May
25
A.G. Holley tuberculosis hospital is envy of health officials in other states
Filed Under crime, health, hurricane, privatization, single stories |
Originally published in The Palm Beach Post on Sunday, May 25, 2008.
By KATHLEEN CHAPMAN
Palm Beach Post Staff Writer
LANTANA - Before the court order that separated Bert Sayre from his family and forced him into isolation, he had no idea what was making him so sick.
And at first, neither did the doctors. But by last May, the roofer from Tampa was too weak to lift his daughter, then only 3 years old.
On his third trip to his third hospital, he finally got the diagnosis. He had tuberculosis, a disease that is now rare in the United States but was once the nation’s leading cause of death.
The antibiotics that doctors prescribed to treat Sayre made him sick, and an emergency room doctor told him they were killing his liver. Sayre was afraid he would die.
The Florida Department of Health judged his disease a threat to the public and said he may have caused the complications by drinking. Sayre denied that and fought commitment because he didn’t want to leave his daughter. After a Hillsborough County court hearing where Sayre said everyone wore a mask, a judge ordered Sayre to A.G. Holley State Hospital.
Sayre, 52, lived for months in an isolation room inside the hospital while he was contagious. He wasn’t the most cooperative patient at first.
“Believe me, I am an ornery old cuss,” he said.
Doctors there confirmed that conventional medications were hurting his liver, even at the locked hospital, where he had no way to drink. They saved his life, Sayre said, by finding another drug that worked. Now, after eight months of treatment, he is leading bingo games to help pass his remaining time inside the hospital.
Sayre said he was in disbelief when he heard that during the state’s legislative session, House Healthcare Council Chairman Aaron Bean, R-Fernandina Beach, proposed closing A.G. Holley to save money.
“You don’t understand how dangerous this disease is, until you get it,” Sayre said.
Instead of shutting down the hospital, Bean added a last-minute amendment to the state budget that requires the state to privatize the 50-bed hospital, built on Lantana Road in 1950.
The state last week asked parties interested in redeveloping the property to notify the state by June 9.
Legislators including Bean and state Rep. Mary Brandenburg, D-West Palm Beach, have said Florida should look at models in other states to see how they care for tuberculosis patients.
But health directors in other states, who are struggling to isolate and treat people who carry dangerous strains of the disease, say Florida’s hospital in Lantana is the envy of the nation.
States across the country have laws that allow judges or health department doctors to lock up people who could spread tuberculosis but refuse to take medication or wear a mask.
With no facility like A.G. Holley, some states, including California, confine people to motel rooms and post guards outside the door to keep them from leaving. And in other states, jails and prisons are the only option for contagious people who won’t cooperate.
Arizona made national news and faced an expensive lawsuit in 2007 when it committed tuberculosis patient Robert Daniels to a jail cell for months with no phone, windows, shower or television.
Dr. Karen Lewis, tuberculosis control officer for Arizona, said state health officials have “looked to A.G. Holley as a wonderful model of what we as a state would love to have.”
In Georgia, which confines about six tuberculosis patients a year by court order, health officials have to rely on local jails and a private prison hospital. The state would be “very interested” in paying to send its own patients to A.G. Holley if the two states could work out payment arrangements, spokeswoman Taka Wiley said.
“If it were possible, we would strongly consider an agreement with A.G. Holley Hospital,” she said.
In other states, there is often financial pressure to release patients before they are fully cured, said Dr. Lee Reichman, executive director of the New Jersey Medical School Global Tuberculosis Institute.
“I wish I had an A.G. Holley Hospital here,” he said.
Many of A.G. Holley’s patients complain about the hospital because they don’t like to be locked up, Sayre said, but they don’t realize how lucky they are.
“You think you are in jail,” he said. “But I know I don’t want to be in jail. I want to be right here in this bed with my remote, getting better. In jail, they treat you like a leper.”
A.G. Holley’s doctors are experts on the disease, while many general physicians “just don’t have the knowledge,” Sayre said.
The hospital’s medical executive director, Dr. David Ashkin, says polls show the overwhelming majority of Americans support isolating people with deadly communicable diseases who don’t accept treatment.
“But if we are saying as a society that we need to protect the public from this person,” Ashkin said, “don’t we owe it to that person to give them the best care possible?”
