CDC: 107 people on TB flights need tests

[mjak]

I am sympathetic to this mans plight; However, I have one issue. Why did he need the CDC or anyone to tell him he should not be traveling. He has been diagnosed with a rare lethal drug resistant contagious illness. Dose not the obligation of humanity based on commonsense, compassion and responsibility dictate to any reasonable intelligent person they can not travel at this time? Did he really feel unless the CDC gave him legal orders to not travel he was free to travel? Sadly, more likley his actions represent an egocentrisim resulting in total disregard for the wellbeing of his fellow man.

mjak

 

[angelmom]

I am sympathetic to this mans plight; However, I have one issue. Why did he need the CDC or anyone to tell him he should not be traveling. He has been diagnosed with a rare lethal drug resistant contagious illness. Dose not the obligation of humanity based on commonsense, compassion and responsibility dictate to any reasonable intelligent person they can not travel at this time? Did he really feel unless the CDC gave him legal orders to not travel he was free to travel? Sadly, more likley his actions represent an egocentrisim resulting in total disregard for the wellbeing of his fellow man.

mjak

I suppose he was trusting the doctors when they told him he was not a risk to anyone, including being intimate with his wife.

In the same way that, when one of my kids has strep and the doctor says they can go back to school after 24 hours on the antibiotics as long as they don't have a fever, I believe them. I have no proof if it's true or not.

 

[mjak]

I suppose he was trusting the doctors when they told him he was not a risk to anyone, including being intimate with his wife.

In the same way that, when one of my kids has strep and the doctor says they can go back to school after 24 hours on the antibiotics as long as they don't have a fever, I believe them. I have no proof if it's true or not.

I am confident no doctor told him he should be traveling. He admitts the CDC told him it was not a good idea. The CDC legally can not prevent a person from traveling without going thru the legal channels. This man is an attorney he knows this. It might not have been possible for the CDC in a court of law to have provided evidnce at that time that he needed to be legally prevented from travel; however, it was obvious that from a humanstic standpoint ( not to mention for his own health) he had no business traveling. From what I read it sounds like he expected the CDC to tell him you may not travel. As an attorney he should know that the CDC can not make a proclemation like that without legal standing behind them. However, if the CDC tells a person that he should not be leaving the country then I think there is no excuse for ignoring that.

mjak

 

[MSM]

I think it is VERY strange that Speaker's father was surreptitiously recording conversations with doctors before he even left the US--why? This makes me think there was some breakdown in the doctor-patient relationship that had occurred prior to the May 11 meeting, or that Speaker was preemptively in CYA mode, and again I have to ask why. That is just very weird behavior. In my whole professional career, I have only heard of one instance of a patient secretly recording conversations with a doctor, and that was someone whose posts I read on a malpractice board who was admittedly trying to entrap his MD into a lawsuit. People take notes all the time to help them remember things, but I've NEVER had someone record a conversation, even openly.

Also, even though the chances of Speaker infecting anyone are low, I still think he was clearly in the wrong for getting on any of those flights to begin with, for several reasons.

For one thing, you just can't assume that everyone around you is as healthy as you are. I said in a previous post that there are lots of people among us who have had transplants, who have bad diabetes, or are otherwise immunosuppressed, and catching even "regular" drug resistant TB can be life threatening to those people. He did not have the right to play roulette with others' lives, especially given that he had no way of knowing the health status of those he potentially exposed.

And I do have trouble believing that the doctors didn't tell him to take precautions to avoid the risk of infecting others. I sure would like to hear the supposed tape recording of that meeting.

Finally, just for comparison, consider the risk of contracting HIV after being stuck with a contaminated needle. Does everyone realize that the rate of contracting HIV after a needlestick with infected fluid is only 0.3%? That doesn't mean that I wouldn't be furious with someone who chose to stick me with a needle, then tried to excuse it by saying that the risk of me getting the disease is low. In fact, if someone did that to me knowingly and deliberately, they would be prosecuted. Just because the risk of injuring someone is low doesn't mean that it's OK.

