I'm going to defend the poor guy who flew on a commercial airliner against CDC advice. The one now in the National Jewish Hospital in Denver being treated for XDR-TB. Someone has to, so it might as well be me. He made a big mistake and the consequences are catastrophic for him and his family. Unlike lots of catastrophic mistakes, however, probably few others will be hurt by it. That's for another post. If it was a big mistake, why defend him?
I'll blame it on my mother. Like all mothers, she tried to teach me a lot of stuff, some of which was pretty useless or wrong, some of which was nice but I didn't pay attention to, and some of which helped form my view of life. In the latter category were two ideas I have tried to live up to (although not always successfully). One was to always try to do the Right Thing. The other was, "put yourself in the other guy's shoes." The first is a good principle to live by, although it's not always possible to know what the Right Thing is, and even if you know, it can be pretty hard to do sometimes. The other developed into a habit and has stood me in good stead throughout my life. It's probably responsible for Mrs. R.'s observation that I am very opinionated but not very judgmental person. So you are getting my opinion here (which I know many disagree with). What you won't get is my condemnation of him. I'm just not judgmental enough for that. Here's why.
Some of the facts -- or at least a version of the facts -- are now emerging. We speculated here (mainly in the comments of our previous posts, here and here) about the likely scenario and now we are finding out we were right on target. The individual involved made a grave error in making his way home against explicit advice to the contrary. But the facts surrounding the episode make his behavior more understandable. At least from his side of the story. Here is some of what he said yesterday in a TV interview:
In an interview with ABC's "Good Morning America," Andrew Speaker, 31, said his father asked health officials whether Speaker was a risk to anyone, and health officials said he was not. "My dad taped it," he said.
Fulton County, Georgia, health officials have said they told Speaker before his trip not to fly.
Speaker said that once he was in Italy, officials with the Centers for Disease Control and Prevention in Atlanta informed him that his case was more serious than they had realized.
He had been diagnosed with multiple drug-resistant tuberculosis. But, he was told, final test results found he had an even more rare, extensively drug-resistant form, known as XDR-TB.
Officials told him him not to take commercial aircraft home, he said on "Good Morning America."
"I said, 'What changed?" Speaker related. "When I left I was told I wasn't a threat to anyone. When I left I was told I wasn't contagious, what changed? Why are you abandoning me like this and expecting me to turn myself over for an indefinite time. What has changed?' And they did not have an answer for that."
[snip]
Speaker said he had been told before the beginning of his trip [NB: I am unsure of the sequence here; does this mean his trip to Europe or his trip home? Given the chronology of information about the XDR diagnosis, presumably it means the trip home]-- which included his wedding -- that in order to fight his illness, "I had one shot, and that was going to be in Denver," at the National Jewish Medical and Research Center, which specializes in treating drug-resistant forms of TB. If he was somewhere else and was not given the exact right mixture of drugs, he said, "That was it, they blew my last shot."
Speaker said officials wanted him to check into a treatment center in Rome indefinitely. But he feared that if he did, he might not make it to Denver. "It is a very real threat that I could have died" in Italy, he said. (CNN)
According to him -- and he says he has it on tape -- he was told he wasn't a risk to anyone before he left. By all accounts this was, and probably still is, true (I will review the evidence in another post). He had no cough or fever or other symptoms (i.e., he has latent, not active TB at this time) and his sputum had no visible tubercle bacilli under the microscope. In other words, he is like 95% of people infected with this bug, not sick. Most are also not infectious. The diagnosis that he was potentially infectious must have come from culturing the sputum for the TB organism, which grows very slowly. It can take months, sometimes. Again, when it grew they probably tested it against the usual drugs and found it was resistant to the first line ones. At that point they likely started the culture growing again against the second line drugs. That takes more time, and he was in Europe before it was discovered it was resistant to those as well, i.e., that he had XDR-TB.
It's at this point things start to unravel. Like most people infected with TB he isn't sick, but the TB can start up and cause active illness at any time. And active TB with XDR strains has a fairly high mortality, not because it is more virulent (it isn't), or more infectious (it isn't) but because TB is not a good disease and it can kill you. We don't fear it now in the US because we have drugs for it. Except, of course, if it is XDR.
