TB-infected man identified, moved to Denver
International TB incident triggered by man's trip raises questions about governments' response; U.S. House to investigate


The Atlanta Journal-Constitution
Published on: 05/31/07

An Atlanta-area man infected with a potentially deadly form of tuberculosis has flown out of Atlanta once again -- this time in the custody of public health officials.

The man, identified by the Associated Press as Andrew Speaker, 31, was moved overnight from Grady Memorial Hospital, hospital officials confirmed. Accompanied by federal marshals and a nurse, he was taken from Grady to Gwinnett's Briscoe Field in an ambulance.

RENEE' HANNANS HENRY/Staff
Dr. Kenneth Castro, director, Division of Tuberculosis Elimination (left) and Dr. Martin Cetron, director, Division of Global Migration and Quarantine, talk with reporters Wednesday on the Centers for Disease Control and Prevention's investigation into people potentially exposed to extensively drug-resistant TB.
 
University of Georgia
This undated photo released by the University of Georgia School of Law on Thursday shows Andrew Speaker.
 

Speaker's insurance company, Kaiser Permanente, arranged for an air ambulance to pick him up at Briscoe. He arrived in Denver around 7:45 a.m. and is currently undergoing evaluation at National Jewish Medical and Research Center.

Speaker had told the Atlanta Journal-Constitution he would be treated at the facility, a leader in multi-drug-resistant tuberculosis research.

The AP, quoting an unidentified federal law enforcement official, said Speaker is a personal injury attorney who practices law with his father in Atlanta.

Ironically, Speaker's father-in-law works in a Centers for Disease Control and Prevention laboratory aimed at preventing the disease, the AP reported. Bob Cooksey has co-authored scholarly papers on tuberculosis.

Cooksey said he gave his son-in-law "fatherly advice" when he learned Speaker had contacted the disease. He also said that had he known his daughter was at risk, he would have not have allowed her to travel.

Cooksey said he did not act in any official CDC capacity in the case.

Cooksey, a microbiologist at the CDC's Mycobacteriology Laboratory Brach, said his daughter Sarah married Speaker a few weeks ago.

According to a Web site connected with Speaker's law firm, he attended the U.S. Naval Academy, graduated from the University of Georgia with a degree in finance and then attended the UGA law school.

As airline passengers around the world worried about whether they were exposed to the drug-resistent TB, public health experts were trying to figure out how Speaker was able to jet off on his honeymoon with the knowledge of government officials.

The case, which has spawned an international health incident involving investigations in several countries, raises difficult questions about balancing the rights of an individual with the needs to protect the public, they said.

And while his current confinement shows the system eventually worked, the experts questioned whether more could have been done before he ever left Atlanta.

"I think this is going to be a lesson learned nationwide of the importance of local and county health departments being the front line of protection for the rest of the population," said Michael Greenberger, a law professor and director of the University of Maryland Center for Health and Homeland Security.

The House Homeland Security Committee announced Tuesday it will hold a June 6 hearing examining health officials' response in the case.

The TB patient, who is being confined under a federal isolation order, has told The Atlanta Journal-Constitution that he specifically told Fulton County health officials he was planning to leave the country for his wedding in Greece, then a honeymoon tour of Europe. He says they only told him they "preferred" he not travel. When pressed on what that meant, the man said they didn't say he couldn't travel.

Speaker was diagnosed with multi-drug resistant TB prior to leaving the country. While that's serious, an even more serious diagnosis of extensively drug-resistant TB, also called XDR TB, was made after he was in Europe.

While he was honeymooning in Rome, CDC officials asked him to agree to indefinite isolation in an Italian hospital. Instead he fled. Despite the CDC putting the man on airlines' "no fly" lists and having his passport flagged, the man and his bride were able to elude health authorities and sneak back into the United States by flying to Canada and driving across the border last week.

Fulton County and Georgia state health officials said they believe Speaker was clearly informed that he shouldn't travel. But they also acknowledge that despite their conversations, as of May 10 they knew he intended to leave the country for his wedding. They also discussed with CDC officials Speaker's intent to fly for at least two days prior to him boarding a May 12 Atlanta to Paris flight, according to CDC spokesman Tom Skinner and Georgia's state epidemiologist Susan Lance.

