Washington officials are considering reviving an annual tuberculosis-screening program for employes at city-run health clinics, following the death of a receptionist who worked in one clinic for more than a year while suffering from a serious, contagious case of tuberculosis.
Although Jean Datcher, 53, was found to have tuberculosis in 1981, her illness was not reported to city officials until late April of this year, when she was hospitalized in Virginia, according to Dr. Hazel Swann, director of the city's tuberculosis-control program.
After Datcher's death May 18, the clinic at 702 15th St. NE took chest X-rays of all 56 of its employes to check for possible infection. No active cases of tuberculosis were found, but two employes and one part-time nurse were put on preventive medication as a precaution, according to Dr. Arthur Hoyte, commissioner of public health.
Datcher was a receptionist in the section that treated pregnant women and infants. Because she had little direct contact with clinic patients, health officials said, there is little likelihood that they were exposed to the disease.
However, the clinic is administering tuberculosis skin tests to those patients who have been treated at the facility during the past year and are still returning for care. Hoyte said no decision has been made on whether to call back inactive patients for the same tests.
Swann said that over the past four years three part-time employes at the same clinic have developed TB. All those cases were reported, all were successfully treated and none still works at the facility, she said yesterday.
Swann said she believes the incident could have been prevented if the city's 15 health clinics had not stopped yearly tuberculosis screening of their 372 employes, who handled 208,690 patient visits last year.
A 1970 Department of Human Services policy requires clinic employes to take skin tests at least every two years, but those rules "fell apart" between 1975 and 1979, when there was no chief of the tuberculosis-control program, Swann said.
Department of Human Services Director James A. Buford has called a meeting of public health officials for today to consider whether, and how to enforce the screening policy. "You can assume the policy will be enforced," Swann said yesterday. However, it is not clear what city office has the responsibility for enforcing any screening program.
Detecting and preventing tuberculosis has been a matter of concern in Washington for years because the city has long had one of the highest rates of the disease of any U.S. city.
In April Mayor Marion Barry announced a 30 percent drop in the number of new TB cases in the city for 1981, from 341 in 1980 to 239 this year, but his announcement stirred some controversy because a change in the method of reporting new cases apparently contributed to the decrease.
Swann said the tuberculosis rate in Washington is currently 37 cases per 100,000 residents, nearly twice the national average of 19 cases per 100,000.
One of Barry's challengers in the race for mayor is seeking to make his administration's handling of the tuberculosis program--including the Datcher case--an issue in the campaign. "The control system has broken down. We're not detecting TB even in the health clinics," said Ward Four City Council member and mayoral candidate Charlene Drew Jarvis, who raised the issue at a candidates' forum this week.
Tuberculosis is caused by bacteria that are inhaled and spread by coughing or sneezing. The infection settles in the lungs and other organs, where it can lie dormant for years. If triggered by poor health, the bacteria multiply and spread in the lungs, typically causing weakness, fever and a chronic cough.
The disease can now be prevented and treated with a two-drug regimen, often without hospitalization. Most patients whose tuberculosis is diagnosed and treated will recover.
Because Datcher's medical records are confidential, it could not be determined whether it was the tuberculosis or some other problem that caused her death.
Swann said Datcher was diagnosed as having tuberculosis early in 1981 and was being treated by Dr. Harry Schumann at Group Health Association. She continued to report to work at the clinic, and although city law requires all tuberculosis cases to be reported to the city health department, her case was not reported, according to Swann.
Last April, Datcher was hospitalized at Arlington Hospital. At that time, the Virginia state laboratory reported to the District's TB office that sputum cultures taken from her were positive. By law, physicians and medical labs are required to report patients with contagious diseases to the health authorities where the patient resides.
"At the time we discovered that she had TB, she was highly contagious," Swann said, adding that the fact that neither the woman nor her doctor advised authorities of her illness "makes people angry and afraid."
According to District regulations, the penalty for failure to report a contagious disease is a $300 fine and/or 90 days in jail and a suspended license.
"We're going to crack down on GHA because that's where reporting is very lax," Swann said. Dr. Bernard Slosberg, chief of internal medicine at GHA, said the association is investigating the incident. Schumann declined to comment on the case.