[Congressional Record (Bound Edition), Volume 153 (2007), Part 12]
[Extensions of Remarks]
[Page 17118]
[From the U.S. Government Publishing Office, www.gpo.gov]




    THE EXTENSIVELY DRUG RESISTANT-TUBERCULOSIS INCIDENT: A POORLY 
  COORDINATED FEDERAL RESPONSE TO AN INCIDENT WITH HOMELAND SECURITY 
                              IMPLICATIONS

                                 ______
                                 

                        HON. SHEILA JACKSON-LEE

                                of texas

                    in the house of representatives

                         Friday, June 22, 2007

  Ms. JACKSON-LEE of Texas. Madam Speaker, I would like to thank the 
Chairman and Ranking Member for holding this very important hearing to 
discuss and investigate a possible breakdown in security procedures or 
the lack of adequate safety measures sufficient to safeguard against 
and minimize a potentially very serious public health security threat, 
namely the contraction of the extensively drug-resistant tuberculosis 
(XDR-TB). I would also like to take this time to welcome our witnesses, 
Dr. Martin S. Cetron, Dr. Jeffrey W. Runge, and Mr. W. Ralph Basham, 
(accompanied by Jayson P. Ahern).
  Mr. Chairman, 2 weeks ago, Mr. Andrew Speaker, an individual known to 
be infected with multi-drug resistant-tuberculosis (MDR-TB) was 
subsequently confirmed to be infected with extensively drug resistant-
tuberculosis (XDR-TB). He disregarded a recommendation from the Centers 
for Disease Control (CDC) to seek medical treatment in Italy, and 
returned to the United States by altering his flight itinerary, flying 
to Canada, and then driving through the U.S.-Canada border. A number of 
homeland security and public health processes were utilized to manage 
the situation and failed at a variety of points.
  The purpose of this hearing is to provide Members with the 
opportunity to (1) determine where weaknesses exist with homeland 
security processes designed to prevent entry into the U.S., (2) explore 
the inefficient interactions between the Department of Homeland 
Security (the Department) and the CDC when addressing public health 
security issues, and (3) identify areas for immediate and longer term 
improvement.
  According to current U.S. public health policy, the CDC must be 
apprised when MDR-TB appears also to be extensively drug resistant so 
that the CDC can provide laboratory confirmation of XDR-TB. A very 
important question immediately comes to mind in Mr. Speaker's case: 
Given the increasing incidence and prevalence of all types of TB, 
including MDR- and XDR-TB, should the CDC have been apprised sooner?
  Mr. Chairman, in urgent matters such as preventing the spread of 
potentially serious and very harmful public health risks such as XDR-
TB, time is most certainly of the essence. In January, Andrew Speaker, 
a 31-year-old Atlanta lawyer, fell and hurt his ribs. He received an X-
ray, revealing an abnormality in the upper lobe of his right lung. This 
suggested tuberculosis. Speaker began meeting regularly with Fulton 
County health officials for treatment. In early March, Speaker 
underwent a procedure to get a sample of sputum from his lungs. By the 
end of the month, lab cultures revealed he had tuberculosis (TB).
  Though it is still unclear, it appears that the CDC was not notified 
of these events until May 17 when it was called in to test for XDR-TB. 
Health officials determined Speaker had a multiple-drug resistant (MDR) 
form of TB. According to press accounts, Fulton County health officials 
called the Georgia Division of Public Health (GDPH) on May 10, but gave 
the impression that the problem was ``largely hypothetical'' The GDPH 
then made a call to the CDC. Some questions still persist and will 
hopefully be answered in this hearing. It is extremely important to 
know when the CDC was notified about Speaker's case of MDR-TB. It is 
also helpful for this Committee to know what the formal procedure by 
which the CDC was asked to perform its analysis. It is reported that 
the CDC was called in to test for XDR-TB on Thursday May 17. Was this 
the proper protocol to follow? If not, why wasn't the CDC asked to 
perform the analysis earlier?
  Notifying the CDC of potential public health threats in a timely 
manner is also important because the sooner the CDC is notified the 
sooner public safety authorities can put measures in place to protect 
the public. Had the CDC been notified, the CDC may have been able to 
prevent Mr. Speaker from traveling and subjecting the public to 
potential risks of contracting XDR-TB.
  As the Chairwoman of the Transportation Security and Infrastructure 
Protection, what I find even more alarming is the fact that the 
Transportation Security Administration was not notified until after the 
incident took place; after he had already posed a threat to the lives 
of hundreds of Americans and non-Americans. Had the TSA received 
forewarning, the identity of Mr. Andrew Speaker could have been 
disclosed in such a manner and he would have been placed on the ``no-
fly'' list.
  Mr. Speaker was simply given too many opportunities to create a 
public health crisis in this country and abroad. On May 12, Speaker 
departed Atlanta on Air France flight 385. Speaker arrived in Paris on 
May 13. On May 14, Speaker flew from Paris to Athens on Air France 
flight 1232. Speaker flew from Athens to Thira Island on Olympic Air 
flight 560 the following day. The CDC called in to test for XDR-TB. On 
May 17, the GDPH was notified that Speaker had flown overseas. Four 
days later, tests came back positive for XDR-TB. Meanwhile on that same 
day, Speaker flew from Mykonos to Athens on Olympic Air 655 and then he 
flew from Athens to Rome on Olympic Air 239.
  Mr. Chairman, questions still persist about the ability of the 
Federal Government to quarantine an individual. DHS officials told 
Committee staff that Federal officials do not have the authority to 
quarantine. This is inaccurate. The President may issue an executive 
order for federal isolation and quarantine for the following 
communicable diseases: Cholera, diphtheria, infectious tuberculosis, 
plague, smallpox, yellow fever, viral hemorrhagic fevers, and SARS. 
What are the policies and procedures to implement a quarantine/
isolation, and what is the role of DHS?
  We must ensure that we provide public health security policies and 
guidelines that result in the highest level of precautions against 
public health threats. There is an old saying that it is better safe 
than sorry.

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