So as I imagine the circumstance, here's a guy whose life suddenly turns in an instant. He gets a message from CDC he now has a life changing disease and his only shot at cure is in a hospital in Denver. But he is told he has to report to Italian authorities and stay in an Italian hospital for an undetermined, possibly indefinite, length of time, during which they may irreparably damage the chance of successful treatment by using an improper drug regimen. So he panics and heads for home. It is important to note this guy was not a fugitive. He wasn't running from anything. He was running to something (home, family and his chance to be cured). As soon as he reached US soil he turned himself in.
I'm sure we'll find out more as the story unfolds further. But I can't find it in myself to pile on. I don't know what I'd do in his shoes. Maybe you know yourself better.
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He said he knew the first line drugs didn't work. He knew the second line drugs didn't work
They had stopped treatment because drugs didn't work.
http://www.ajc.com/health/content/health/stories/2007/05/29/0530meshtb…
..."stopped treatment. The man said he and his private doctor with the agreement of government health officials made plans for him to undergo cutting-edge treatment"...
What did he think that meant? He had XDR-TB.
The health dept told he they "preferred he not travel" -
so?- they had to cover themselves; because
there was still some risk he could infect someone.
They just lacked the legal authority to say, "this minute we can force you to stay put, Mr.Lawyer with CDC connections who has big plans two days from now."
I'd like to see some dates and proof of when they "tried" to "hand-deliver" a "directive". It only said when the paper was dated, not which day they tried, failed to find him, and seemed to fail to put out an apb.
..."Katkowsky said after that conversation," (where he said, he'd travel anyway) "the department attempted to hand-deliver a medical directive, dated May 11, to the man telling him not to travel, but his home address was vacant and he was not at his place of business"...
Then what happened? Did they call the airports? Alert internationals? What?
His selfish, "entitlement" attitude lost him sympathy from day one of this story;
are there courtroom acting lessons in law school?
crfullmoon: Have you ever gone to work sick? Or sent a child to school sick? Or not gotten your flu shot one year? All those acts endanger other people and for far less cost avoidance than this guy's flight home. You are arguing that the facts show he knew he had XDR before he left home. I don't think that's the case, but we'll see as the story unfolds.
In my own practice, I will note that most patients, if not all, upon learning of a new and life-impacting diagnosis, go through stages of taking in the fact that they have a major problem, then they move through stages of adapting to and living with the problem. There is no "perfect" patient, "perfect diagnostician nor any "perfect" diagnosis. All patients deomnstrate varying degrees of compliance based on an infinite number of variables: their knowledge, their family role, their work role, their social status, their ability to obtain health services, their socioeconomic status, their desire to remain independent, their risk tolerance, their risk aversion, their psychological make-up, their education, their perceived value of health advice, etc. The public health folks can address the variables much more intelligently than I can do so here.
But to finally get to my point: there is no magic formula for a patient to receive a diagnosis and become instantly proficient at managing the disease, illness or disability.
I come away with the impression that this fellow, very well-educated and motivated to obtain treatment, was in dome denial about the severity of the illness primarily because he repeatedly asserts that he didn't feel sick, didn't look sick and didn't have symptoms.
That's pretty much the reason that people who are non-compliant with taking full courses of antibiotics give for stopping the drugs. It squares with why people don't take anti-hypertensive medications as prescribed, nor follow a therapeutic diet and prescribed activity.
My guess is that he experienced a disconnect between an intellectual understanding of the disease and the real risks of exposure because of the information he knew that his sputum had produced no TB bacilli, he wasn't symptomatic, and he couldn't relate that to transmission risk.
To finish, let me just add that we all transmit viruses and bacteria to varying degrees. And we all break compliance with reduction of transmission each and every time we don't thoroughly wash our hands between human to human contact (hand shaking at a wedding counts here, as well as party handshakes), we travel and go to work when sneezing, coughing and exhibiting respiratory symptoms, and we don't disinfect all surfaces before and after contact (telephones, keyboards, computer mice, earbuds, mic mouthpieces, coffee cups, etc).
