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My Turn
Other Views from Those in the Know
Marc J. Yacht, M.D.
former president, Florida Association of County Health Officials
State's Defense Rings Hollow in Closing A.G. Holley

The Florida Department of Health’s defense of its decision to close the state’s only tuberculosis hospital rings hollow in light of 13 dead and 99 ill. The risk for more cases remains. 

The Centers for Disease Control views the current outbreak as the nation’s worst tuberculosis outbreak in 20 years -- in a state with a history of problematic TB. It is difficult to justify how this was not considered a public health crisis, with little information being released to lawmakers or the general public.

On March 23, a number of retired health department executives and health-related association officials pleaded in a formal letter to Gov. Rick Scott that he veto HB 1263, which would close  A.G. Holley State Hospital and further cut state health department programs. Prior to sending the letter, multiple efforts were made to dissuade legislators from passing this bill, but the effort fell on deaf ears. 

None of the signatories, including myself, knew about the major developing outbreak in Jacksonville.  We declared that the closing of A.G. Holley created an unacceptable community health risk due to the nature of the patients housed at the facility. Homeless people, due to their lack of insurance and transience, are the typical patient.

“A.G. Holley cares for persons with TB who are a substantial threat to public health,” we said in the letter. “They either have dangerous forms of multiple drug resistant TB or are ordered by the court to be treated until they are cured because they are not compliant with taking medication.”

When this recommendation was offered, it was expected the hospital would stay open until January 1, 2013.  The response was to push up its closure by six months -- to July 1, about two weeks ago.  

Two years ago, an effort to build a smaller, more efficient facility did not materialize. Now, the hospital’s early closing has left questionable alternatives to the placement of patients. 

The governor indicated the private sector could treat the patients, but the response so far has been unenthusiastic. For example, Jackson Memorial Hospital in Miami accepted eight or nine patients on a temporary basis, when the governor’s office claimed it would take 16. As far as we know, Jackson has indicated it will take one patient from the Jacksonville outbreak.

In its determination to close Florida’s only TB hospital, there was inadequate regard to accommodating patients. With the forced exodus of qualified health department staff, one has to wonder what advice the governor received about releasing 25 patients into the community with their potential difficulties.  The private sector understood it and wanted little to do with the governor’s initiative.

Florida TB case numbers may be down, but we can anticipate at least 750 new cases this year.  With the unexpected Jacksonville outbreak, those numbers may be higher. 

The seriousness of an outbreak among the homeless cannot be minimized. Transients can be easily lost to follow-up if they don’t cooperate with treatment. Many of these patients have alcohol, drug, nutrition and mental health problems. They pose risks to the community when in hotels, motels, under bridges, or in the woods. A.G. Holley assured adequate treatment, as well as other critically needed services.

Our letter addressed much more than A.G. Holley. It also addressed the weakening of women’s health programs, the repeal of programs focused on healthy lifestyles, and the undermined authority and resources for health services to low-income communities.  

As one example, the Division of Environmental Health has been eliminated.  Programs in this division regulated septic tanks, drinking water, as well as responses to rabies, West Nile Virus and other public-health threats. Health workforce-training programs and recruitment statutes were repealed, further fragmenting Florida’s weakened public-health initiatives. 

Along with a purge in the state’s public-health leadership, 12,000 jobs were lost. I would describe the health department now as weakened and politicized, lacking the professional skills necessary to adequately protect Florida citizens from public-health threats. The TB outbreak is one example. There will be others.

Gov. Scott should reopen A.G. Holley and continue the effort to build a new and smaller facility. Every effort must be made to ensure that the professional staff of DOH consists of qualified, knowledgeable and experienced professionals. The legislature should begin formulating a bill to strengthen Florida’s public health system. Many of us would be happy to assist. 

The TB outbreak is a warning and a serious one.  The governor should heed that warning. His spokespersons have defended the indefensible.

Marc J. Yacht, M.D., is a former president of the Florida Association of County Health Officials.

by Dr. Radut.