Under fire for handling of TB outbreak, state health department releases plan

Under fire for its secretive handling of a north Florida tuberculosis outbreak that has blossomed into the worst in the United States, the Florida Department of Health today released an ambitious new plan for cutting the state's tuberculosis rate in half by 2020.

The plan, released this morning in advance of a press call from new state Surgeon General Dr. John Armstrong, describes separating the state's TB patients into three tiers of severity. The first tier would encompass 90 percent of all cases and keep them under the care of the state's 67 county-based health departments.

The second tier, which would be for higher risk patients who have more complex medical and social needs, would be managed by one of eight regional TB networks. Palm Beach County would be grouped with Broward and Miami-Dade counties.

The third tier would send TB patients to contracted hospitals geared toward housing patients who are ordered confined by courts because they are deemed to pose a risk to others.

All tiers would be responsible for sending patients to "alternative care settings" if they lacked the ability to stay isolated in their homes while contagious.

Left undefined are exactly which hospitals will contract for the care, and which "alternative care settings" would house TB patients. And, significantly, the plan does not spell out the details on which level of government will be responsible for paying for the patients' care. TB patients' care can be extremely expensive.

The state has been rushing to craft the new protocols for handling patients sick with tuberculosis after the Florida Legislature and Gov. Rick Scott this spring ordered the closure of A.G. Holley, the 60-year-old TB sanatorium in Lantana that has long taken those deemed non-compliant or difficult to treat.

Critics warned that the state had closed a key safety net hospital without a backup plan in place, and had done so without sharing information about a TB outbreak within Jacksonville's homeless community that a CDC official called the worst in the nation in two decades.

The report notes that despite the Jacksonville situation, Florida as a state is enjoying one of the lowest rates of TB infection in decades. It was 5.7 cases per 100,000 residents in 2007 and had fallen to 4.0 per 100,000 in 2011.

The agency sets a goal of cutting the TB rate in Florida to 2.0 per 100,000 by 2020. That will be especially challenging given the high rate of tuberculosis infection in the rest of the world and Florida's place as a state with a large and transient immigrant population. According to 2010 figures from the World Bank, Peru and Russia had a TB rate of about 106 per 100,000. In Haiti, it was 230 per 100,000. In Brazil, it was 43 per 100,000. In Mexico, it was 16 per 100,000.

Florida's rate was closer to Canada's, which was 5 per 100,000.

Check back for more details on this breaking news story.


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