Tackle a complex infectious disease case with a timeline, knowledge of key players

© The Medical-Legal News, 2007

By Maureen Orr, RN

There has been much news lately concerning the Atlanta attorney, Andrew Speaker, who was diagnosed with a drug-resistant form of tuberculosis, XDR-TB or Extremely Drug-Resistant Tuberculosis, and then hopped on planes to enjoy his honeymoon in Europe.

What is groundbreaking about this case are the international implications from the apparent failure of systems in alerting other countries and the World Health Organization (WHO) that a person with such an infection was traveling via airplanes to multiple countries.

This brings to mind the statement of Senator Howard Baker, Jr., during the Watergate hearings, when he asked that what his committee needed to discover was “what did the president know and when did he know it?”

In this case, it will be vital to know what the patient knew and when he knew it due to the possibility that he might have transmitted a disease to the hundreds of passengers who shared his airspace on crowded airplanes.

There have been television interviews with Speaker, the TB carrier, and his various family members, who noted the Centers for Disease Control (CDC) advised Speaker before he left for his wedding and honeymoon that they “preferred that he not travel.”

However, once he was overseas, representatives of the CDC reported on national television that Speaker had been advised not only not to travel, but to report to local Italian authorities immediately for quarantine.

Issues that come to mind for an attorney, LNC or other investigator of the medical records in this case, are to detail in records reviewed or by timeline as follows:

1) What was Mr. Speaker told by whom and when? 

2) Whom did the CDC speak to and when?

3) When was WHO’s Department of Tuberculosis and Air Travel informed of the situation?

4) When were other countries informed of the situation?

5) When was the Border Patrol informed and what were the specific instructions provided to the Border Patrol?

6) When were the passengers on all of the planes in which Speaker traveled informed that they might have been exposed and need to be tested, and what were the results of the testing?

Development of a timeline would need to be time specific as well as date specific. It would need to include information from all of Speaker’s personal physicians, all persons from the CDC who were involved with the case, including his father-in-law, Dr. Cooksey, (who ironically was also a tuberculosis expert), contacts at WHO and all potentially exposed patients.

In this age of rapid international travel and instant communication it is vital that all countries cooperate to prevent the rapid spread of diseases such as bird-flu and EDR-TB, otherwise the world potentially faces the loss of millions of people through rapid spread of diseases that currently have no available treatment. •

Maureen Orr is a legal nurse consultant and former certified public health nurse in Jacksonville, Fla.; mjorr44@aol.com.