Realistically, many people have undiagnosed, untreated and undetected communicable diseases, and we are all exposed and expose others to varying degrees.
Last year in Boston, a worker from India brought with him the gift of measles. It struck a number of people working on the same floor, and it caused concern to the public health folks in that just a mile down the road, the headquarters of the Christian Scientists is located and that the majority of workers there do not believe and do not receive preventive vaccinations. There was concern about measles taking hold in this population. But the surveillance, prevention and risk aversion techniques worked, and there was only a small increase in measles cases. I don't think that it migrated away from the immediate work place.
There again, the worker was in the prodromal stage and was asymptomatic when he flew.
There ought to be a law.... but it sounds like there isn't one. He did something the rest of society deems stupid and endangering, but unless we decide to have some strong law against not following the advice of doctors, we're going to have to expect people to do things like this.
It's starting to sound as if this guy knew what was going on, honestly considered his options, and made some bad decisions. It wasn't reckless as much as it was ignorant, perhaps misinformed, and a bit selfish.
The thing that really gets me, though, is why he wouldn't have consulted with his own father-in-law, who studies the damn thing that he had. Perhaps he did; I don't know. Regardless, if he were as contemplative as he's making himself out to have been, he would have contacted his father-in-law and sought advice from him, which hopefully was the correct advice. If this actually did happen, and his father-in-law told him to go ahead with the travels, then they certainly are both to blame, the father-in-law perhaps even more so. Sure, he's not a medical doctor, but he probably knows more about it than most medical doctors in the first place.
bdf: I'm guessing he did ask his father in law, who knows more about this bug, presumably, than anyone else dealing with the case. The problem with the father in law is that he has a personal conflict of interest. Does he tell his daughter's husband, stay in Italy and take a chance it will be a long time before you can get to Denver? Or something else, like, you are not infectious, are very unlikely to put anyone at risk and you are much better off at home (all of which is true, scientifically, but not necessarily along other dimensions). So it may be that the father in law is more of a problem than a resource here. Now I am a father in law with technical knowledge and if I put myself in his place, I think I'd tell him to get home. How he got home is the problem. At this point we don't know what the options were. CDC refused him their plane but claims there was still some negotiation possible but he precipitously came home. I think we'll have to wait for more info.
N=1: I agree with your analysis here. It takes a slightly different perspective on it than mine, and I will admit that those who condemn his behavior also have a valid perspective. Perhaps the most relevant conclusion is that this is a more complicated problem than appears on the surface, and as you well point out, is not limited to this individual but appears in various ways throughout clinical practice.
If he was being treated for TB at the health department, was it INH for latent disease, or with antibiotics for active TB? I would think if they had diagnosed active TB initially, they would have known already that it was XDR through sputum samples. What prompted them to do a sputum culture at this point? Could latent TB have progressed despite the INH because the organism was XDR? And does a positive sputum culture always mean the TB is active?
Okay, I read in the last few minutes that Speaker had in fact talked with the father-in-law prior to flying home, and he had advised Speaker not to fly. If that's true, my placing the blame on the FIL is misplaced, and it seems that Speaker then did most definitely go against medical (scientific, whatever) advice.
N=1 & revere,
I respectfully disagree. He was FULLY aware of his actions and the understanding of what he faced, as evidenced by having his father/lawyer tape record (legally???) a conversation with the CDC.
Also remember this also wasn't some schmuck who gets a devastating medical bomb dropped on him about a life altering disease and has to struggle with understanding it by searching the internet for relevant articles filled with oversized and complicated words. His future father in law worked for the CDC and NOT as a janitor.
I also have trouble buying that Denver is the ONLY place where he has a chance of surviving. We have wonderful devices called telephones and fax machines that allow the transmittal of patient information that would ensure that he was given the exact right mixture of drugs.
His action were cold, calculating and selfish, selfish, selfish.
Gilmore
P.S. I have gone to work "a little under the weather" and have also skipped/forgotten about getting my yearly flu vaccination, but EVERYTIME the CDC calls and asks that I take the day off work Ive complied.
Though it is not popular,
some people are better off cancelling work rather than make people sick,
and keeping sick kids out of school even though school pressures to keep the daily head tally up for the wrong reasons.
