This is the state of tuberculosis control at the D.C. Health Department's Tuberculosis Control Bureau in our nation's capital in the year 2004.

Doctors who refer patients to the bureau for screening and long-term follow-up care say the staff has been mishandling treatment of many infected patients and turning away people seeking TB screening.

The bureau's chest X-ray machine, which provides evidence of TB in the lungs, is 16 years old and breaks down often; at other times, staff members report, they have run out of X-ray film or chemicals, which forces the office to close. Located in a run-down building on the campus of the shuttered D.C. General Hospital, the bureau has unreliable water, air-conditioning and heating systems, city officials say.

In recent months, the agency stopped filing regular TB reports with the Centers for Disease Control and Prevention in Atlanta, and local doctors say that leaves them unable to tell whether TB incidence in the District is rising or falling this year.

Doctors also say the city has no designated facility to house homeless TB patients where health officials can observe them taking daily medications for up to a year -- the only reliable way to contain an infectious disease diagnosed in 79 District residents last year. Instead, many TB patients roam the streets and move from shelter to shelter without sticking with the therapy.

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The District TB rate in 2003 was 13.8 per 100,000 residents, compared with 5.1 for the nation, and immigrants and African Americans are at greatest risk, according to experts.

What does this say about the state of public health in this country?

And good thing we got rid of the OSHA TB standard, now that the problem is solved:

In the past year, the woman has been hospitalized for several 30-day stays in an isolation room at George Washington University Hospital at a cost of about $250,000 to her Medicaid health maintenance organization, Health Right. But the woman did not always stay in her room and walked the halls or stood in front of the hospital without a surgical mask, according to Goetcheus and others familiar with the case.

Last month the woman landed in the D.C. jail, and Goetcheus was incensed to learn that the woman was not segregated from other inmates and did not receive all of her drugs while there, potentially exposing people to multidrug-resistant TB. Finally, concerned officials at Health Right notified the city's Child and Family Services Agency of the problem, and it took her children for screening.

Meanwhile, next door in Virginia, a second hospital worker has been found to have active TB: 

Second hospital worker found to have active TB
Chesapeake General Hospital after a nurse at the hospital died of TB last month.

By ELIZABETH SIMPSON, The Virginian-Pilot
© July 20, 2004

CHESAPEAKE — Health officials won’t know until later in the week whether a new round of people will need to be tested for tuberculosis now that another health-care worker at Chesapeake General Hospital has developed an active case of the disease

The most recent case involved an employee who worked on the same unit as a nurse who died of TB in June. The co-worker has not yet shown symptoms of the disease, however, so health officials are hopeful she did not spread the bacteria.

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According to the state Department of Health, 59 cases of confirmed, active tuberculosis were reported in 2003 in the eastern region of Virginia, which includes Hampton Roads. Statewide, 332 TB cases were confirmed last year, a 5.4 percent increase from 2002, when there were 292 cases.