Saturday, June 2, 2007

TB patient under microscope

As the Atlanta lawyer with a dangerous form of tuberculosis began treatment At National Jewish Medical and Research Center in Denver, government officials and the patient provided sharply divergent accounts of his 12 days of world travel.

The accounts seemed to agree only in the missed opportunities to head off what has become an international public health scandal.

The man, Andrew Speaker, has said that public health officials in Fulton County, Ga., told him a trip would not be risky. But those officials said that he had been clearly warned of the dangers.

In interviews, public health officials at the county, state, and federal levels all said that he should not have traveled and defended their handling of the case.

The finger-pointing extended to Canada, Greece, and Italy, where officials said they had received no word of Speaker's presence in their countries in time to take action. Italian officials said they had to take the initiative in calling the Centers for Disease Control in Atlanta to ask about rumors that a man with extreme drug-resistant tuberculosis was in their country.
The likelihood that Speaker might have infected other passengers is low, tuberculosis experts say, because the disease is not as contagious as illnesses like influenza.

But the risk was still real, and the bizarre case - which, thanks to the 24-hour news cycle, has become the most famous tuberculosis drama since "La Boheme" - calls into question preparations to deal with medical crises like influenza pandemics and even bioterror attacks.

In the sharpest contradiction in the accounts, Speaker said on Friday on "Good Morning America" that county health officials who met with him all but wished him bon voyage. Although they urged him not to travel to his wedding in Greece because of his tuberculosis, he recalled, they backed off under his father's lawyerly prodding.

Steven R. Katowsky, director of the Fulton County Department of Health and Wellness, said in an interview that the county had little power to detain Speaker, but insisted that they could not have made their warning more clear. "We told him that if you travel, you're putting people at risk," Katowsky said.

County officials said that Speaker did change his travel plans after the meeting. But instead of canceling his reservations for a wedding and monthlong honeymoon, he moved up the departure date, from May 14 to May 12 - too soon to get the follow-up letter from the county stating, "it is imperative that you are aware that you are traveling against medical advice."

Katowsky said: "We are talking about a person who both had the intent and the means to escape the jurisdiction."

Critics are blasting him as a modern-day Typhoid Mary after he boarded two trans-Atlantic flights despite warnings from health officials.

His friends say that's not the "Drew" Speaker they know.

"I know if he had any thought whatsoever that he would put others in harm's way, he absolutely would not have gone," said David Rich, a Nashville attorney who was Speaker's law school roommate.

"If you subtract this TB thing from Drew Speaker, he's really a pillar of the community," Rich said.

The young attorney met Sarah Spence Cooksey, an aspiring lawyer, at an Atlanta pub and handed her his fancy business card. When she called, she asked for "Mr. Speaker."

But the man she ended up flirting with was not Andrew, but his father, Ted, who practices law with his son.

The young couple's relationship blossomed. They stayed up late debating ethics, the law and politics. He called her and her young daughter "his girls." They got married in May in Greece, honeymooned in Europe, and friends say they were eager to get married life started.

Instead, the couple described by friends as loving, energetic and athletic is now at the center of an international health scare.

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