 

[MSM]

Oh yeah, one more thing: the more I think about his decision to fly into Canada after he was fully aware he had XDR TB, the angrier it makes me. I think he had several other reasonable options for getting back into the US that he could have pursued. Even if you buy his story that the CDC refused to help him, he could have contacted his health insurance company (I read somewhere it's Kaiser) and asked them for assistance. Now, admittedly, that would be tough, but Kaiser apparently flew him on a private plane from Atlanta to Denver, so maybe they would have sent a plane to get him in Italy. Also, you can purchase emergency medical insurance for trips that covers the cost of transport back to the US in the event of emergency. Seems to me that since he knew before he left that he had a form of TB that could only be treated in Denver, MAYBE it would have made sense to look into such insurance in the event of a health problem overseas. Some of the articles make it clear that he had looked into a private jet and found that it would cost $100,000. As a last resort, he should have done this instead of knowingly exposing others to XDR TB. I have to believe that a couple of attorneys could come up with the money in an emergency. So he opted to gamble with others' lives instead of laying out a large amount of cash.

 

[Details]

From the articles, his father tape recorded his meeting with the CDC, to get the lack of complete restriction on travel on tape. To me, that shows very clearly that he knew they couldn't legally tell him no, even though he also knew he shouldn't go.

His story is a lot inconsistient - he acts like he didn't think it was that serious, but also says, "Before I left, I knew that it was made clear to me, that in order to fight this, I had one shot, and that was going to be in Denver," he said. If doctors in Europe tried to treat him and it went wrong, he said, "it's very real that I could have died there." - so he did know it was serious before he left. And why would you go on your honeymoon, thinking you were dying like that? I'd have isolated myself from my fiancee - no way would I expose someone I loved to this.

But once he was told that it was serious (in Rome when they knew it was XDR), and not only for him, but so serious that he was being put on the no-fly list - I just see absolutely no excuse at all to decide to travel anyway - period. He knew what he had, and he chose to expose a few hundred others to it. Italy has good hospitals, and they could fly him to America if he needed it. Even were it $100,000 and the CDC offered no help (which I honestly don't believe - his FIL is CDC - I'm sure he would have been medevac'd out) - $100,000, or risking spreading a fatal illness to other people - hmmm, which to chose? Going to a perfectly good Italian hospital or Denver at the cost of maybe killing a few people - hmmm, what should I do?

I don't care how contagious he was - I'm sure whoever he got it from wasn't a coughing, sputtering wreck either. He is contagious, and that's plenty. This thing goes for the elderly, children, and anyone already sick - people who can't fight back, and it's got very good chances of killing them. He should be sued, by every person he put at risk - for their time to be tested, for their fear during the next 2 months until the second test comes out (hopefully) clean. And by the CDC, airlines, and other countries for their time and effort in tracking down some of the people he exposed, AFTER he knew what exactly he had, and how very dangerous it is.

There's an article on CBS News on the spread of this disease in Africa. They had a few patients with it, and now it's just spreading around, taking out patients, and 4 of the nurses treating it. Of course, the medical system there isn't anything related to ours nor Europes and Canadas - but it's nothing we want spreading. With no way to kill it with modern medicines, the only difference between us and Africa is improved quarentine measures, and more support to keep the body alive a little longer to see if it can beat the TB.

 

[FLMom]

Why is it that the CDC could afford to fly him in a private plane under armed guard within the US, but didn't have the funds to do so internationally?

If they were truly covering their azzes you'd think they'd send a chartered flight to whisk him back from Europe before he was even able to hop the next plane.

If they were serious enough to hand deliver a note, why didn't they send something to inform INTERPOL? It wasn't like they didn't know his itenerary, seeing as his FIL is with the CDC?!

Just thinking out loud. . .

 

[MSM]

FL Mom, good questions...from my understanding, the CDC had no legal authority to stop his travel or alert international authorities before they knew he had XDR TB. I posted a quote and a link a few pages back that describes the process for obtaining a court order to prevent Speaker from travelling. The first step was to deliver him a written medical directive, which they tried to do but were unsuccessful. The current law states that they can only get a court order after he fails to comply with the written directive. Since he never got the written directive, they couldn't get a court order, and they had no legal authority to alert other countries...until he was diagnosed with XDR TB. At that point, they did alert Italy and placed him on the no-fly list into the US. I don't know the legal information about what else they were allowed to do, such as asking other countries to place him on no fly lists. Anyone else know the law here?

Edited to add: It is only Speaker's side of the story that the CDC said it didn't have the funds to fly him internationally. The CDC spokesperson said they were in the process of arranging to do so, but it was the Memorial Day weekend and they couldn't arrange it immediately. It's "he said, CDC said," if you will..