Untreated TB requires the person to wear a mask - I suppose that makes people unpopular in public? -yet, they'd be doing the right thing, and safer to the public than the people who hide their problems. (Why does a politician seeking councelling after a family tragedy and getting flak for it come to mind? Politicians who wouldn't be caught dead in a shrink's office can be the scariest of all.)
It isn't popular, but, some people wouldn't want to risk giving drug-resistant TB (nor "regular" TB) to other people, and would wear an appropriate mask around others.
Who would want passing on something life-threatening to others on their conscience? This guy knew the second-line drugs failed; he was untreated, he went against medical advice, then, he knew tptb flagged his passport; he was a tort lawyer, right??
Anger, Denial, Bargaining, Acceptance.......This guy went through them all and in the nutshell that Revere describes above he left on an assumption that all was good, AMA! They didnt want him to travel, he did it anyway, AMA. He was contacted by the CDC and told to go to an Italian hospital, he didnt AMA! He traveled again, AMA! He talked his way across the border, AMA! Now he shows up and says he is sorry, but he felt his life was in danger. Sorry but when it looks and smells like bullshit, I dont call it fecal matter.
He could have checked in but was making assumptions that he wasnt infective enough to pose a risk. That lasted right up until the CDC told him flat not to do it. Revere you are probably the most compassionate guy I have ever had the pleasure to rag on, God love ya! But Jesus H. Christ he was told not to move and he did it anyway. It became a mission of deception in a foreign country and multiples of that just to get in here. Osama would have been proud of him.
Not many rabid dogs running around these days in the US because of vaccinations. Every now and then one gets loose and I dont judge them for who they were, I judge them for what they are now. We shoot them down South and on sight. Extreme? Yep, and the dog doesnt go on to infect anyone with rabies. Sometimes you have to do what is necessary to protect the public.
I pause and wonder Revere what would have happened if the guy was running as a bio-fugitive and had Ebola, Smallpox, or Plague if your response would be the same? If you saw him running and making contact with people on a concourse at an airport would you try to reason with him, or would you pop a cap into his butt?
For me its inexcusable and in previous posts you made the statement that the guy was a dry run for panflu. If so, this is just one guy and sure we try to do the right thing with the resources at hand, but there is always going to be an Andrew Speaker out there who doesnt think that the rules apply to them. Talk about standing in the world for the US. I guarantee you the phone has been SMOKIN' from Greece to Italy, to Czechoslovakia with the State Department. They are going to want us to PAY for the testing for all the people who turn a test positive for the next 10 years.
Should there been a detain if possible, shoot on sight? If society crumbles around us as a result of panflu or TB, then it goes the way of the gun anyway. For me Andrew Speaker is and was a walking time bomb. You can defuse it maybe but sometimes its just better to stand back and pop a shot into it to stop it from going off in an a less than controlled manner. Flamingly infective? Well from what I am told and where he is now, he is on the beaten path for the pine box. It goes highly infectious at the end stages...Correct? If thats not the case then why did he run. I cant speak for him. Maybe you could get an interview with him to post up.
Does it mean I would have shot him? Only if there was no other way and Speaker was a very determined bioweapon for all intents and purposes. If his name had been Mohammed or Osama I wonder if you would still carry the same view about mindset and how to treat his status.
I believe this guy is on his way out without a doubt and he bolted for the what he thought was his only chance. He quit communicating and he ran. I hope he wasnt communicable while he did.
Sounds like both sides are to blame.
Goverment did not do enough to convey the importance of staying put. The guy should not have pushed his right to travel.
If any time is the right time to be extra cautious, it's when a person is told they have an potentially infectious, deadly disease.
No way. You're told that you have Nasty Beasty X, which may become infectious at any time and kill a bunch of folk. You're told to get ye to a hospital. What kind of ass says screw you to basically the entire planet and runs for what might be a marginally better chance?
I tell you now, if I ever do that you CAN shoot me. You have my permission.
This is utterly selfish asshattery of the highest order.
