Doctors Criticize Care At District's TB Bureau

Patients share such frustrations. Darius Hawkins, 41, of Southeast Washington, was referred to the bureau for a chest X-ray after a TB skin test was positive this year. "I called before I went, but when I went there they were closed," he said. "The sign said they wasn't open that day. I was very frustrated."

Floyd Simpkins, 73, a retired mover from Northwest Washington, said he went to the bureau for a screening several months ago. "I never did get in," he said. "They stopped us right at the door and said they didn't do X-rays anymore." Both were later found not to have active tuberculosis.

Janelle Goetcheus, medical director of more than a dozen charity clinics in the city run by Unity Health Care, said the federal inaction is unconscionable. "CDC has always been aware of inadequacies of TB control in the District, and they've never moved," Goetcheus said. "They know how bad it is."

The city has no place to house homeless TB patients for "directly observed therapy," in which a worker watches to make sure a patient swallows antibiotics every day. The therapy lasts more than six months, and patients who interrupt treatment are more likely to suffer a serious relapse and to spread drug-resistant strains of TB, experts say.

Goetcheus and others are particularly upset about one HIV-positive woman with multidrug-resistant TB who has chronically neglected to take her four drugs a day. She was missing for a week in June, Goetcheus said.

In the past year, the woman has been hospitalized for several 30-day stays in an isolation room at George Washington University Hospital at a cost of about $250,000 to her Medicaid health maintenance organization, Health Right. But the woman did not always stay in her room and walked the halls or stood in front of the hospital without a surgical mask, according to Goetcheus and others familiar with the case.

Last month the woman landed in the D.C. jail, and Goetcheus was incensed to learn that the woman was not segregated from other inmates and did not receive all of her drugs while there, potentially exposing people to multidrug-resistant TB. Finally, concerned officials at Health Right notified the city's Child and Family Services Agency of the problem, and it took her children for screening.

Walter Faggett, the Health Department's acting chief medical officer, dismissed such concerns, saying that the woman has not been contagious since April. "She did miss a couple doses of intravenous medication, but clinically we are very comfortable that she has recovered and has been treated adequately," he said.

Faggett said that the city has identified places in Maryland where homeless patients can be sent for directly observed therapy but that facilities once used by the city are no longer available.

The city should invest in providing monitored therapy settings, said Peter Hotez, chairman of microbiology and tropical medicine at George Washington University.

"New York City was practically brought to its knees [in the late 1980s] because of lapses in directly observed therapy for TB," he wrote in an e-mail. "It was only because the city recognized the critical importance of surveillance and expanded use of directly observed therapy in institutional settings that the problem was brought under control. If it is really true that the District has become complacent with this therapy, especially among HIV-infected patients with TB, then they are potentially creating a timebomb."

Freeman, the Medical Society official, said Tillery should be given a chance to fix the problems.

"Attacking Herb Tillery and Walter Faggett isn't the answer," Freeman said. "We need to give them support, and if that fails, we need to go up the line to talk about what the problem is. Mr. Mayor?"