Skinner said Fulton County health officials contacted CDC on May 10 and said that Speaker, who at the time was diagnosed with multi-drug resistant tuberculosis, had told them he planned fly aboard airlines. The discussions continued on May 11, Skinner said. "We discussed with them several options to prohibit him from flying," Skinner said. All of those options involved actions that needed to be taken by state or local health authorities, he said.

Skinner said CDC never heard back from local health officials until May 18 -- after Speaker had already left the United States.

Lance said: "They gave us some options on how to proceed, but none of them were basically available," she said. She did not elaborate on what those options were.

While Georgia health officials can obtain a court order to restrict the actions of a person or to even involuntarily commit them for treatment, Lance said the individual first needs to be served with a medical order telling them what they can and cannot do.

"If they don't comply with the medical order, then we seek a court order to compel them to comply," Lance said.

Fulton County health officials have said they tried to hand deliver Speaker a medical order telling him he could not travel, but that his home was vacant and he was not at his office when they tried to serve him with it on May 11.

Lance said state and county health officials thought Speaker was departing at a later date, not on May 12 when he flew from Atlanta to Paris. "I think the Fulton County Department of Health and Wellness did their job to the best of their ability," Lance said, but she added that "there probably needs to be a review" of the state's laws and procedures governing restricting an ill person's travel.

At a press conference Wednesday, Dr. Martin Cetron, director of CDC's Division of Global Migration and Quarantine, said health officials are focused right now on the evolving investigation, tracing the man's movements and identifying what passengers were closest to him on long flights -- those over 8 hours in duration -- to identify those who may be at risk.

He noted that CDC officials are encouraged that the man continues to be "smear negative" which indicates he is at low risk of spreading the disease, that the man doesn't have any coughing or symptoms and that his wife continues to test negative for TB.

"I think that is reassuring," he said. "Those are encouraging findings."

However, the consequences would be great if the disease were to spread because treatments are so limited, Cetron said, especially for people who are immune compromised. That's why the CDC took the extraordinary step of isolating the patient and issuing an international health alert while trying to find people with whom he had extended contact.

The CDC is trying to locate approximately 80 passengers and 27 crew members who were on the two transatlantic flights and may have been near the infected passenger, Cetron said.

Passengers who are at highest risk on those flights were sitting within two rows of the man. They are urged to call 1-800-CDC INFO so they can receive a TB test to determine if they have been infected with the TB bacterium.

The man was on Air France flight 385 from Atlanta to Paris on May 12 and on Czech Air flight 0104 from Prague to Montreal on May 24.

On the Air France flight departing Atlanta, he sat in row 30, Skinner said. On the Czech Air flight he was sitting in 12C.

CDC officials said Wednesday they have not yet received a passenger manifest from Air France, and that pinpointing the man's seat takes time. "This is a cumbersome and challenging process to locate passengers," Cetron said.

The agency also released details of several short flights within Europe taken by the couple, but said that they were all of short duration and involved less risk.

Cetron has said CDC would be involved in his transport to the Denver facility.

"We're working on plan to insure the patient can move safely across state lines," he said.

Staff writer Kevin Duffy and the Associated Press contributed to this report.

Comments

By Mary Ann Kelly

Jun 7, 2007 9:27 AM | Link to this

in response to tom, june 3...
wake up
what is wrong with you?
YOU are such a typical example of why this world is allowed to behave as it does
understand what?
looks pretty much like black and white issues at hand
pay attention to a key word here...infectious
hmmm...
obviously, you have never been exposed to the medical world.
get a book...particularly on TB
get with it
pour a cup of espresso, quadruple scoop
i am assuming that you do not have children
and, if you do, i am certain that they are allowed to whine as well as you do.
good lord.

