(NOTE: This is part two of a report on a pending lawsuit over South Carolina’s handling of a tuberculosis outbreak at Ninety Six Primary School this spring. Part one ran on Thursday)
A wrongful termination lawsuit has broached the question: Why did it take South Carolina’s public health agency more than two months to quarantine an employee infected with tuberculosis (TB) at Ninety Six Primary School, especially as that employee risked spreading the virus to hundreds of students and faculty?
“This employee was so highly contagious… it’s off the charts. One of the worst cases ever recorded in South Carolina,” said Spartanburg attorney John Reckenbeil, who is representing three Department of Health & Environmental Control (DHEC) nurses that claim they were improperly fired as scapegoats due to mistakes by their superiors.
In part one, we focused on the confusion at DHEC over the situation in Greenwood County, as staffers sent conflicting messages about the status of the infected employee and other faculty who returned positive skin tests for TB germs. Staffers also expressed surprise at the number of students who may have been exposed to the infected employee.
In part two, we investigate what steps the agency took to put the infected employee into quarantine and why it took so long to keep him from exposing other members of the public to the virus.
Was inaction due to a computer glitch?
On March 8, DHEC was notified about a suspected case of TB in Greenwood County. Upon learning about the situation, DHEC’s nursing site supervisor for the county Latrina Richard visited the infected school employee.
Because TB germs can be spread through the air (usually by coughing, sneezing, or talking), DHEC policies require identified cases to be reported and treated. Most people who get the germs never actually develop the disease and are thus not contagious. However, about 10 percent of those infected do become sick.
To stop an infected patient from spreading the disease, DHEC policy requires they receive medication for 14 days (to be taken in the presence of a nurse). The patient is also not supposed to leave home. The patient must also undergo skin tests and chest X-rays to determine the extent of the infection.
In order for a case to be “confirmed,” Reckenbeil said DHEC policies require four conditions. The first three conditions are: patient shows symptoms of the virus, has abnormal x-ray results, and cultures collected from bodily fluids come back positive. The fourth element requires those results to be reported to the federal Centers for Disease Control & Prevention (CDC) in Atlanta.
Reckenbeil claims the first three criteria were met by mid-April— the patient undoubtedly had the disease. However, the information was not submitted to the CDC. He says Richard was told by supervisors (including the agency’s TB division director Shea Rabley) that there was a computer glitch in the network which connects DHEC’s central offices to the CDC. This malfunction would not allow the agency to immediately notify the Centers for Disease Control.
“All the Columbia office had to do was push a button and send the information to the CDC,” he told South Carolina Radio Network. “And they didn’t do it.”
According to the attorney, this sparked a chain of events. Because the CDC was not notified, the case was not officially “confirmed” under DHEC’s policy. That would prove critical when Rabley told Director of Public Health Jamie Shuster in an April 17 email that there had not been any cases of TB “confirmed and/or reported to the CDC at this time.”
Emails we obtained show that Shuster decided not to notify parents based on that information. “Since I have been at DHEC, the only time we have sent something to a school to send home with parents is when there is a confirmed case,” she wrote in an email that day.
Reckenbeil said the fact that the public was never notified or students tested due to a technicality amounts to incompetence by DHEC officials. “The idea of the future of our society hinging on a computer malfunction as to whether or not you start treating people for a very contagious disease is scary,” he told South Carolina Radio Network.
“There’s been no reasonable investigation”
He insists the lack of a “confirmed” case also meant state officials never tried to forcibly quarantine the school employee, who was continuing to go out in public and even return to work with the disease in his system.
An involuntary quarantine requires an emergency order that can only be issued by the DHEC director (Catherine Templeton) or Gov. Nikki Haley. However, currently there is no evidence that shows either woman knew about the situation in Greenwood County until late May, when Templeton visited the Greenwood health offices for a separate reason. Templeton did not issue the quarantine order until June 6.
In its response to the lawsuits DHEC criticizes Richard, regional nurse Anne Ashley, and Upstate TB program manager Malinda Martin for not issuing a public health order on their own. Rabley was also fired about two weeks after the outbreak was revealed to the public.
In an interview with The State newspaper last week, Templeton blamed the regional staffers for acting too slowly. “They all shared in this lethargy,” she reportedly told the paper.
Reckenbeil called Templeton’s comments reckless. “She clearly has not looked at the evidence to make a reasonable conclusion as to what took place… There’s been no reasonable investigation that she’s undertaken to see what the truth is. So I do think (her comments) are reckless. And they’re malicious, and they’re defamatory.”
In their response, DHEC officials said Richard violated agency policy by bringing the infected employee to the Greenwood County health offices.
Reckenbeil said Richard was forced to bring the infected employee to the agency offices for treatment on one occasion because the infected patient would not stay home. He also maintained that only DHEC’s central office could have issued a public health order, not his clients.
A DHEC spokesman said he had nothing to add about new developments beyond the agency’s legal response to the lawsuit. DHEC’s answer does not address the alleged computer glitch (which was not mentioned in the original lawsuits). Templeton has never spoken to South Carolina Radio Network about the investigation.
The public is likely to learn more on August 8, when the state Senate Medical Affairs Committee is scheduled to hold a public hearing into DHEC’s handling of the case.
State Sen. Floyd Nicholson (D-Greenwood), who requested the hearing, said he is withholding judgment until he learns more about what happened. “That’s what we want to get as the bottom line,” he told Greenwood affiliate WCRS this week, “Could things have been done in a more timely manner? And whose fault was it that it was not done in a timely manner?”