Thursday, September 27, 2012

Report: Fla. agencies withheld TB outbreak info || AP - First Amendment Center

Report: Fla. agencies withheld TB outbreak info

by Associated Press,
September 25th 2012

JACKSONVILLE, Fla.  — When Jacksonville City Councilman Robin Lumb tried to ask questions about the recent tuberculosis outbreak among Jacksonville’s homeless, he was never able to get answers.

Lumb was 6 years old when his father was diagnosed with active TB, and he said a vivid part of his childhood was frequently being tested for TB.

He wanted to know the implications of the Jacksonville outbreak, but the Duval County Health Department wouldn’t return e-mails, he said.

He wasn’t the only one who couldn’t get an explanation.

A review of state and local health department e-mails over a four-year period shows the agencies released only select information to the public regarding an increase in TB cases among Jacksonville’s homeless population, despite recommendations from the U.S. Centers for Disease Control and the local public information officer.

The e-mails revealed the health department’s hesitancy to release public records to a reporter. They also revealed that the department didn’t publicize a tuberculosis investigation at a local school despite the director later saying the department typically does. Earlier, the health department began discussing the outbreak publicly only after an e-mail was mistakenly sent to reporters.

Health officials said their decisions were in the public’s best interest, but others such as Lumb say they have a responsibility to release details of the outbreak.

“They shouldn’t be trying to make this information private,” Lumb said. “What you’re really saying is the public isn’t sophisticated enough to absorb the information.”

The CDC sent representatives to Jacksonville in February to assist in investigating an outbreak of a particular strain of tuberculosis among Jacksonville’s homeless.

E-mails between CDC representative Gail Grant and Jimmy Keller, deputy chief for the state’s TB program, reveal the decision not to release information about the recent investigation was made by Max Salfinger, the section administrator for the state’s tuberculosis program.

Grant said Salfinger was not interested in reaching out to the news media about the report, despite the CDC’s effort to gather talking points on the department’s behalf.

Calls to Grant and Keller were not returned in time for this story.

Salfinger, who recently took a position at a Denver hospital, declined to comment.

Mayor’s surprise

In April, the CDC’s report was shared with the Duval County Health Department. E-mails from Jacksonville Mayor Alvin Brown’s office show health department officials discussed the CDC findings in May with state Rep. Mia Jones, Brown’s special assistant and his point person in the TB investigation.

In July, Brown issued a statement to the Times-Union that he was surprised and concerned about TB among the homeless. The mayor did not respond to several requests for interviews with the Times-Union to answer why he was surprised by the outbreak when Jones had been at the meetings.

Jones sat in on conference calls with the health department on Brown’s behalf and said she keeps him up to date.

She said Duval County Health Department officials didn’t request help from the state quickly enough when they knew Jacksonville had a TB problem. But once lines of communication opened up among various agencies, she was satisfied.

Jones said she didn’t consider informing the general population about the outbreak a priority, echoing sentiment from the state health department.

“You don’t want to create a situation of having people be worried and in a frenzy if they don’t need to be,” she said. “To create that level of frustration when it wasn’t necessary — I don’t think that would’ve been the right approach for it.”

As for Lumb’s questions — including some posed to Brown’s office — Jones said the health department was responsible for answering his questions.

Outbreak at assisted-living facility

In November 2008, the local health department discovered an outbreak of tuberculosis in a Jacksonville assisted-living facility, Golden Retreat. The CDC was called in to assist the health department and found 18 active cases of TB.

On April 16, 2009, Richard Doggett, a TB supervisor for the Duval County Health Department, shared with colleagues a story written by the Times-Union about an active case of TB found at the University of North Florida.

“UNF sent the advisory out as a precaution against anyone accusing them of a cover-up,” Doggett wrote.

Doggett ends the e-mail with, “Let’s hope they never find out about G.R.”

G.R. refers to Golden Retreat. The outbreak at Golden Retreat was the source of the same strain of tuberculosis that is circulating among Jacksonville’s homeless. The CDC’s report on Golden Retreat found 18 active cases of tuberculosis, including two deaths. There have been a total of 14 deaths in Jacksonville associated with this strain of tuberculosis.

Doggett declined to comment for this story.

Officials at UNF sent a campus-wide email that said 30 people who had been in close contact with the University Center kitchen worker would be tested. Those people would be contacted individually.

“We put as many details in there as we could because it allowed the members of the campus community to gauge for themselves whether they were at risk. In this case the vast majority of people were not at risk,” said UNF spokeswoman Sharon Ashton. “We never had a discussion about, ‘Do we send out this e-mail to the campus community or not?’ It was just a matter of, ‘How do we best phrase it to get the message across?’”

Robert Harmon, the Duval County Health Department director, told the Times-Union in July that a decision on when to release information is based on a “judgment call,” and that the department doesn’t want to incite panic among the public.

In an editorial written for the Dec. 20 issue of Folio Weekly, Harmon wrote, “There have been TB cases and outbreaks in the past, such as at schools, when we have notified the public via the news media in order to encourage unknown contacts to be tested.”

However, when there was an active case of TB at Lee High School, Harmon’s department did not notify the news media. Calls to Harmon for comment were not returned.

On the last day of school in 2011, Lee High School sent out letters to parents about an active case of tuberculosis, said Jill Johnson, spokeswoman for Duval County Public Schools. The health department tested 32 people at Lee, and two tested positive.

County TB manager: Records request ‘tedious’

In one instance, some health department officials wanted to release some information to the public, but their recommendations were ignored.

Duval County Health Department’s public information officer Charles Griggs and CDC representatives encouraged the release of some records. However, some requested public records regarding tuberculosis investigations were never released to former Folio Weekly reporter Susan Cooper Eastman regarding the 2009 CDC report, according to the e-mails.

Aaron Hilliard, assistant director of the Duval County Health Department, wrote that releasing more information would compromise current and future TB investigations.

Cynthia Benjamin, Duval’s TB manager, wrote, “(Eastman) is asking for too many specifics that in my experience we have never given to anyone outside of our local TB program, the state office or CDC. We have been accommodating up to this point but this request is beginning to become tedious and time consuming.”

Keller sent an e-mail in November that said he told Duval County to hold off releasing the documents. A document from the CDC said the report was open under public-records laws.

The Times-Union asked Griggs last week if he agreed with that decision. In an e-mail to the newspaper, he didn’t directly answer that question.

“While we strive to provide information to the media in a most timely and efficient manner possible during these types of investigations, we must also work to preserve patient information,” Griggs said in the statement. “(The e-mails) provide our thought process in handling the information exchange, it may not reflect the full context of additional meetings/conference calls that were also held in conjunction with these communications.”

Florida requires state and local agencies to release public documents. If exempted items need to be redacted, the agency has to provide the remainder of the document regardless of internal policies, said Barbara Petersen, president of the First Amendment Foundation.

Additionally, the amount of time or effort it takes to fill a request should not affect whether or not the record is released, she said.

“The law prevails, not their rules,” Petersen said.

This story appears courtesy of The (Jacksonville) Florida Times-Union

Tags: Florida, medical records, medicine or science, public records

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