 

[angelmom]

I took the whole tape recording totally different...but not surprised given how the tone of the posts is running.

My take on it was that he has been meeting with these people since January and asking over and over if he needed to take any precautions with his fiancee/wife and daughter, other family members, friends, coworkers, etc. and being told "No. You are not contagious. You are not a risk."

He repeatedly told them about his plans to travel and asked if he needed to cancel his wedding (he asked them, they didn't tell him to do it) and they said no. They said (on tape) that they had to advise him not to travel - to cover themselves - but that he was not a risk.

At some point, I can imagine his dad saying, "Wait a minute, I can't believe they are telling you this. How can that be true?" And then, fearing a lawsuit if someone did get sick, he decided to tape the conversation. Because he didn't want his son blamed if this exact thing happened, or if someone got sick. I never heard that the taping was done secretly, but who cares if it was? It just proves what was said.

They were saying one thing to cover their asses, but telling him something totally different. If he's really so contagious (which I don't believe from what I've read) then the Fulton Co Health Dept. took a serious risk with his wife, her daughter and lots of other people for months. If he's not, then they are just covering b/c someone found out. Go back to page 1 and look - that was my bet from the beginning and I still think that's what will turn out to be true.

Just b/c they found out it was a different kind of TB doesn't change how contagious he is. He is still smear negative according to reports from the Denver hospital. An official there says "He's about as noninfectious as you can be." (see link above) His health can be in grave danger without him being a danger to others. In fact, he was probably in more danger from others than to others on that plane.

If not for the injury in January, this guy would still be walking around without a care in the world. How do you protect against that?

I just hope I never bump into any of you who are screaming, "SUE! SUE!"

 

[MSM]

Angelmom, you left out the rest of Daley's quote. I read it to mean that the general population has no cause for concern, but he does indicate that there is a level of concern for people sitting around Speaker, and that those people need to be tested:

Jewish Medical and Research Center, where Andrew Speaker is undergoing treatment for extensively drug-resistant tuberculosis. "It's gotten attention undeservedly — at least in terms of this fear," Daley said.



While Daley said the Centers for Disease Control and Prevention has good reason to contact and test passengers who sat in rows near Speaker on two trans-Atlantic flights — as a precaution — the health fears are unfounded for members of the general public or those who may have had brief encounters with the man.


Angelmom, I have a question for you. In one of my posts above, I mentioned that the risk of contracting HIV after a needlestick with an HIV-contaminated needle was only 0.3%. How would you feel if someone stuck you with a contaminated needle when they could have avoided doing so? Would you not be angry, because you had a 99.7% chance of being OK? I don't know the exact chance of passengers around Speaker contracting TB, but I think this is a reasonable comparison to make. I just think it is negligent behavior.

ETA: If I found out that one of my patients was recording me without my consent, I'd confront the patient and seriously consider firing him/her. That is a huge red flag that there is some fundamental deception or distrust going on. If there is a legitimate reason to record the meeting, consent should be obtained from all parties.

here's the quote stating that the doctors didn't know about the taping:

Asked about the tape, Steve Katkowsky of the Fulton County Health Department told CNN, "If such a recording was made it was without the consent and without the knowledge of Fulton County Health Department officials."

http://www.cnn.com/2007/HEALTH/conditions/06/01/tb.flight/

 

[accordn2me]

I totally agree with Dr. MSM about the secret taping. Why do it in secret if "we're thinking everything's fine?" And if it were done secretly, I seriously doubt it will be allowed should this ever go to court. It's too easy to clip and edit such things in your favor.

I still stand by my suspicion of why he had the X-ray that discovered the mass in his lung because he was "worried he had bruised his rib." That's suspect.

And now there's a secret tape recording? Like Andrew Speaker proclaimed, he is intelligent and well-educated. He knew what was going on.

If a doctor tells you....you need to go to the M.D. Anderson cancer center in Houston.....or you need to take your child to St. Jude's....YOU KNOW IT'S SERIOUS! Same with this guy being told he should go to Denver.

 

[JBean]

I totally agree with Dr. MSM about the secret taping. Why do it in secret if "we're thinking everything's fine?" And if it were done secretly, I seriously doubt it will be allowed should this ever go to court. It's too easy to clip and edit such things in your favor.

I still stand by my suspicion of why he had the X-ray that discovered the mass in his lung because he was "worried he had bruised his rib." That's suspect.

