Apr
22
Closing A.G. Holley tuberculosis facility would be perilous, survey of health departments says
Filed Under health, single stories |
Originally published in The Palm Beach Post on Tuesday, April 22, 2008.
By KATHLEEN CHAPMAN
Palm Beach Post Staff Writer
LANTANA - More people will become sick and die from tuberculosis if lawmakers close A.G. Holley State Hospital without an effective plan to treat difficult patients, county health department directors from around Florida warn.
Leaders of 49 of the 55 health departments that responded to a survey this month said they don’t think their communities can handle A.G. Holley’s approximately 50 patients. Most of those patients have been involuntarily committed to the state hospital in Lantana because they are contagious but refuse to take their medication. Tuberculosis is caused by bacteria and is spread through the air from one person to another when a person coughs or sneezes.
Dr. Kevin Sherin, who oversaw the online survey for the Florida Association of County Health Officers, said the hospitals in his area “would be hard pressed to know what to do” with homeless people and other difficult patients who have severely drug-resistant strains of the disease but refuse treatment.
Forms of tuberculosis that don’t respond well to medication “are something we don’t want to break out,” said Sherin, who also heads the Orange County Health Department. “It could kill lots of people.”
Many health directors said they rely on doctors at A.G. Holley for advice.
“Most of our docs here do not know how to treat a difficult case of TB properly, nor do they want to,” a representative of the St. Lucie County Health Department wrote.
“We have a long way to go before we can even pretend to be able to handle this on a local level,” a representative from Madison County wrote.
The association disclosed the responders’ affiliations but not their names.
The Florida House this month approved a state budget proposal that orders the closing of A.G. Holley, which opened in 1950 and is the last free-standing state tuberculosis hospital in the nation.
Alongside patients who have been committed for refusing treatment, the hospital also houses those who have difficult cases or complications such as AIDS. Some are in A.G. Holley voluntarily.
Tuberculosis can be fatal if untreated, but an aggressive public health campaign over several decades has made the disease rare in the United States. House leaders believe that A.G. Holley has outlived its usefulness and say the state can cut $5 million from the hospital’s $11 million budget by closing it and contracting with private hospitals.
“Other states get along very well without a TB hospital. I think we can, too,” said Rep. Aaron Bean, R-Fernandina Beach, chairman of the House Health Care Council.
Bean said he was not moved by the survey results. “I’m still confident,” he said.
Gov. Charlie Crist has asked the state Office of Tourism, Trade and Economic Development to work with the legislature and the town of Lantana on possible redevelopment of the hospital property. Some private organizations have expressed interest in taking over the care A.G. Holley provides, said Rep. Mary Brandenburg, D-West Palm Beach.
“The Florida Legislature certainly is not going to eliminate funding for care of tuberculosis patients,” she said. “What the discussion has been is how best to provide that care and how best to protect the public health.”
When 49 states are “doing it differently,” Brandenburg said, “that tells me that they may know something that we don’t know.”
But employees of some local health departments say they worry about the care people would get at hospitals that aren’t set up for contagious patients who may have to be isolated for months.
A survey respondent from the Nassau County Health Department said the agency had one patient who was confined to one of Florida’s university hospitals. The patient was kept in “a small room at the end of a long hall” and had no social stimulation or chance for exercise, the representative wrote.
The care was not optimal, the respondent wrote, and the treatment was “inhumane.”
A representative of the Jackson County Health Department said the county sent a patient to A.G. Holley this year because it did not have a facility or a thoracic surgeon necessary to treat him.
“This 28-year-old would be dead today if not for the quick action and treatment he received” from A.G. Holley, the representative wrote.
The anonymous survey was sent to directors and administrators at every county health department in Florida. Some directors responded themselves and others passed the survey on to local experts, Sherin said.
Leaders of the state Department of Health have expressed similar misgivings, saying they doubt the patients could find adequate care elsewhere. Many of the patients have no insurance, they noted.
People who support closing the hospital keep saying they trust the state to come up with a plan, said Rep. Shelley Vana, D-Lantana.
“But if you trust the Department of Health, they are telling you they can’t do it,” Vana said. She plans to use the survey in the debate about the hospital’s future.
In the late 19th and early 20th centuries, tuberculosis was the leading cause of death in the U.S., but the fatality rate fell to fewer than one in 100,000 cases by the mid-1990s, according to the national Centers for Disease Control and Prevention.
The first tuberculosis sanitarium in the nation was established at Lake Saranac, N.Y., in 1885. By the 1950s, there were more than 800, with more than 70,000 beds. By the mid-1970s, the number of beds had dropped to fewer than 10,000.
Staff writers Dara Kam and Ron Hayes contributed to this story.
A.G. Holley survey responses
Employees of health departments from throughout Florida predict dire consequences if lawmakers close the state tuberculosis hospital in Lantana:
“Closure of A.G. Holley will result in more TB infections and deaths due to lack of specialized treatments.” - St. Johns County
“That means exposure, exposure,exposure … spread of disease … more cases … more manpowerand money to treat cases … back to square one!!!” - St. Lucie County
“Help,I am in shock.” - Jackson County
“This is our last resort to getting difficult clients treated to cure! The likely drug-resistant TB cases that will result from the inability to adequately treat non-adherent clients is frightening!” - Alachua County
“Don’t do it. This is a much-needed facility for essential services that can’t be provided elsewhere. No one could provide the comprehensive service and monitoring necessary for any amount of money, in the individual counties.” - Marion County
Source: Florida Association of County Health Officers
Copyright 2008 The Palm Beach Newspapers, Inc.
Palm Beach Post (Florida)
April 22, 2008 Tuesday
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