(Maybe I'm missing something, but why did he think Denver was the alpha and the omega? I mean, whatever magic powers they have there, couldn't he get some in Deepest Darkest Italy? I hear they do have telephones in several non-US nations now days - if he was worried they'd screw up, couldn't he just call the homeland and get stuff explained to the Foreign Infidels in small words? Can anyone tell me why anyone would have told him that his only chance was Denver?
Do they have a jade monkey?)
I see nothing wrong with this gentleman's behavior at the time he left the country.
Once he was out of the country, and fully informed of the seriousness of his infection, he decided to fly back to the US because he was afraid he wouldn't get satisfactory treatment in Italy.
That means he knew how bad it was, and probably thought it was even worse than the actuality, since his life has never been considered to be in immediate danger. And he went back anyway, taking public flights and exposing dozens if not hundreds of people to the infection he was so worried about.
Yes, I can put myself in his shoes. I can empathize with his fear, his terror, and his loss of rational thought. I can understand why he said the things he did soon after returning - particularly how he didn't understand the fuss because he had cooperated completely, except with the "insane" demand that he not fly. And because of that, I would ask that the same thing be done to him as I would hope would be done to me if I were in his situation:
Shoot him.
1. From the first quote below, it sounds like TB Man was planning to go to Denver before he got the XDR-TB diagnosis.
and
2. There is no evidence -- yet -- that Fulton County was emphasizing his risk to others when they advised him not to travel.
I will add a link that documents the sentences in quotes below later. For now:
A television station in Atlanta, the Fox affiliate, got a redacted copy of the letter Fulton County said it tried to deliver to Andrew Speaker. The tv station did not read or post the entire letter, but here are the two sentences they read:
"As a precaution it is strongly recommended that you postpone your travel and see a specialist in Denver Colorado."
"It imperative that you are aware that you are traveling against medical advice."
There was NOTHING in the part of the letter they read which mentioned him being a risk to others.
Awaiting the full text of that letter. And hoping the father will release the tape he says he has.
Is there any information about how he contracted this strain of TB?
labclick: No info available to me. It is only said he did a lot of international travel in areas where TB is endemic (which is most of the world).
It was sheer luck he was diagnosed in the first place. If I recall, they saw something on X-rays when he was treated for rib injury. Most people (95%) infected with TB who do not have symptoms are not diagnosed until the TB has gone latent,so in that very short window where they may be slightly infectious, they are doing whatever.
What percentage of these have XDR TB is not known. But to worry about the potential health risk of one healthy individual who was not sick or very infectious, if infectious at all is puzzling, when HIV infected individuals and homeless/substance abuse individuals, or illegal immigrants with TB are on the streets because no one wants them in isolation for weeks since they don't have health insurance.
My understanding is he had negative sputum test results. Perhaps he had a bronchoscopy which was then cultured. This is not usually done except when an individual is highly suspected of having TB.
If he is having treatment and it is latent,it is probably preventive in nature. Since it is XDR TB,I am not sure what that treatment might be. In the first 1-2 years of being infected, there is risk of it going on to active infection, but 90-95% of those with TB never go on to have active disease once it is latent.
Not sure if this guys insurance covered him abroad. If not, the cost of being isolated in Italy would have been horrendous, not to mention the cost for his family to be in Italy with him.
The idea that some feel he should not have been allowed entry back into the country by car is curious.
I suspect there is something more to this story than is being told.Perhaps we are trying to get more cooperation from other countries on sharing information about passengers health,or we are making this guy into an example to justify more extensive use of government mandated quarantine/isolation going forward.
Paul-This is the guy you DO pay taxes for in public healthcare. He has a totally incurable disease and he is trapped in a foreign land. As stated before the USAF maintains a group along with the army at Ft. Detrick MD that would go and collect him
-OR-
As I said he could have called Glaxo or Sanofi, and they would have wheeled out their little quarantine buggies that you probably have never seen and gone and grabbed him. Good riddance would have been the attitude of the countries he passed thru.
I will say this and its more in defense of Revere rather than Andrew Speaker. I want him standing their as my doc if I should ever turn up with this stuff. I will know that he has expended every dollar, every effort to ensure that I got the best care even though I am a conservative. We have all worked him over a bit in disagreement, but folks wouldnt you rather have it his way if you turned up with this shit?
