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
LENGTH: 1,659 words

By KATHLEEN CHAPMAN
Palm Beach Post Staff Writer

LANTANA – Discussions about privatizing the state’s tuberculosis treatment program started weeks before lawmakers changed the state budget to make it mandatory.

Two potential suitors say they received calls from Gov. Charlie Crist’s economic development office about a month ago, asking whether they would be interested in taking over the program, now run by A.G. Holley State Hospital in Lantana.

One call went to the National Jewish Medical and Research Center, a renowned program based in Denver whose president is a former vice president at a medical technology company in Fort Lauderdale.

Another went to Jorge Dominicis, president of GEO Care, a Boca Raton-based company that runs psychiatric hospitals for the state.

Both said they had talked intermittently during the past two years about taking over management of A.G. Holley. Both told Crist’s Office of Tourism, Trade and Economic Development that they might consider bidding for the work.

A Crist spokesman, however, said Wednesday that the governor’s office did not push for the budget amendment, which came last week on the second-to-last night of the 60-day legislative session.

Crist’s economic development director had no idea how the measure came about, gubernatorial spokesman Sterling Ivey said.

The flurry of activity follows years of inconclusive talks about A.G. Holley, dating to former Gov. Jeb Bush’s administration.

State Rep. Mary Brandenburg, who supports exploring privatization, said the efforts haven’t always been well coordinated.

“I can understand why anyone might think the left hand doesn’t know what the right hand is doing,” said Brandenburg, D-West Palm Beach, whose district includes Lantana. She and Dominicis informally discussed GEO Care’s interest in the program as recently as last year.

State Rep. Aaron Bean, R-Fernandina Beach, who inserted the language into the budget, said last week he had no specific company in mind to take the program private.

Ivey said Dale Brill, director of Crist’s economic development office, approached Brandenburg and other legislators several weeks before the session’s end and mentioned the possibility of privatizing the hospital. The meeting included Bean, head of the House Healthcare Council.

Ivey said Brill didn’t talk to Bean about A.G. Holley in the last week of the session and didn’t ask for the amendment. “He (Brill) said, ‘I have no idea how the language got in there,’” Ivey said.

Bean’s amendment requires the state to find a private company to design, build and run a TB hospital in an unspecified location. It gives the state health department until July 1 to begin that process and calls for a contract that could last 20 years.

The town of Lantana and the Palm Beach County Health Department have long worked with officials in Tallahassee on plans for the property that houses the aging TB hospital east of Interstate 95. But the state seemed to be moving slowly until this spring.

National Jewish’s president and chief executive officer, Dr. Michael Salem, said his talks with the state have been “very preliminary.” He said he would “need a lot more discussion in order to understand what the state would want to do.”

The hospital already has a regional office in Boca Raton for education, outreach and fund raising. In the past three years, 800 patients from Florida have flown to National Jewish in Denver for care.

“If there is some way we could serve the people down there in a significant way, even more than we do now, it’s something that we would consider,” Salem said.

National Jewish, which finished its first hospital building in 1893, has been ranked the top respiratory center in the country by U.S. News and World Report for 10 years. The nonprofit has no hospitals outside Colorado, but has been expanding, hiring many new specialists in the past 18 months, Salem said.

He said he has watched with interest as the Mayo and Cleveland clinics have expanded in Florida while the state has lured branches of The Scripps Research Institute and the Burnham Institute for Medical Research.

Two years ago, under Bush, the state Department of Health asked companies interested in taking over A.G. Holley to submit proposals. GEO Care was the only one to respond, and the state opted not to privatize.

GEO Care runs psychiatric hospitals under contract with the Florida Department of Children and Families, including a program for mentally ill jail inmates in Martin County. It’s a subsidiary of the security company GEO Group, formerly Wackenhut.

As recently as last year, Dominicis said, he talked with Brandenburg about possibly managing A.G. Holley.

“I’ve known Mary a long time,” Dominicis said. “I’m not sure who approached whom.”

Dominicis said he told the governor’s office in a brief conversation last month that he might be interested. But on Wednesday, Dominicis said: “We are not interested.”

