SC must get to bottom of tuberculosis fiasco

info@islandpacket.comJuly 28, 2013 

Protecting the public from the spread of infectious disease, particularly one that is growing increasingly resistant to treatment, should be a top priority for state health officials.

But the handling of a case involving a man infected with tuberculosis, who worked as a janitor in an Upstate elementary school, is a damaging indictment of the Department of Health and Environmental Control and its ability -- even its willingness -- to do its job.

The bottom line is that more than 100 people have tested positive for the disease, 53 of them schoolchildren. Two months passed before DHEC notified parents of the possible tuberculosis contamination.

DHEC staff members learned from the janitor's private doctor that he was infected March 8, but parents of children in the school where he worked weren't told about the threat until May 28, and the children weren't tested until May 31. The infected patient disregarded orders to stay home and it wasn't until June 6 that DHEC ordered him into quarantine.

DHEC director Catherine Templeton summed up the situation well and succinctly: "DHEC screwed this up."

Now Templeton needs to make sure something like this doesn't happen again.

The history of the case is full of confusion and conflicting information. Who knew what and when will take some sorting out, much of it likely to come in a courtroom.

Three nurses and the state's TB director have been fired for their handling of the case, and they, in turn, have sued DHEC. They claim they didn't get the help or guidance they needed from their supervisors and didn't have the authority to order the janitor into quarantine.

In its answer to the lawsuit, DHEC claims the nurses violated policies for dealing with TB patients and that the nurses never sought a quarantine order.

Templeton says the nurses should have acted -- or reported to her what was going on -- despite their supervisors' actions.

She told The (Columbia) State newspaper that she only learned about the case when she visited the Greenwood health clinic, came upon a TB nurse from another clinic there and started asking questions. She found out that an investigation didn't start until six days after the initial report, instead of 24 hours, and the clinic manager had the infected patient come to the clinic for his initial treatment, potentially exposing more people to the disease.

Templeton describes the fired nurses' claims that they had asked Columbia officials for permission to test children and inform the public as "not inaccurate." But she also says that she has repeatedly told DHEC employees that when they see something wrong they need to go around their managers and tell her.

That's an important message to people working for an agency long known for its culture of avoiding accountability, in large part due to its size and diverse responsibilities. But it still doesn't excuses supervisors' actions.

Templeton's candid assessment is welcome, but what comes next will tell us whether she can make a difference to the health and well-being of the people of South Carolina and restore their confidence in her agency's ability to do its job.

And Templeton must be willing to hold accountable people higher up in the chain of command at DHEC. One of her top appointments, Jamie Shuster, the agency's public health director, knew of the outbreak a month before she accompanied Templeton to that Greenwood clinic, The State reports.

DHEC spokesman Mark Plowden says that in April, tuberculosis staff members had not confirmed tuberculosis. He told The State newspaper when Templeton and Shuster learned of "persistent problems" in May, they intervened in the investigation to speed things up. But he didn't address an April 17 email from one of the ousted nurses that stated eight people had tested positive.

Sorting this out shouldn't be left solely to DHEC. The Senate Medical Affairs Committee is to hold a hearing Aug. 8 on how the agency responded to the tuberculosis outbreak in Greenwood County.

Templeton's candor should continue, and senators should get answers to their questions. The public deserves no less.

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