However, the hospital no longer needs such a large building or the surrounding land, and the town of Lantana has long worked with the state on a plan that would preserve the tuberculosis treatment program while attracting a medical research complex to the site. Dale Brill, who heads Gov. Charlie Crist’s Office of Tourism, Trade and Economic Development, is overseeing development plans.
Brill said A.G. Holley is a “world-class facility” and did not ask Bean to write the budget amendment that privatized it. A draft of Brill’s invitation to bid for development of the land requires that any private institution taking over the tuberculosis program retain or at least give hiring priority to current workers, have 10 years of public health experience, be “intimately involved” with protecting the public from tuberculosis and take orders on patient care from the state.
The program could stay on the same land in Lantana, move elsewhere in Florida or become part of a teaching hospital.
Patients at A.G. Holley are confined to isolation rooms, where negative pressure keeps contaminated air from leaving, until they are no longer contagious. Patients who are contagious are required to wear masks when they walk through the hospital. They also may go outdoors, where the disease doesn’t spread because of the air and sunlight.
After patients stop coughing bacteria into the air, they can take off their masks and spend time in the hospital’s recreation room, which has television, video games and pool. Alcoholics Anonymous and Narcotics Anonymous groups are available, and the hospital offers arts and crafts, including crocheting.
Patients who earn the trust of administrators and are no longer contagious may leave for fishing trips, entertainment and church.
In 2007, the state of Florida reported 980 tuberculosis cases. When told they have a potentially fatal disease, most people faithfully take medication over several months until they are cured. But a small percentage refuse. Others get sick when they combine the TB medications, which are processed in the liver, with drugs or alcohol.
Difficult patients are potential incubators for new, dangerous forms of tuberculosis. When people start taking the drugs but stop before they are fully cured, the strongest bacteria survive. The patient then develops a more dangerous, drug-resistant strain that can be spread to as many as 30 people over time. Each case of tuberculosis resistant to conventional drugs can take up to $500,000 and a year or more to treat.
Awsha Sanders, 26, was ordered to A.G. Holley against her will on Feb. 26. She said she has long been obsessed with cleanliness, but couldn’t avoid germs at the homeless shelter in Tampa, where she saw women coughing blood into the sink.
She lost a baby at five months because she was so sick with tuberculosis. Health department workers tried to give her drugs, often coming to meet her in local parks.
When they said she had missed 18 doses, she was ordered to A.G. Holley.
Sanders said she fought commitment because she doesn’t like to be held captive. But she is glad she came.
“God knows where I would have been, or how much sicker I would have been,” she said.
Sayre thinks he probably caught tuberculosis from another roofer.
It was the first he had heard of the disease since he was tested in school as a little kid.
“You think it’s only overseas,” he said. “But anyone can get this.”
He is scheduled to be released soon and hopes the state will preserve the same high standards for the patients who come after him.
If they don’t, he said, “people are going to die. And they are going to spread it like wildfire.”
About tuberculosis
> The disease was once called consumption, because it seems to eat away at the body, causing weakness and severe weight loss. The bacteria attack the lungs, causing a bloody cough.
> Tuberculosis is not as contagious as the measles or chicken pox, but medical experts estimate that one person can spread the airborne disease to up to 30 people over time.
> Though about one in three people worldwide carry the bacteria that cause tuberculosis, only one in every 10 who have the bacteria will get sick.
> The disease was once the leading cause of death in the United States, and many states are now grappling with drug-resistant strains.
Treatment in the U.S.
How other states handle contagious tuberculosis patients who refuse to cooperate with treatment:
> California: Uses guards to keep patients inside hospital rooms, motel rooms or the patients’ homes. Tuberculosis patients who are mentally ill can be sent to the state’s psychiatric hospital.
> North Carolina: Patients who repeatedly refuse treatment can be criminally prosecuted as ‘health law violators.’ They are sent to one of three prisons.
> Texas: Replacing its 1953 state tuberculosis hospital with a $35.2 million, 75-bed facility.
> New Mexico: Has an agreement to send patients to Texas.
> Massachusetts: Opened a 12-bed wing for tuberculosis inside a public hospital.
> Missouri: Has eight beds inside a university hospital dedicated to tuberculosis patients.
> Georgia: Has special rooms in local jails or a private prison.
> New Jersey: Has isolation rooms in a teaching hospital.
Copyright 2008 The Palm Beach Newspapers, Inc.
Palm Beach Post (Florida)
May 25, 2008 Sunday
FINAL EDITION
SECTION: A SECTION; Pg. 1A
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