And now there's a secret tape recording? Like Andrew Speaker proclaimed, he is intelligent and well-educated. He knew what was going on.

If a doctor tells you....you need to go to the M.D. Anderson cancer center in Houston.....or you need to take your child to St. Jude's....YOU KNOW IT'S SERIOUS! Same with this guy being told he should go to Denver.

I had an xray when I was afarid I sprained my ankle. I had it in order to rule out a break. I think the same can be said of a rib. You do want to know if it is broken or bruised and I think an x ray is SOP.

 

[accordn2me]

I had an xray when I was afarid I sprained my ankle. I had it in order to rule out a break. I think the same can be said of a rib. You do want to know if it is broken or bruised and I think an x ray is SOP.

An ankle I can understand. You could put it in a cast....or put a brace on it......or get some crutches, a walker, wheelchair....prop it up.....stay off of it...but if it were your rib.......what cha gonna do?

Actually someone said you could tape the rib...or WIRE it...OUCH! But I've never heard of anyone having ribs wired....not saying they wouldn't do it. What I am saying is that I personally believe Andrew Speaker knew something was wrong with his LUNGS and that's why he had a LUNG X-ray. It's just my hunch.


SOP

 

[JBean]

An ankle I can understand. You could put it in a cast....or put a brace on it......or get some crutches, a walker, wheelchair....prop it up.....stay off of it...but if it were your rib.......what cha gonna do?

Actually someone said you could tape the rib...or WIRE it...OUCH! But I've never heard of anyone having ribs wired....not saying they wouldn't do it. What I am saying is that I personally believe Andrew Speaker knew something was wrong with his LUNGS and that's why he had a LUNG X-ray. It's just my hunch.


SOP

standard operating procedure..sorry.
There is not anything to be done ,necessarily, about a broken collarbone either, but you still x ray it to know what you are dealing with. .I still think x ray is SOP. You have to rule everything else out, and in the event it is broken, you need to make certain it is a simple fracture and is not interfering with anything else.

 

[Buzz Mills]

LOL, which reminds me that I didn't finish my "falling down the stairs" story. About six weeks after my night in the emergency dept,, I get a letter from my doctor, saying that they want me to come back in, because they noticed something at the bottom of my right lung, on the follow-up X-rays performed a month later. So after more X-rays, I get another letter from my doctor for more X-rays on a slightly different angle. So after even more X-rays, I get a call from my doctor scheduling me for a catscan. I did the catscan, followed by a call from my doctor, deciding that, according to the lung people, whatever I had in the bottom of my lung wasn't serious. Then I get a letter a few weeks later, and yes, the diagnosis by the lung people, verifies that whatever mass I have in the bottom of my lung, isn't, in their opinion, dangerous.................however, it goes on to talk about the golf ball size tumor I have in my left kidney, and the lump at the top of my right lung. When I called my doctor about this, she said, they didn't consider them dangerous. Easy for her to say, can you imagine the fears, these things might give rise to, if it were you??

 

[accordn2me]

LOL, which reminds me that I didn't finish the "falling down the stairs" story. About six weeks after my night in the emergency dept,, I get a letter from my doctor, saying that they want me to come back in, because they noticed something at the bottom of my right lung, on the follow-up X-rays performed a month later. So after more X-rays, I get another letter from my doctor for more X-rays on a slightly different angle. So after even more X-rays, I get a call from my doctor scheduling me for a catscan. I did the catscan, followed by a call from my doctor, deciding that, according to the lung people, whatever I had in the bottom of my lung wasn't serious. Then I get a letter a few weeks later, and yes, the diagnosis by the lung people, verifies that whatever mass I have in the bottom of my lung, isn't, in their opinion, dangerous.................however, it goes on to talk about the golf ball size tumor I have in my left kidney, and the lump at the top of my right lung. When I called my doctor about this, she said, they didn't consider them dangerous. Easy for her to say, can you imagine the fears, these things might give rise to, if it were you??

I would chain myself in the MRI room and demand an MRI then I would go to another hospital and do the same thing. And if cops showed up I would scream they better stay away because I have all these contaigous masses growing inside me and doctors don't know what they are!

That's crazy, Buzz! What's the diagnosis?

 

[Buzz Mills]

I would chain myself in the MRI room and demand an MRI then I would go to another hospital and do the same thing. And if cops showed up I would scream they better stay away because I have all these contaigous masses growing inside me and doctors don't know what they are!

