Florida Department of Health aims to cut Tuberculosis rates in half

Jul 30, 2012

The following article was published in The Florida Current on July 30, 2012:

Department of Health Aims to Cut TB Rates in Half

By James Call


Florida has a new plan to cut the state tuberculosis rate in half by 2020.  Monday, Surgeon General John Armstrong convened a conference call to announce the release of the “Florida Tuberculosis System of Care,” a 16-page report.

“This is a modification and update of what occurred before in our state done in a way to ensure clarity across every element of our Florida Department of Health, our county health departments,” said Armstrong, who is also the DOH Secretary.

The new plan creates three tiers of care depending on the severity of the case. The first tier, covering about 90 percent of cases, would be handled by the county health departments. Eight regional networks would be set up for patients needing the second tier of coverage. The most complex cases would be handled by a third tier that includes contracted hospitals. All tiers would be responsible for sending patients to alternative care settings if they lack the ability to stay in their home or follow a schedule for medication.

Armstrong said the plan was developed in response to the closing of the A.G. Holley State Hospital in Lantana and not to the criticism DOH received for a lack of information concerning a recent TB outbreak in Jacksonville. An April report by the Centers for Disease Control called it among the worst in the past 20 years. It was issued after the Florida Legislature voted to close A.G. Holley, which prompted numerous lawmakers to complain that they knew nothing about the Jacksonville outbreak.  

TB is a potentially fatal infectious lung disease. The bacterium that causes it spreads through the air when an infected person coughs and sneezes. A person with an uncomplicated case will take dozens of pills a day for six months or more. Failure to take the medication for the prescribed time period may cause the infection to become drug resistant.

“Most patients are treated in their homes and for patients who do not have a home we are trying to give the next best thing,” said David Ashkin, a TB expert and physician who helped DOH develop the plan.

“It could be single-room occupancy; it could be a boardinghouse. It could be a place where people are housed for long periods of time. The most important thing is keeping them on meds. If that is the way to protect the community, then house them until we are sure they will be no risk in a congregated setting,” Ashkin said.

Protests erupted when it was discovered this year that the state was housing TB patients in Jacksonville-area motels.  Armstrong said motels will no longer be used but the department’s use of the term “alternative care settings” raises concerns of one lawmaker.

Rep. Mark  Pafford,  D-West Palm Beach, said it sounds like the department is suggesting a “sober house,”  or a halfway house as an appropriate place to house TB patients needing to follow a prescription-drug schedule.

“Why would you want to put another layer of responsibility on the least regulated industry in the state?” Pafford said.

“This sounds like policy being made outside of session.  This is policy-making from a passenger seat and the Legislature is getting away without having to make an important policy decision.” 

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