Attaboy Revere. Patron Saint of lost causes?
> Denver
Here's why (stolen from this informative thread): http://www.democraticunderground.com/discuss/duboard.php?az=view_all&ad…
---------- excerpt--------
Kudos to the CDC. Watching Dr. Cetron's media update on the treatment/response to XMDR TB patient. An articulate, open update describing the CDC response ....
.... he's flying to Denver for treatment at the National Jewish Hospital which was once a TB sanitorium.
.... they do a specialized operation to remove infected portion of the lung to maximize effectiveness of antibiotic treatment(s).
.... A lobectomy....
Jody Lanard, you make the point I've been wondering about: was he made fully aware that the reason they "preferred he not travel" was the possibility of transmission? I'm not going to argue that he made a reasonable decision; clearly, he didn't. But it's a decision I could see myself making if I thought that I was being advised not to travel because of potentially harmful effects to my own health.
I had friends who recently postponed their trip to Europe for a month, because a few days before they'd planned to leave, she had tripped and hit her head, sustaining a mild concussion. Hence the advice against travel. It had nothing to do with danger to others, but I can kind of imagine that if instead of being a middle-aged pair going to Europe as they do at least once a year, they'd been a young couple going off to get married (caterers, guests, reservations, disappointment, blah blah blah - all irrelevant when you consider infecting others, but still) they might have gone anyway.
It's a terrible situation, but at this point, I'm not inclined to demonize the man. The fact that he's a lawyer makes it a little easier to pile on, doesn't it?
Revere. Patron Saint. Yes
I may disagree, but I hold you in the highest esteem for sticking your chin out for repeated thumping by stating your unpopular opinion and for having the compassion to forgive this man.
His parents say he was told by CDC to hire a private jet, but they could not have EASILY afforded the expense. . . Hmm
gilmore: The expense was said to be $100,000.
How stupid can he play; to not know DR-TB was a threat to others? (It is not his lawyer status, but his entitlement attitude; rules don't apply to him, and, trying to pull one over on everyone for selfish reasons; reckless, when he had something with such life-impacting consequences if others caught it.)
He knew legally they couldn't lock him up in the doctor's office, at the time they said they wanted him to avoid commercial flights, when he taped conversations and said he wouldn't cancel his travel plans.
Moved his departure date up two days so they wouldn't be able to hand him in writing medical advice not to fly. Sounds criminal to me. Left Rome, too.
Now he's crying crocodile tears for the camera?
Suddenly understands DR-TB/XDR-TB is deadly - for him ?
At least if the public wakes up and sees "biosecurity", (China's imports & our FDA also come to mind) pandemic preparedness and homeland security have just been going through the motions, and the people getting paid to write the plans, or look busy, have benefitted more than the public has, something may come of this.
Surely the bozo was insured and this is where the military comes into play. There are regulations covering this and especially where they want the guy out. If we can go to Grenada to pick up yuppie med students who are in danger, we can go to Greece or Italy. He would have had to sign a waiver and they would have sent him to a treatment facility, but get him they would have.
Dumbass yes, and there is no corner on that market. He got scared, he quit communicating and faced with possible lockdown, he bolted. He followed no medical protocols post of the notification and for THAT he needs his ass kicked.
Revere knows probably what the outcome is for this kid and I get the big picture. Dead man walking in all likelyhood (50% mortality inside of 5 years) likely dead in 2 years. Its not his fault he got it, it is that he bolted and possibly infected a bunch of people and created a diplomatic incident. We can and will be compassionate for the one, if its BF we likely will not.
CRF-Everything that can be done for preparedness IMO with the resources available for BF are being done. Resources in this case is money. Any state that doesnt prepare is going to take it right on the chin if high CFR flu comes to be. Its looking more and more like it will each day. I cant fault anyone for whats not being done. Its the system and it sucks and it might not ever happen. I wouldnt stake my life on it right now though.
I was wondering what the tab for a private Rome - Denver flight would have been. . . $100K, huh. . . How much will be spent on tracking down and testing those he exposed? Lets not forget the cost of all the Zanex those folks will be gobbling as they "anxiously" (weeks\months) await what will most very likely be a negative test result.
