Travel Followed Lack of Cooperation, Late Reaction, Weak Safeguards
By David Brown and Spencer Hsu
Washington Post Staff Writers
Thursday, June 7, 2007
Officials of federal agencies that guard public health and the nation's borders yesterday told congressional committees that they made mistakes in their unsuccessful effort to stop an Atlanta lawyer from traveling on two continents with an extremely dangerous form of tuberculosis last month.
The hearings provided the fullest accounting to date of an episode that has embarrassed the agencies at a time when immigration is dominating the political debate and the threat of pandemic flu or bioterror attack remains a concern.
The Centers for Disease Control and Prevention was too trusting toward 31-year-old Andrew Speaker and too slow in notifying other agencies that he was abroad once it learned he had ignored medical advice and flown to Europe while still infectious, said Julie L. Gerberding, the CDC's director.
The agency also was late in telling the World Health Organization and the government of Italy, where Speaker and his bride were honeymooning.
"We failed to take action to limit his movements. . . . I think we can do that faster. I think we should have done it faster. In retrospect, that was a mistake," Gerberding told a subcommittee of the Senate Committee on Appropriations.
Speaker himself addressed the committee through a telephone hookup from his room at National Jewish Medical and Research Center in Denver, where he is undergoing treatment for "extensively drug-resistant" tuberculosis (XDR-TB).
He defended his actions by saying doctors told him he could not infect others and would need to wait at least three weeks before he could begin a two-year course of anti-TB therapy. Together, he said, those alleged assertions convinced him to go ahead with long-standing plans to get married on a Greek island and then travel to Rome and Florence.
"Nobody has said a single thing to me that I am a threat to anyone," he recalled of a conversation on May 10 with physicians from the health department of Fulton County, where he lives in an Atlanta suburb.
While this was going on, members of the House Homeland Security Committee were also hearing sometimes-conflicting narratives of the events and official mea culpas.
U.S. Customs and Border Protection (CBP) "had an opportunity to detain Mr. Speaker at the border, and we missed," and "that missed opportunity is inexcusable," said Commissioner W. Ralph Basham, accepting what he called the need for "100 percent success, 100 percent of the time."
But homeland security officials blamed what they called "a single point of failure," the front-line border inspector who ignored an alert to detain and isolate Speaker and to contact health authorities.
"Those actions appear to be indefensible," Basham said. Jayson P. Ahern, an assistant CBP commissioner, added: "We didn't execute well enough."
Although Speaker's TB bacterium is very hard to treat, he has little of it in his lungs. That means, on a purely statistical basis, he is unlikely to transmit it to others, although it is not impossible. Health officials confirmed last week that despite months of exposure to him, his wife, family members and co-workers in an Atlanta law firm remain uninfected.
Speaker has previously said that CDC -- which has two huge campuses in Atlanta -- knew in late April of his wedding plans, and knew on May 10 that his TB was at least partly drug-resistant. Gerberding, on the other hand, testified that the agency did not learn his identity -- and that he had left the country -- until May 18, six days after his outbound flight.
That contradiction was partly explained yesterday.
Present at Speaker's meetings with the Fulton County health department was a physician who is an employee of CDC assigned to the county to provide expertise in TB treatment.
Neither Fulton County nor the CDC would identify that doctor yesterday. Steven Katkowsky, head of the county health department, said he does not know whether the doctor told anyone at CDC headquarters that a local man with infectious TB -- whose fiancee's father, coincidentally, is a CDC scientist -- was giving strong signals that he planned to take a transatlantic flight against medical advice.
Gerberding was repeatedly asked by Sen. Tom Harkin (D-Iowa), the subcommittee chairman, why it took four days -- May 18 to 22 -- to make contact with Speaker and notify Homeland Security and WHO of his existence.
She said that time was spent confirming his diagnosis, determining the legality of releasing the information to others, and working on strategies for getting him home safely, among other tasks.
"We can't just call the world and say 'There is an itinerant TB patient on the loose,' " she said.
Yet even as U.S. officials engaged in self-criticism, their accounts opened up new questions.
Gerberding, while faulting Speaker for not cooperating with authorities and the CDC for not sharing information sooner, maintained that even "if we sped notification, it would not have mattered," because systems were not in place to track Speaker down before he left Rome May 24 and returned to the United States through Canada.
But Homeland Security officials have said earlier notification could have helped them deploy other tools, such as putting Speaker's name on a "no-fly" list that is shared with Canadian authorities and airlines before he landed in Montreal and drove across the border at Champlain, N.Y.
And while Basham faulted the Champlain border guard, who is on administrative leave and under investigation, DHS officials admitted they have since changed their system to prevent front-line screeners from single-handedly clearing alerts on individuals' passports and have taken other undisclosed steps to back up such alerts.
Border officials testified that they caught the inspector's error only by a mix of caution and luck, because starting May 22 they had ordered a special, twice-a-day check of a database of airline reservations to see if Speaker had changed his expected June 5 return to the United States.
As it turns out, the database is linked to records that also show when a passport flagged by authorities has been swiped at a border crossing, as Speaker's did when he reentered at 6:18 p.m. on May 24.
"I'm not going to sit here and say the system worked," Basham said. "It may have worked the way it was designed, but it was not good enough."
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