TALLAHASSEE, Fla. — Some angry lawmakers want Gov. Rick Scott to create a panel to investigate a tuberculosis outbreak after learning that state officials kept mum about the epidemic even as the legislature was debating closing Florida's only TB hospital in Lantana.
But the House and Senate sponsors of a Department of Health reorganization that included the closure of A.G. Holley Hospital said state health officials did exactly what they should have. The outbreak, they said, did not justify keeping the aging facility open.
State Rep. Mack Bernard, a Democrat from West Palm Beach who supported the measure this spring, said he would have voted against it had he known about the outbreak of a virulent TB strain first found in an assisted living facility and later spread through homeless shelters in Jacksonville.
"It is outrageous that they would hide that information or not give that information to us before we voted," said Bernard, who is running for the Senate district where A.G. Holley is located.
The outbreak in Jacksonville, linked to 13 deaths and 99 illnesses, is the nation's worst epidemic of the airborne disease in the past two decades, according to the Center for Disease Control. About 3,000 people may have had close contact within the past two years with contagious people at Jacksonville's homeless shelters, area jails and a mental health clinic. So far, only 253 people have been found and evaluated for TB infection.
State and local health department officials called the CDC for help in 2009 after a spike in TB cases in Jacksonville. The total number of TB cases in the region declined after that but state officials sought aid from the CDC again in February after an increase in cases of a particular strain called FL 046.
Even as the state sought help from the CDC, closing down A.G Holley Hospital — a priority for the GOP-dominated legislature for years — was the topic of intense debate during committee meetings and on the chambers' floors. But the outbreak was never mentioned.
Bernard said he will ask Scott to set up a panel to look into the epidemic and to find out if there are TB clusters elsewhere in the state.
"We need to do whatever's necessary," he said. "We don't know what other information that we don't know."
Sen. Maria Sachs, a Delray Beach Democrat running against Sen. Ellyn Bogdanoff in a Palm Beach-Broward County district near the hospital, called the closure of the hospital "egregious and reckless."
In a letter to Scott sent Tuesday, Sachs asked the governor to create a panel to "review the efficacy of closing this important facility at this time."
And she rebuked state officials for failing to tell lawmakers about the Jacksonville epidemic.
"In the interest of transparency in government, it is absolutely essential that all information be available to legislators and considered by them before a vote," she wrote.
Scott needs to act immediately, Sachs said Tuesday.
"The first thing he needs to do is empanel an independent group. The second thing is to turn the air conditioning back on at A.G. Holley in case we need it," she said.
Last year, Duval County sent 11 patients to A.G. Holley under court order. With A.G. Holley now closed, one was sent to Jackson Memorial Hospital in Miami instead of the nearby Shands hospital. Others remaining in Jacksonville are being placed in motels to make it easier for public health nurses to keep tabs on them, Duval County officials said.
"It's scary," Sachs said. "All they have to do is go on a city bus and you're impacting the citizens of Duval County. Or they get on a train. Or they eat at a restaurant. These people need help. They don't need to be shoveled around to various motels," she said.
Senate Health Regulation Committee Rene Garcia said he knew about the outbreak but did not share information about it because state and local health officials were handling it properly.
"These things happen all the time. This cluster didn't start recently. This has been going on since 2008. Ever since that point, the numbers have remained steady. So I think the Department of Health has gotten control over it. Knowing that the CDC is involved and is helping the county health department in Jacksonville, I think it's OK. It's working the way it should work," Garcia, R-Hialeah, said.
Florida has contracted with two hospitals — Shands Jacksonville and Jackson Memorial in Miami — to treat patients who would have once been sent to A.G. Holley.
And lawmakers are spending the same amount of money — about $11 million a year — on those contracts as they were spending to keep the aging hospital open, said Rep. Matt Hudson, chairman of the House health care budget committee and author of a DOH overhaul
The Jacksonville outbreak and the closing of the hospital are unrelated, Hudson said.
"As far as I'm concerned, I did not know about (the outbreak) but it would not have changed my opinion. We simply made a decision on how best to treat people. That treatment is not best in a 60-some-odd year facility that was falling apart," Hudson, R-Naples, said.
Hudson also believes state and local health officials handled the situation appropriately. They asked the CDC for help and requested and received a federal grant in 2009 to help pay for staff. The Duval County Health Department also set up a coalition to monitor the situation. And the number of TB cases in Jacksonville continues to drop, Hudson said.
"I'm not sure what more you could actually ask for, quite frankly," Hudson said. "I'm not sure what a task force from other parts of the state would do for Duval County when everyone' s engaged and everyone's involved and they're going about it the right way," he said.
But state Sen. Audrey Gibson, D-Jacksonville, said placing the infected residents in her community in motels "is just crazy." Gibson said the Duval County delegation needs to get involved.
"The first order of business is the safety of the people in the area and in the state," she said. "If there is an emergency role to be played by the legislature, then yes without question we need to not just do hearings, we need to be acting. The question is, is there a place for people right now? Where do they go? I don't know."