He said that after learning details of a state Health Department consultant’s report from 2007 that criticized GEO Care’s first proposal to take over A.G. Holley. The consultant said GEO wasn’t qualified and might not offer any savings.

Dominicis agreed that tuberculosis treatment is a specialized field, but said the report’s findings on costs were “ludicrous.” He said GEO would have worked with the state and would have hired most of the experts working at A.G. Holley, as it has in other hospitals.

Brandenburg would like to see the state do an objective study of what system would best serve TB patients and the public: “It has almost seemed to me that there are a lot of different people going in different directions.”

A.G. Holley timeline

Proposals for treating the tuberculosis patients committed to A.G. Holley State Hospital have changed over the years:

December 2004: A state advisory council begins meeting to decide the future of the A.G. Holley campus in Lantana.

January 2006: Plans for a medical research center on the site, almost complete, include a new 50-bed hospital that the state Department of Health would run.

July 2006: Under Gov. Jeb Bush, the state Health Department asks companies to submit proposals to privatize the hospital. Only GEO Care responds.

2007: Health Department consultants recommend against privatization.

Spring 2008: An economic development adviser to Gov. Charlie Crist contacts executives at GEO Care and Denver-based National Jewish Medical and Research Center, asking whether they might be interested in managing the hospital. Separately, state Rep. Aaron Bean, chairman of the House Healthcare Council, calls for cutting the hospital’s $11 million budget in half, closing it and requiring the state to look for private bidders to take the patients.

April 27, 2008: House and Senate leaders agree on a budget that includes full funding and would keep the hospital open.

May 1, 2008: On the next-to-last day of the legislative session, Bean inserts an amendment to the budget that requires the state to seek private bidders to design, build and operate a new TB hospital. The location of the new hospital is not specified.

Copyright 2008 The Palm Beach Newspapers, Inc.
Palm Beach Post (Florida)
May 8, 2008 Thursday
FINAL EDITION
SECTION: A SECTION; Pg. 1A
LENGTH: 1,167 words

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
FINAL EDITION
SECTION: A SECTION; Pg. 1A
LENGTH: 1,077 words

By KATHLEEN CHAPMAN
Palm Beach Post Staff Writer

WEST PALM BEACH – More than one in 10 people who drank city water when it was contaminated with fecal bacteria said they got sick, according to a survey of residents released by the Palm Beach County Health Department on Wednesday.

The more unheated tap water that residents drank in September and October, the more likely they were to say they felt ill, surveyors found.

The health department targeted a random sample of 5,000 households out of 23,763 West Palm Beach residential water customers between Oct. 12 and Nov. 2. Most of the households chosen for the survey didn’t have a home phone number, failed to return messages or didn’t want to participate.

But of the 315 water customers who agreed to the interview, 38 people — or 12 percent — said they had symptoms such as diarrhea, stomach pain and nausea. Of those, six said they sought medical treatment.

The survey asked residents how much unheated tap water they drank in the weeks before and after Sept. 28, when the city discovered the bacteria and issued a boil-water notice affecting 120,000 people.

The contamination was probably caused by problems at the city water treatment plant sometime between Sept. 19 and Sept. 25. City officials discovered the contamination on Sept. 28, when test results came back positive from a sample taken two days before. Another test on Oct. 30 showed fecal coliform and E. coli bacteria in the water coming from the treatment plant.

Surveyors can’t say for sure that the contaminated water caused the illnesses, because they relied on people’s own reports, rather than medical tests. Salmonella, norovirus and a variety of other common germs cause the same symptoms as water-borne bacteria.

But in a normal month, the report said, only about 2 percent of the population has some kind of gastrointestinal problem. Twelve percent of the population reporting stomach sickness in one month is “very high,” health department Director Dr. Jean Malecki said. “That makes this important.”

With tests showing fecal bacteria in the water on Sept. 26 and Oct. 30, the plausibility of a cause-effect relationship is even higher, Malecki said.

In recent months, the city has cleaned its water with chlorine, a more powerful disinfectant, and brought in an independent contractor to make improvements to the water treatment system. The chlorine treatments are scheduled to end Feb. 14, at which point the city should have the best water quality in years, Mayor Lois Frankel said.