That's crazy, Buzz! What's the diagnosis?

Thanks for asking a2me, I'm still alive and kicking, doing great......................................except for my urine being red.

 

[angelmom]

Angelmom, I have a question for you. In one of my posts above, I mentioned that the risk of contracting HIV after a needlestick with an HIV-contaminated needle was only 0.3%. How would you feel if someone stuck you with a contaminated needle when they could have avoided doing so? Would you not be angry, because you had a 99.7% chance of being OK? I don't know the exact chance of passengers around Speaker contracting TB, but I think this is a reasonable comparison to make. I just think it is negligent behavior.

ETA: If I found out that one of my patients was recording me without my consent, I'd confront the patient and seriously consider firing him/her. That is a huge red flag that there is some fundamental deception or distrust going on. If there is a legitimate reason to record the meeting, consent should be obtained from all parties.

here's the quote stating that the doctors didn't know about the taping:

Asked about the tape, Steve Katkowsky of the Fulton County Health Department told CNN, "If such a recording was made it was without the consent and without the knowledge of Fulton County Health Department officials."

http://www.cnn.com/2007/HEALTH/conditions/06/01/tb.flight/

Well, I guess I can't compare someone poking me with an HIV+ needle for no good reason to what this guy did. He was told over and over that he was not contagious, and asked them what had changed. Nothing (regarding the level of contagion) had changed, so I'm sure he felt that if he was no risk for 5 months of living with his wife, then a few hours on a plane would be a very small risk compared to dying a slow death in Italy. Which is what he was told would happen.

And I agree that a secret taping indicates a lack of trust. Speaker couldn't just change doctors until he found one he felt comfortable with - this was the county health dept. and he was at their mercy. He couldn't just go somewhere else. This lack of trust is exactly what I am getting at - they were not giving him a straight answer and he knew that they would not back him up if it came down to this situation.

I am going to just agree to disagree on this. I am tired of arguing about it. All I know is that years and years of dealing with Fulton County makes me doubt a word that comes out of their mouths.

 

[Details]

He was told by them in Rome that everything had changed. It's exactly the same as the HIV needle. At first, he thought the needle had at worst a .03% chance of giving you the flu - and that's an OK risk. Now you find out that the needle is carrying full blown AIDS to everyone you stick with it (and a full 30-50% risk of death) - and you keep on doing it.

When the diagnosis changed, everything changed. An acceptable risk with regular, or even drug resistant TB is very different than an acceptable risk with XDR TB.

Not that he should have gone in the first place - sounds to me like the clear message was, "It's a bad idea, but we can't tell you No, and yes, in answer to your question, you're unlikely to infect anyone, especially not someone young and healthy like your wife." (TB takes hold much more easily in the elderly and babies - a healthy adult can usually fight off an exposure on their own). He was scared enough to breakt he law to go to denver, but still decided to go to Rome? Doesn't make sense.

I'm also not buying this 'CDC abandoned poor little me to die' story. He was just too impatient to wait, and didn't care about anyone else.

 

[MSM]

I was looking up some info on the protocols for which TB patients require respiratory isolation. Apparently there are several ways to determine who should be isolated, and when to discontinue isolation. I had remembered that patients considered to be on effective medication are usually not in isolation. That may be why Andrew was told he didn't have to be in isolation while he was on what they thought was effective treatment...until they realized May 11 that he had drug-resistant TB and the meds hadn't been working after all. I don't know how well this was explained to him, but it sounds to me like there were good medical reasons for the changes in information he received along the way. He just chose not to believe what he was hearing--maybe he didn't want to believe it, maybe he couldn't understand it.

Discontinuing isolation of patients with known TB often is less important for physicians but of paramount importance to the hospital infection control staff, who need to know when a patient no longer can transmit the tubercle bacillus. Previous work, including studies comparing home versus hospital therapy[20] and comparing outcome according to smear or culture status at discharge[21], is >25 years old and may no longer be pertinent to TB care in the 21st century.
Among time-honored approaches[22], the most common is the practice of considering discharge after 2 weeks of apparently effective therapy. Others wait until the sputum AFB smear converts from positive to negative, which may take 4 to 6 weeks. In areas where drug-resistant TB is common, a more cautious approach might be waiting for at least 2 weeks of smear-negativity or, if MDRTB is documented, for culture negativity.

http://www.medscape.com/viewarticle/414401_4