By icbt

Jun 4, 2007 9:49 AM | Link to this

This Speaker guy/lawyer is truly despicable,dishonest,selfish,no respect to other human beings & to think he is in a profession to help & defend others. He is so much concerned about himself & this wedding to a woman whom he shares the same description & just forgot the consequences of it all- putting other human beings in great danger,poor people all around the places/countries he visited that we will never know & never be treated the same way he is being taken care of,by USA,by our own taxes. You are so arogant & a liar & i hope you suffer & repay the anguish you brought to others. You & your entire artificial family.

By tom

Jun 3, 2007 9:41 PM | Link to this

I've read many comments about Andrew Speaker. Yes, I understand that he's done a very dangerous thing, putting thousands of people in danger. This cannot be forgiven but it can be understood. I've noticed that none of the comments have noted that this man was traveling to his own wedding.
Perhaps this was a great love and in the history of all the foolish and criminal things men have done for love, this is hardly one of the worst. It does not mean that love excuses crime or foolishness. I've found this book called It Is Not Too Late that talks about biological war and this type of spread of infections. In the end, even as we blame him, we have to also understand him.

By tom

Jun 3, 2007 9:37 PM | Link to this

I've read many comments about Andrew Speaker. Yes, I understand that he's done a very dangerous thing, putting thousands of people in danger. This cannot be forgiven but it can be understood. I've noticed that none of the comments have noted that this man was traveling to his own wedding.
Perhaps this was a great love and in the history of all the foolish and criminal things men have done for love, this is hardly one of the worst. It does not mean that love excuses crime or foolishness. I've found this book called It Is Not Too Late at itisnottoolate.com that talks about biological war and this type of spread of infections. In the end, even as we blame him, we have to also understand him.

By YouPeopleJustDontGetIt

Jun 3, 2007 12:57 PM | Link to this

His arrogance blinds him. His equally arrogant wife supports him.

For somebody who calls himself "educatated, intelligent and respectable" he seems very STUPID and very DESPISED (doesn't know anything about his TB condition but chooses to travel and, last I checked, Speaker is not respected at all).

He complained about the armed guard in NY and ATL. Hey, jerk, the guard is armed to protect YOU from people that have malicious intent. How I wish I could have those tax dollars back.

This guy and his wife are so self servicing it like a little piece of EGO HELL is being manifested on earth. Their offspring might well be the antichrist if they ever have any. It's sad to think people like him and his family end up in positions that are meant to be helping others. They clearly have no idea what compassion selfless servitude is. I wonder if they choose these jobs because they feel something lacking in their soul?

Here's another hint for Mr. Speaker. Apologies from you are empty. Show action and initiative on your part that you mean to fix this however you can. Offer compensations for time wasted, offer to pay the entire estimated cost of finding all the people you came in contact with and having them tested. Of course, you will do none of that. You sitting up on your "best treatment facility in the world" while the common people you possibly infected cope however they can afford is sickening.


By KatLover

Jun 2, 2007 11:43 PM | Link to this

Do me a favor people... keep posting so I know where you are. I feel safe living in Atlanta, once more.

Talk about it being a ME ME ME ME ME ME thing.

Andrew, my prayers are with you. I hope you get well soon.

By Jim

Jun 2, 2007 10:49 PM | Link to this

Wait a minute. If this guy was smear negative, he was not infectious according to CDC guidelines.

To the lay person, he "was not coughing bacteria into the air!"

He did have the bacteria in his lungs and would be cuture positive.

What's the real story here?

By runawaybachelor

Jun 2, 2007 8:21 PM | Link to this

We may never know the full extent of how much damage he did, and to whom.

Also, if someone is infected and doesn't know it, they could go on to infect hundreds and potentially create an epidemic.

By runawaybachelor

Jun 2, 2007 8:21 PM | Link to this

We may never know the full extent of how much damage he did, and to whom.

Also, if someone is infected and doesn't know it, they could go on to infect hundreds and potentially create an epidemic.

By Jim

Jun 2, 2007 7:05 PM | Link to this

Wait a minute. If this guy was smear negative, he was not infectious according to CDC guidelines.

To the lay person, he "was not coughing bacteria into the air".

He did have the bacteria in his lungs and would be cuture positive?

What's the real story here?

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