Though “we’ll never definitively know” what made people sick, Frankel said, “what is important is that something like this doesn’t ever happen again and that we don’t even have to speculate whether someone got sick or not.”

The sample size of 315 people is a limitation to the study, Malecki said, and it is possible that people with complaints were more likely to call back after receiving a message from the health department.

But a key finding, Malecki said, is a strong link between how much water people drank and whether they reported symptoms.

Those who reported having drinks with unheated tap water before the boil water order were eight times more likely to say they felt sick than those people who drank no tap water, the report said. And people who drank the most water were more likely to report symptoms than people who drank less.

Surveyors found that link to be statistically significant, meaning that there is less than a 5 percent possibility of the difference in reported illness rates being caused by random chance.

The survey asked people how much water they drank between Sept. 1 and the boil-water notice on Sept. 28.

It also asked how much they had to drink from the time of the boil-water notice until the date of the call from surveyors in October or November.

The results show that some of the people who got sick continued to drink unheated water, despite a warning from the city.

Frankel said the survey “confirmed to me the importance of having a good system to get the word out to people and the importance to everyone when they are told to boil water, to do that.”

City leaders have repeatedly stressed that despite the anecdotal survey, there are no confirmed cases of water-borne illnesses.

A total of 128 people called the health department themselves last fall to say they thought the water was making them sick. None of their stool samples tested positive for water-borne bacteria, Malecki said, but bacteria can clear the body quickly and wouldn’t necessarily show up in lab tests days later.

Of the 38 people who reported sickness in the random survey, most said they recovered on their own with five days. But the survey still sends a message about the importance of clean drinking water, Malecki said.

“People expect to have safe, potable water,” she said. “And if it is not, people get angry — not just sick.”

Frankel said city leaders have worked “24 hours a day” to improve the water system.

“We don’t want people to think they got sick from the water or may have gotten sick from the water,” Frankel said. “That just shouldn’t be.”

Copyright 2008 The Palm Beach Newspapers, Inc.
Palm Beach Post (Florida)
January 24, 2008 Thursday
FINAL EDITION
SECTION: LOCAL; Pg. 1B
LENGTH: 838 words

By KATHLEEN CHAPMAN
Palm Beach Post Staff Writer

Palm Beach County emergency managers hope they have found a new group of foot soldiers in the war against bioterrorism: country clubs and condo board presidents.

Faced with a mandate to plan for the distribution of antibiotics to the county’s 1.3 million people in 48 hours, health officials here have hit on a quintessentially South Florida solution: If terrorists drop anthrax or another biological weapon over Palm Beach County, residents of neighborhoods that agree to partner with the Palm Beach County Health Department would be able to offer a private supply of antibiotics at their local clubhouses.

Everyone else would be told to remain calm and head for one of the shopping malls in the county, where shuttles would carry people to public centers distributing antibiotics.

The plan was born out of necessity. Palm Beach County is one of 72 metro areas nationwide that gets federal money to plan for a biological attack. The program, called the Cities Readiness Initiative, began in 2004 and requires cities to have a plan to distribute antibiotics quickly from a federal hoard called the Strategic National Stockpile. The county was added to the list in 2005, and the county health department received $267,000 this year for planning.

Some big cities, including Seattle, Boston and Philadelphia, have developed plans to distribute antibiotics by mail, with an armed guard or police officer escorting every postal worker from door to door. Broward County plans to organize through its towns and cities. Orlando is setting up a system of drive-through distribution, where people could pick up antibiotics through their car windows.

Philip Levenstein, who heads the effort for the Palm Beach County Health Department, didn’t think drive-through drug distribution would be a good idea in this county.

“I don’t have to tell you about the kind of drivers we have in South Florida. People from all 50 states, each coming in with a different perspective on what the driving requirements are,” Levenstein said. “I would be very concerned about doing anything mobilized. It could be very riotous.”

Though the county may lack courteous motorists, it has no shortage of shopping malls and gated communities. And when Levenstein had a hard time registering volunteers to work at the public distribution points, he turned to the homeowners associations.