He's a lawyer, his Dad's a lawyer, father in law has 25 years in at CDC. Their wedding was in Greece, the honeymoon in Rome. Perhaps they couldn't have easily afforded the expense, but they seem to be able to toss the cash around when they want to.
If they can "spin" their way into the wholesome, misunderstood and taken advantage family that I'm sure they must be I see a future work prospects at Fox networks or the Bush Admin.
We all must make decisions in our life. Do we think solely of ourself or do we put others before ourselves and think of the greater good? I'd rather be in a foxhole with Revere, crfullmoon and M. Randolph Kruger than any of that clan.
Pass me an MRE,
Gilmore
The Atlanta Journal Constitution released the full text (minus the redacted text) of the May 11 Fulton County Health Department letter to Andrew Speaker. (See my note above from June 2) Here it is, from: http://tinyurl.com/33j9n9. In the history of warnings, this would score rather low on clarity about potential risk to others, I think. Analyse it and weep.
May 11, 2007
(Redacted)
Dear Mr. (Redacted)
This letter shall serve as follow up to Dr. Eric Benning's meeting with you on May 10, 2007. (two lines redacted)
The Fulton County Department of Health and Wellness (redacted) has been notified that you are planning to travel to Greece on May 14, 2007. As a precaution it is strongly recommended that you postpone your travel and see a (redacted) specialist in Denver, Colorado. In the event you do not comply with this recommendation the Fulton County Department of Health and Wellness (redacted) cannot be responsible for the exposure of this (redacted) to the public. It is imperative that you are aware that you are traveling against medical advice (AMA).
Sincerely,
Aliya Yamin, M.D.
(redacted)
AY/sec
Cc: (redacted)
Dr. Steven Katkowsky - Director, Fulton County Department of Health and Wellness Dr. Eric Benning - Medical Director, (redacted)
I guess I am of the mindset that the damage if its there is done. He is here and supposedly was cognizant at the time of the damage. We dont generally kick people when they are down. We give them a subsidy instead. So, cracking aside what do we have here?
The letter above from Jody Lanard is the old governmental two step. They should have taken him into custody and the guy likely knew he was dead if he went, dead if he came back. So what would they have done to him? Locked him up as Revere said. Yep, Typhoid Mary.
So we are railing against this moron who violated very common sense and WITHOUT QUESTION the law. The letter he received above clearly shows that. Should he be indicted? They do it for anyone who has AIDS/HIV and decides they want to jump bones with someone unprotected. If they develop it, then its considered to be attempted murder in every state now. If someone can trace him back as index then he is without a doubt a felon if they get it.
Question is should they indict him? Moral or legal dilemma.
He's a lawyer with a preexiting (entitlement) condition:
he moved his departure date up two days
so they couldn't hand him papers-
and the doctors/CDC can't convince me they couldn't call the airports or alert the police and find this guy.
They knew where he was going; can't be that everyone who looked at his passport would have let him through, if action had been taken in a timely manner, after hours, weekend, or not. Big CDC employee wingding abroad or not. Fiasco, and waste of money.
As I understand it, he took active steps (flying to Canada and driving over the border) to avoid having been put on the No-Fly list. I don't see how to square that with a generous interpretation of his knowledge and state of mind at the time.
He understood he might be prevented from returning to the US. Regarding the border, it didn't make any sense to stop him there. He was on his way to turn himself in to public health authorities in New York. He was not a fugitive. He was trying to turn himself in so he could go for treatment (part of the plan even before he left, as he told Fulton County Health Dept.).
What I'd like to know, and haven't seen addressed in the media, is how this guy was exposed to the TB in the first place. Through his father-in-law?
Jess: It's not known (which is not unusual). CDC said early on that neither his father in law nor his wife are infected and that the strain is different than the ones worked on by CDC. That's all we know about that. The patient has been reported to have done a lot of international travel in the last 6 years in countries where TB is endemic. The only one I saw mentioned explicitly was Vietnam. It's likely we'll never know the answer to the question.
