Timeline leaves questions about treatment of Myrtle Beach TB patient

06/21/2013 5:57 PM

06/21/2013 5:59 PM

State health officials say the hospital that treated a tuberculosis patient from the Street Reach homeless shelter here followed proper protocols in notifying the agency of the health threat, although a timeline of events provided by the health agency points to an apparent lapse that could have put others at risk.

State law requires physicians and medical facilities to notify the S.C. Department of Health and Environmental Control of any suspected or confirmed case of TB within 24 hours. That includes any preliminary lab results that might point toward a suspected case.

DHEC spokesman Jim Beasley said the hospital – which the agency refuses to name – complied with the law.

But the timeline indicates the contagious patient was discharged from the hospital and then put on a public bus with a one-way ticket to Georgia before all the test results were in and the seriousness of the case had been identified.

The Street Reach patient was admitted to the hospital on May 27 and was discharged on June 4, according to DHEC spokesman Mark Plowden.

Beasley said the hospital’s initial testing of the Street Reach patient came back negative for TB. Additional laboratory tests, however, confirmed an active TB diagnosis. The hospital notified DHEC of the positive test result on June 6, which Beasley said was within the 24-hour time period allowed by law. That means the result of the additional testing wasn’t known until June 5 at the earliest – the day after the Street Reach patient had been discharged. Plowden said the patient was given a bus ticket to Georgia upon the patient’s discharge.

DHEC is not identifying the patient or the hospital that treated the patient. Joan Carroza, spokeswoman for Grand Strand Regional Medical Center, declined to comment, citing privacy laws. Conway Medical Center spokeswoman Julie Rajotte said she could not determine whether the patient had been treated there without the name of the patient. Those two hospitals serve the immediate Myrtle Beach area.

DHEC considers TB an “urgently reportable” medical condition. Any physician who fails to notify DHEC about such conditions within a 24-hour period is guilty of a misdemeanor, according to state law. Violations are punishable by a fine of up to $100 or a jail term of up to 30 days.

The patient now is being treated for TB at a Georgia medical facility, according to Nancy Nydam, media relations specialist with the Georgia Department of Public Health. Nydam said the patient’s family members have not tested positive for the disease but an investigation into whether others should be tested is ongoing.

Health officials from South Carolina and Georgia have declined to say whether any bus patients might have been exposed to the disease.

Nurses have been testing Street Reach clients, staff and volunteers for the disease this week and results of those tests should be known by next week.

“In the event additional TB cases are identified, the scope of the contact investigation will be expanded [beyond Street Reach],” DHEC spokeswoman Lindsey Evans said. “We have not identified any additional cases to date.”

DHEC started investigating the Street Reach case in the days after the hospital notified the state agency. Evans said the hospital provided DHEC with records of the case on June 7 and an investigation began June 10, with DHEC trying to determine which hospital staff might have been exposed to the patient. The following day, Street Reach started putting together a list of clients who had stayed at the shelter during the same time period – April 26 through May 17 – as the patient.

“Street Reach shreds rosters daily, so they required time to piece to together a list,” Evans said.

DHEC visited the homeless shelter on June 12, and by June 17 Street Reach had been able to compile a list of clients who were staying at the shelter with the patient. A list of staff and volunteers who might have been exposed to the disease was compiled the following day.

TB testing supplies arrived at DHEC on Wednesday, Evans said, and the agency held a meeting that day with Street Reach staff and clients to inform them of the potential health problem. Testing took place the following two days.

“Each TB investigation presents a unique set of challenges that determine how the investigation proceeds,” Evans said. “Working with the homeless, for example, requires a lot of work to identify potential contacts that may not be necessary in other settings. Also, the sequence of the investigation may change or overlap with other steps based on new information.”

Kathy Jenkins – executive director of New Directions of Horry County Inc., which operates the shelter – estimates more than 200 people were tested at the shelter on Thursday and Friday.

A positive test does not necessarily mean someone has the disease, and further evaluation – such as a chest X-ray – is necessary. About 1 out of every 10 people who are infected with the germ get the disease, although it can take weeks or even years before the disease develops.

There were 122 cases of TB reported last year in South Carolina, including nine in Horry County. The statewide total is a decline from the average annual number of 153 reported cases. Preliminary reports show 28 reported cases of TB disease so far in 2013.

TB is spread through the air when people who have an active infection transmit respiratory fluids, usually by coughing or sneezing, according to the federal Centers for Disease Control.

Symptoms of TB include a bad cough that lasts three weeks or longer, pain in the chest, coughing up blood, fever, night sweats, fatigue and weight loss. People who have HIV or other immune system diseases, those with diabetes and those who abuse alcohol or drugs are more susceptible to the disease. TB usually affects the lungs but also can attack the kidney, spine and brain.

TB responds well to antibiotics, according to DHEC. Cases of extremely drug-resistant TB are rare.

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