At least 30 neighborhoods have expressed an interest in distributing a private supply of antibiotics to their residents, he said. But before they sign formal agreements, attorneys at the state need to address associations’ concerns that they could be held legally responsible if something went wrong, he said.

State and federal emergency managers say Palm Beach County’s plan to enlist homeowners associations is probably the only one of its kind nationwide.

“This is an exciting new idea, and we have really only been working on it for a few months,” said Ken Sturrock, a regional emergency response manager for the state Department of Health. “As far as we know, they are pioneers.”

Sturrock said he believes the count’s plan will work, even if it isn’t a traditional role for homeowners associations.

“We are planning for doomsday,” he said. “Most communities are more interested in the neighbor’s pink house with the broken-down boat in front. They are much less interested in Armageddon.”

But the anthrax attack in 2001, which killed tabloid photo editor Robert Stevens at the American Media Inc. offices in Boca Raton, got the attention of people in Palm Beach County and around the county, Sturrock said.

The emergency plan was developed for anthrax, which can be sprayed over a large area but is not spread person-to-person and can be stopped with antibiotics if caught in time.

The plans would have to be changed in the case of a contagious disease such as pandemic flu, when people would need to be separated.

Homeowners associations that agree to participate in case of a disaster would not have to give drugs to anyone outside their communities. Levenstein said he won’t publicize the names of communities that sign up because of the fear that, in a public health panic, people would storm their gates looking for antibiotics. People who do not live in a participating neighborhood would be bused from mall parking lots to distribution points around the county, where they would be asked about their symptoms and allowed to pick up medication for up to 15 friends and family members. The clinic locations also will remain a secret, Levenstein said.

Sturrock said he knows the plan to set up private antibiotic distribution in gated neighborhoods sounds “a little elitist,” but it will help elderly people who have difficulty traveling. And in any kind of contagious epidemic, the neighborhood organizations could help keep people from mingling with others who could make them sick, Sturrock said.

Without the private neighborhood supplies, the county would need about 45 public distribution points, Levenstein said. The health department would need up to 5,400 people for the effort, but it has fewer than 1,000 employees, he said.

To help make up the difference, he is advertising that those selected as volunteers for public distribution points will get first priority medication for themselves and their families. But attendance at his seminars has so far been light.

Another presentation for people interested in helping at public distribution points is scheduled for 3:30 p.m. Oct. 30 at the Mounts Botanical Garden auditorium at 531 North Military Trail in West Palm Beach.

Ultimately, Levenstein also hopes to register large employers that could offer to distribute medication to employees. Any big neighborhoods that pitch in also will reduce the strain on volunteers at public distribution sites, he said.

Bob Schulbaum, president of the Alliance of Delray Residential Associations, said homeowners associations are organized and capable.

When flu shot shortages forced seniors to wait in long lines several years ago, the associations took the initiative and now distribute up to 11,000 shots a year themselves.

Some residents of Delray Beach’s retirement communities remember the devastating flu epidemic after World War I, Schulbaum said, and most lived through World War II.

“There is nothing wrong with being prepared,” he said. “You can’t say it’s never going to happen here. We had the 9/11 terrorists living right over here on Atlantic Avenue. … We are not pooh-poohing this thing.”

But Schulbaum said he can’t recommend that his neighborhoods participate until the state addresses liability concerns.

“We heartily want to join in the effort,” Schulbaum said. “If they remove the obstacle, we will ask our communities to participate.”

Stephanie Dulin, who oversees the Strategic National Stockpile for the Centers for Disease Control and Prevention, said she believes Palm Beach County is the only one of 72 participants in the federal program that is turning to homeowners associations. She commends the local health department for its creativity.

“A lot of us are really trying to think of novel ideas, and obviously Palm Beach has come up with what would work in their local community,” Dulin said.

Anyone interested in becoming a volunteer for the bioterror plan can contact the Palm Beach County Health Department at (561) 355-3150.

Copyright 2007 The Palm Beach Newspapers, Inc.
Palm Beach Post (Florida)
October 21, 2007 Sunday
FINAL EDITION
SECTION: A SECTION; Pg. 1A
LENGTH: 1,219 words