Health officials in Florida hastened their closure of the nation's only dedicated tuberculosis hospital on cost-cutting grounds as one of the worst outbreaks of the deadly disease in 20 years was taking a grip on the state, it has been revealed.
At least 3,000 people in Jacksonville may have been exposed to the highly contagious respiratory illness that claimed 13 lives in the city and left another 100 sick in the last two years, a report from the Atlanta-based Centers for Disease Control and Prevention (CDC) concluded.
But news of the severity of the outbreak never reached Florida's politicians, who voted in March to bring forward the closure of the 100-bed AG Holley state hospital in Lantana by six months to July 2.
As a result, patients once deemed too sick for contact with the public were released into the community and others newly diagnosed with the disease, mostly from the homeless population, are being put up in local motels in an effort to keep them on their medications.
"The high number of deaths in this outbreak emphasises the need for vigilant active case finding, improved education about TB, and ongoing screening at all sites with outbreak cases," states the report written by Robert Luo, a senior doctor with the CDC's epidemic intelligence service, and obtained by the Palm Beach Post following a public records request.
The CDC confirmed it was one of the worst outbreaks of TB anywhere in the United States for at least two decades.
Meanwhile, the Florida department of health expects to save up to $10m a year by closing AG Holley, which had treated patients with the most severe cases of the disease since 1950. The hospital discharged its last patients a week ago.
In a statement, the department defended the closure, insisting that patients in need of hospitalisation would receive adequate care at public hospitals in Miami and Jacksonville, which also agreed to take some of the most severe AG Holley cases.
"We move into the future with confidence that these patients will receive continued high quality care in settings closer to their communities," said Dr John Armstrong, Florida's surgeon general.
Yet before the closure was announced the department always claimed that patients admitted to AG Holley "cannot be treated and cured in the community".
In its 2013 health plan, it stated: "All of AG Holley's patients have failed treatment in their communities or have been diagnosed as medically complex requiring specialised care and treatment."
Of the patients discharged last week, 18 were released into the care of their own doctors, supervised by their county health departments. The state health board said that declining cases of TB statewide, 753 in 2011, a 10% decrease on the previous year, justified the hospital's closure.
Opponents have demanded an investigation by Florida governor Rick Scott, saying that the hospital's closure was rushed and that the need for a purpose-built facility with rooms with individual air and water systems to combat virulent airborne diseases was greater than ever.
Maria Lorts Sachs, a state senator who represents Lantana and a vocal long-term supporter of the hospital, told the Guardian: "Who knows how the vote would have been impacted by knowledge of this outbreak?
"It's a serious thing when a major fact is withheld from us. There needs to be an inquiry into whoever kept this secret and there needs to be an inquiry into why there was such a rush to close the hospital. The governor should stop everything, stop the closure and have a review. This is a dangerous thing and we need to make sure our people are safe."
The CDC's investigation into the Jacksonville outbreak revealed that only 253 people from about 3,000 exposed to the infection in Duval County's homeless shelters, prisons and mental health clinics had been traced and tested.
Effective treatment often requires regular, long-term uses of drugs, which officials acknowledge is often difficult to administer. If medications are not taken regularly, strains of the disease can become drug-resistant.
Charles Griggs, spokesman for the Duval County health department, said: "Since the identified outbreak cluster is primarily concentrated within at-risk individuals in Jacksonville's homeless community, we are concentrating our efforts in the most impacted areas of need.
"We are also trying to guard against the further negative stigmatisation of an already challenged population. There is no evidence to suggest that the identified cluster outbreak has had a significant impact on the local general population.
"The closure of AG Holley has very little impact on our local outbreak. Over the past two years, DCHD has been engaged in active TB outreach screenings at various locations that service our local homeless community.
"No patient who requires the level of treatment and care associated with hospitalisation are housed at local motels. Only low-risk clients who may require directly observed therapy as treatment are potentially housed in motels."
[Sick man coughing via Shutterstock]