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BMJ. 2007 June 16; 334(7606): 1242.
PMCID: PMC1892504

Congressional hearings highlight mistakes in case of tuberculosis patient

Two hearings last week at the US Congress investigated failures in the case of Andrew Speaker, the 31 year old lawyer from Atlanta who flew to France, Greece, Italy, the Czech Republic, and Canada after being told that he had drug resistant tuberculosis and should not travel on commercial airlines (BMJ 2007;334:1187, 9 Jun, doi: 10.1136/bmj.39237.452269.DB).

Health agencies could not prevent him flying, could not locate him on international flights, and were slow to place him on a “no fly” list. The agencies were tardy in notifying the World Health Organization, European countries, and Canada, the hearings found, and a border agent disregarded instructions to stop him.

Congressional representatives called Mr Speaker “a walking biological weapon” and said that if the incident had involved someone with smallpox it could have been disastrous.

Julie Gerberding, director of the Centers for Disease Control and Prevention (CDC), said that public health authorities rely on the voluntary cooperation of patients with tuberculosis. The vast majority of patients provide that, she said. In retrospect, the way Mr Speaker's case was handled was a mistake, she said.

The hearings were held by the Senate Appropriations Committee's subcommittee on labour, health and human services, education, and related agencies and by the House of Representatives' Homeland Security Committee.

Mr Speaker testified by telephone from the National Jewish Medical and Research Center in Denver. He said that he had been told he was not contagious and that no one forbade him flying. “I didn't go running off or hide from people. It's a complete fallacy, and it's a lie,” he said.

The New York Times reported a telephone interview with Mr Speaker (www.nytimes.com, 9 Jun, “TB Patient Says Officials Are Trying to Blame Him to Cover Mistakes”). “He accused health officials of trying to destroy his credibility in order to cover their own mistakes,” the article said. “Officials had never told him that he was infectious. They themselves never wore masks around him . . . and never told him that he posed any risk to his wife or daughter.”

Mr Speaker's tuberculosis was detected in January after he underwent radiography for a rib injury. On 10 May his local health department in Fulton County, Georgia, learnt that he had multidrug resistant tuberculosis and advised him not to travel to Europe for his honeymoon.

The department could not forbid him travelling and could act only if he violated an order.

Mr Speaker had planned to travel on 14 May, but on 12 May he flew on a different airline to Paris and then to Greece and Rome.

On 12 May, after he had left the United States, the county health department tried to serve him with a written notice advising him not to travel.

Dr Gerberding testified that on 18 May the Department of Homeland Security and the CDC began trying to locate him. However, the airline tracking system couldn't find anyone who had cancelled their original reservations and made entirely new ones. Nor could the system track a wanted person who was flying outside the United States, as Mr Speaker and his wife did.

On 22 May the agencies learnt that he had extensively drug resistant tuberculosis. On 23 May Mr Speaker was contacted in Rome and told to go to an Italian hospital and not to fly except on an expensive private jet. The CDC's airplane was not equipped to provide respiratory isolation.

On 24 May Mr Speaker and his wife flew to Prague and then to Montreal. They drove to the United States that evening and were admitted by a border guard who ignored a computerised alert.

On the same day the agencies asked the US Transportation Security Administration to put Mr Speaker on a “no fly” list. Lawyers discussed for several hours whether the administration could do this, as the list is for potential terrorists. They finally added his name to an “adjunct” list, shortly after he had driven into the United States.

On 25 May the agencies notified WHO.

Notes

Testimony given at the House of Representatives' Homeland Security Committee hearing is at http://hsc.house.gov/hearings/index.asp?ID=56. A webcast of the hearing of the Senate Appropriations Committee's subcommittee on labour, health and human services, education and related agencies is available at http://appropriations.senate.gov/labor.cfm (under “Subcommittee News”).


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