In August of 1977, 74-year-old William Brawner developed a cough. He had had "a touch of TB" as a child, he told his family. Now it was back -- this time with a vengance.
In two years, tuberculosis swept through four generations of Brawner's family nearly killing his newborn great-granddaughter, Adrienne Morgan. And all largely because of the city health department's failure to properly control the disease.
"We knew that family," said Dr. Hazel Swann, director of the city's TB control program. "We knew them for two years. We didn't follow up on them, didn't even check them. We've got a new generation of TB."
In 1977, Brawner's family included his daughter Jean Creek, her husband Donald and their five children, his daughter Joan Brawner and her six children. They all lived in a four-bedroom town house in Northeast Washington that has since been gutted, waiting for renewal.
After Brawner came down with his cough, a public health nurse visited the family and gave them skin tests for TB.According to city clinic records, several of the tests turned up positive -- a sign of an early TB infection -- so the family was told to take a daily dose of the antibiotic isoniazid, to keep the TB from progressing.
But Donald Creek stopped taking his medicine -- without telling his wife -- and in February 1978 was admitted to D.C. General Hospital with active tuberculosis in his lungs.
His case wasn't severe then, according to his wife, so he was sent home again with pills with instruction to return to the Upshur Street clinic for check-ups. The family was tested again, and several more had become infected with TB. They kept taking the pills.
But after several months, Creek again stopped taking his pills or going to the clinic regularly -- and lied to his wife about it.
"He should have thought about those kids being in the house," she said. "He knew how dangerous (TB) is . . . He's old enough, and he's not stupid."
Investigators hauled Creek into the clinic in July because he failed to keep his appointments. He said he was taking his pills, but at his next visit a month later, an X-ray showed that the TB was worse and a test of his sputum showed that he was still spreading the disease.
Up to that point, the health department appears to have done what it could to help Creek and protect his family. But then it started to slip up.
An X-ray in September showed no improvement, but this time Creek's sputum test showed no germs. At a November visit -- again Creek had to be brought in -- the same confusing results turned up.
There were several possibilities: The tests may have turned up negative because Creek failed to cough up a good specimen, because the specimens sat around too long before being tested, or because of a lab error. Or, assuming that he had been taking his pills, the disease might have progressed because his germs had become resistant to the medication he was taking.
But health officials never challenged the lab results, nor was Creek ever given a drug sensitivity test to make sure his medicines were working, according to clinic records.
The November visit was Creek's last.The clinic made several new appointments for him, but waited another four months before it sent investigators to his home in March. They found Creek -- by now quite sick, according to his wife -- but he refused to return.
Under city law, uncooperative TB patients can be committed to a hospital for treatment, but only if their last sputum test shows evidence of the disease. Creek's test four months earlier had turned up negative, so the TB clinic decided to close his file with a notation, "lost to supervision," according to its nursing coordinator, Sarah Farley.
A month later, in April, Creek was admitted to D.C. General Hospital with advanced, active tuberculosis, his sputum loaded with germs.
At the same time, his new granddaughtter born before the last investigator came around -- got sick, too. His wife and the baby's mother, Jacqueline Creek, took the baby to the city clinic on Hunt Place NE, where, they said, doctors prescribed cough medicine and Tylenol for Adrienne's "cold," never suspecting TB. (The clinic director said he could not comment on the case, citing patient confidentiality.)
But the baby kept developing a fever and in July, her mother tried the emergency room at D.c. gEneral Hospital. Again, she said, cold medicine was prescribed.
But the next day, Adrienne had a seizure. This time, her family took her to Children's Hospital, where within 24 hours, doctors said they thought the baby had tuberculosis meningitis.
She was placed in the intensive care unit, unable to eat, unable to move her arms and legs, unable to keep her neck from arching back. The TB had spread from her lungs to her spinal cord and brain, causing seizures that drugs could not control.
Doctors eventually had to operate, inserting a tube in the baby's head to prevent excess fluid from building up inside her brain.
Three months later she went home -- with five kinds of medicine and a medal from the doctors for being such a strong fighter.
Adrienne lived, but she left Swann horrified at how the city health department had failed: allowing Donald Creek to develop active TB six months after his father-in-law; failing to recheck contradictory lab results; allowing months to go by without checking up on Creek; giving up on his treatment because his cultures were negative although according to his wife, he was sick; and failing to reinvestigate the family -- and catch Adrienne's case -- after he was admitted to the hospital.
Today, Adrienne still needs physical therapy to recover the full strength of her arms and legs, and the meningitis may have left her partially deaf. It may be years before doctors can tell whether she will suffer epilepsy or other brain damage.