Everybody seems to have a stake in their own version of the truth. The guy was getting married - that alone would cloud his judgement. And according to AP video, he says he was specifically told he was not contagious.
From the Associated Press, June 7, in the Washington Post, at: http://tinyurl.com/2go9cj
>In the [May 10] tape recording _ made by Speaker's father, Ted, also a lawyer _ the patient asks about the hospital's accommodations.
>"Now, that I don't know," says Dr. Eric Benning, medical director of the Fulton County health department. "But because of the fact that you actually are not contagious, there's no reason for you to be sequestered."
>At another point on the tape, Benning says: "As far as we can tell, you are not a threat to anybody right now." [end of excerpt from AP article]
[Please note: In Georgia, it is legal for one party to a conversation to audiotape it without informing others.]
So what did Fulton County "advise?" They didn't tell Speaker that traveling was a threat to HIS health. They DID tell him he was "not contagious," and "not a threat to anybody right now."
They NEGLECTED to tell him that if he violated their medical advice, THEN they would try to have him restrained by law and/or force.
What, exactly, is the MEDICAL advice they gave him? Not to travel. Why? No particular reason. But they were clear that they would not be responsible for it if he did.
But they will be, after all. They had a patient with active TB, and they forgot to advise him to be on "voluntary" home isolation, under which conditions they could have monitored his "compliance," and taken the usual administrative and legal steps if he didn't comply.
Here is an excerpt from the State of Georgia's TB control instructions, at: http://tinyurl.com/ysnctl
"Infection control and isolation measures
"Persons suspected to have tuberculosis should be isolated from others while infectious (contagious). Infectiousness declines rapidly after a person starts on TB medication.
...
"Many patients are not sick enough to require hospitalization and are placed on home isolation. This means the person must stay in his/her home except for medical visits. During necessary medical visits outside the home, the patient must wear a surgical mask the entire time. There should be no visitors to the home during this time until the patient is classified as no longer infectious. Healthcare workers who come to the home must wear an N95 mask."
Now, who was acting against "medical advice"? Not Andrew Speaker. Looks like Fulton County, to me. And no one would ever have believed it if Papa Speaker hadn't taped the meeting. The officials all wanted to hang Speaker out to dry.
Who did Dr. Benning tell, and when (and what) did he tell them, about the "advice" he gave Speaker at the May 10 meeting? That would be worth a Hearing.
"If we can go to Grenada to pick up yuppie med students who are in danger, we can go to Greece or Italy. He would have had to sign a waiver and they would have sent him to a treatment facility, but get him they would have."
Yeah, maybe he could have caught a flight on the "extraordinary rendition" jet on the way back.
The Head of the CDC's explanation why they didn't fly him back on their jet was particularly wea, I thought: she said the jet only had one HVAC system, so the pilots, crew would be exposed.
1. Why doesn't the frickin' CDC jet have a separate containment area? Jeez, of all the gubmint agencies, except maybe USAMRIID, they're the most likely to be dealing with people infected with Bad Shit We Don't Want To Get Out.
2. Why couldn't they give the guy PPE like a half face respirator during the flight? Or somesuch jerry-rigged containment? Jeez.
Sock Puppet----Yeah, Duh! The Ft. Detrick boys have all of this including a really nice little C-130/C-5A package that rolls right in there. Looks like one of the mobile command post jobberdo's. I am sure that if Speaker had asked for it he would have received one and he could have climbed onto Air Force One as far as I am concerned.... But thats just me.
But the CDC did tell him to stay put in Rome apparently.... Thats where I developed the rub with this. Its all in the semantics up until that point and thats where the bio-terrorism began in the eyes of the CDC. Speaker knew exactly what he was doing. CDC had no jurisdiction except to put him on the no fly list. Speaker could have called the CDC hotline or the local health department and he would have gotten in just fine as he hit our border, but he didnt. Look, I am not sleighting him for the deal just that if you have something like this regardless of whether you are getting married or not, you dont go flopping all around Europe. Common sense. If anyone turns up with XDR from any flight for the next five years he can kiss his life savings goodbye. Liability lawyers and all. In a lawsuit you are guilty until you prove yourself innocent.
This sight sucks its to long