number of TB patients shrank, the other facilities closed. When Holley was shut down, it had about 35 patients supported by a staff of 130.

The Florida Department of Health decided 17 of the patients still needed hospitalization, so they were transferred to Jackson. The others were allowed to go home, with careful monitoring by health officials, Rivera said. Since then, four other TB patients have been sent to Jackson — from Orlando, Jacksonville, South Broward and the Panhandle.

A.G. Holley was almost the last of its kind. Records of the American Hospital Association list only one remaining TB hospital in the country, the Texas Center for Infectious Disease in San Antonio.Because of vaccinations, better nutrition and better drugs, tuberculosis in America has been trending downward for decades, including each of the last 19 years. The Centers for Disease Control and Prevention report that the TB rate in 2011 was 3.4 cases per 100,000 people — an all-time low.

“What’s important is the patients are getting good, dependable care,” said James Howell, a physician on the faculty of Nova Southeastern who recently headed a discussion on TB at a South Florida Hospital and Healthcare Association meeting. He called A.G. Holley “a big old battleship when you needed a state-of-the art cruiser.”

Tuberculosis is a highly contagious airborne disease that can endanger the public if a patient is untreated, and nine of the patients transferred to Jackson are hospitalized under court order because they refused to take needed medications. Howell said the noncompliant patients tend to be homeless, alcoholic or have drug problems.

Marc J. Yacht, a retired physician and longtime public health officer, said he still had many doubts about the closing of Holley. He wonders whether Jackson will be committed to long-term care for TB patients. “I have concerns if they’re going to release them quickly and they go to hotels, motels and under bridges. These patients require ongoing attention.”

The Jackson patients are in a locked unit with “negative air flow” that prevents the air in the unit from circulating to other areas, said Jackson spokesman Edwin O’Dell. He said Jackson is being adequately compensated for the care by the state.

Yacht said Florida had a particular need for a TB hospital because of the state’s large number of immigrants. TB remains a major problem in other areas of the world, and the CDC reports that in the United States, the TB rate is 12 times higher among foreign-born residents than those born in the U.S.

In fact, state statistics show that of the 156 active cases in Miami-Dade in 2011, 78 percent were foreign-born. Rivera says all known cases in Miami-Dade are under supervision, do not represent a public danger and do not require hospitalization.

“TB is nothing to be swept under the rug,” said Yacht, a former president of the Florida Association of County Health Officials. “It’s a very serious problem when it breaks out.”

That’s what happened in Jacksonville. In April, the CDC sent the state a report that Jacksonville had “one of the most extensive TB outbreaks that the CDC has been invited to assist with since the early 1990s.” The report discussed a dangerous strain of the disease that had produced 99 illnesses and 13 deaths.

The report received widespread attention in June after a Palm Beach Post reporter obtained it through a public records request. Yacht and others accused the Scott administration of covering up the outbreak so there wasn’t a controversy about closing A.G. Holley.

Florida Surgeon General John H. Armstrong replied with a letter saying that the deaths were spread out over eight years and in most cases the deaths were due to other causes, such as hepatitis C, “with TB being present in addition.” He said there was no attempt to hide the report.

Rivera said two cases with the Jacksonville strain had been found in Miami-Dade, one in 2009 and another in 2011. The two cases were unrelated and both were successfully treated, she said.

Scott spokeswoman Jackie Schutz said in an email Tuesday that the state health department is negotiating a long-term contract with Jackson, so it’s unclear how much taxpayers will save. She said the Holley campus will be transferred to the Bureau of State Lands, which could sell it or use it for other purposes.




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