1. Health

With Florida's last TB hospital closed, health officials announce plan to handle new cases

Published Jul. 31, 2012

After weeks of being pummeled with questions about how Florida manages tuberculosis cases, state officials on Monday announced a new plan that emphasizes caring for patients as close to home as possible.

For decades, Florida sent its most difficult TB cases to the A.G. Holley State Hospital in Palm Beach County, the last sanitarium of its kind in the country. But in April, state lawmakers voted to shutter the institution to save money. Since then, news of an outbreak among Jacksonville's homeless population, and reported efforts to keep it secret, have raised concerns about the state's ability to contain the airborne lung disease.

On Monday, state Surgeon General Dr. John Armstrong said the state's new plan is a response to Holley's closure, not a damage-control effort directed at Jacksonville. In fact, in a conference call with reporters, Armstrong deflected questions about Jacksonville.

"This is a program that puts the focus on our patients, has communities as a central part of the care process, and ensures that we have outcomes that are measurable that will allow us to constantly improve," he said of the new Florida Tuberculosis System of Care.

Across Florida, the number of tuberculosis cases has been declining in recent years and officials said it is on track to fall further in 2012. According to the state Department of Health, 753 cases were reported in Florida last year, a drop of 10 percent from the previous two years. There have been 284 cases reported so far this year.

But tuberculosis has made news lately, both in Jacksonville and locally. This month, active cases have been reported in employees at MacDill Air Force Base and at a Largo charter school.

Like typhoid fever and dysentery, tuberculosis is thought by many to be a disease of the past, largely absent from the modern United States. But with no effective vaccine, it remains a significant public health threat, although with proper care it usually can be cured.

At one time, Holley held 500 patients. By the time it closed, there were fewer than 50.

Without treatment, TB can be fatal. It also can morph into drug-resistant strains.

Still, although the bacteria that causes the disease is airborne, it is not easily spread, requiring contact over 6 to 8 hours with a person in the active phase of the disease.

The state's plan creates three tiers of care for tuberculosis patients based on the severity of their disease and if they have other medical problems that complicate treatment:

• Most people with tuberculosis are Level 1 patients, meaning their own doctors or county health officials can treat them at home. In some cases, the county health department sends workers to deliver medications ensuring that patients are taking the pills, which can have unpleasant side effects. Failure to do so can lead to drug-resistant strains.

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• In the past, patients whose cases worsened could be sent Holley. Without that option, the state is grouping counties into networks that can share expertise and equipment to treat these so-called Level 2 patients. In the Tampa Bay area, for instance, a county official in Manatee might consult with officials in Hillsborough on tough cases.

"What we're trying to do is provide a little more coordination," said Dr. Douglas Holt, the health officer for Hillsborough County. "Have we done some of this in the past? Absolutely. But have we had a system to do it? No."

• Level 3 patients — those with a drug-resistant strain or who have serious health complications such as kidney disease or AIDS — would be taken to one of two academic medical centers: Jackson Health System in Miami, affiliated with the University of Miami; or Shands Jacksonville Medical Center, affiliated with the University of Florida .

In some parts of the state, homeless TB patients have been housed in cheap motels so they could be monitored by public health officials as they recovered. That's what happened in Jacksonville, the Palm Beach Post reported Sunday.

Holt said that there are no such "TB motels'' in the Tampa Bay area. The practice is being eliminated elsewhere in the state, he said, so the general public need not be concerned about exposure to active TB cases.

"We're trying to avoid places that people could just drive in and say, 'I need a room,' " he said.

Instead, he said, counties will look for studio apartments or boarding houses where patients can be more readily isolated.

Contact Anna Phillips at


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