Tuesday, June 5, 2007

Inquiry Into Role of Tuberculosis Patient’s Father-in-Law

The Centers for Disease Control and Prevention is investigating what role, if any, a staff scientist played in the international health scare set off by the odyssey of his son-in-law, who has extremely drug-resistant tuberculosis.

The scientist, Robert Cooksey, is a microbiologist who works with tuberculosis and other organisms at the federal diseases agency in Atlanta. Dr. Cooksey said he had given his daughter’s fiancĂ©, Andrew Speaker, “fatherly advice” about traveling to Greece for his wedding and honeymoon in Europe in May.

But yesterday Dr. Cooksey did not directly address the question of what he would have done under the same circumstances. “I wasn’t in that situation,” Dr. Cooksey said on the ABC program “Good Morning America,” “but I probably would have done the very same thing.”

On the same program, Andrew Speaker’s father, Ted, said that he, Andrew and others met with Fulton County health officials in Atlanta on May 10, four days before Andrew was planning to leave for Europe. Participants at the meeting were told that Andrew had a form of tuberculosis that was resistant to many drugs and difficult to treat.

At that point, Dr. Cooksey said on television, Andrew’s smear tests showed no tuberculosis bacteria “and so, by the guidelines, he was not considered infectious” to others.

But guidelines issued by the World Health Organization say that “patients with multiple drug resistant tuberculosis should not travel until” no tuberculosis bacteria grow on culture tests performed in a laboratory.

The Fulton County health officials said they “preferred” that Andrew Speaker not travel but did not cite a specific reason. Ted Speaker said that he asked a health official whether he was “just saying this to cover yourself” and that the official replied, “Yes.”

Ted Speaker said that in part because of a hearing loss, he taped the interview, without the knowledge of the Fulton County health officials, and that he would make it available at an unspecified time.

Andrew Speaker chose to fly to Europe on May 12, two days ahead of schedule, and flew back to North America during the honeymoon. He is now being treated at National Jewish Medical and Research Center in Denver. Yesterday, two smear tests there confirmed similar tests performed in Atlanta and New York City that he does not appear to be highly infectious to others because doctors and microbiologists saw no evidence of TB bacteria, hospital officials said. Findings from a third smear are pending as are those from cultures, which will take weeks.

The C.D.C. said late Saturday that it was undertaking a number of reviews related to Mr. Speaker’s case, including how Dr. Cooksey “was involved in this matter.”

Dr. Julie L. Gerberding, the director of the centers, said on Friday that Dr. Cooksey “may have been involved in preparing one of the lab tests to determine the type of bacteria” present in the specimen sent to the C.D.C. by Fulton County and Georgia State health officials.

She said it was not until May 18 that the centers learned the identity of the patient whose specimen was being tested there or that the patient had left the country.

The even more dangerous form was not reported until May 22.

Dr. Cooksey “certainly has not been engaged in the details or the ongoing decisions about how to handle this particular situation,” Dr. Gerberding said at a news conference.

Yesterday, the C.D.C. said it did not know whether Mr. Speaker’s name was on the specimens that Dr. Cooksey might have worked with or whether the labels were coded.

Dr. Gerberding also said that at several times “he helped us facilitate communication with his son-in-law and the wife,” Sarah. Dr. Cooksey’s “assistance was actually extremely helpful in getting us in cellphone” contact with Andrew Speaker in Europe, Dr. Gerberding said, “to help us determine how to help him get into a safer health care environment.”

On Saturday, officials in Denver gave Mr. Speaker a letter ordering that he “be detained” for treatment “until further laboratory tests indicate that your TB is no longer likely to be contagious.” The Denver order rescinded another one issued by the C.D.C. that put Mr. Speaker under a rarely used federal isolation order.

The centers and National Jewish have provided few details about Mr. Speaker’s medical course since his TB was accidentally detected when he had a chest X-ray for a rib injury in January. Dr. Cooksey has said that he has never had tuberculosis and could not have infected Mr. Speaker.


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