S.C. Senate hearing

SC DHEC blasted for missteps in school TB probe

sfretwell@thestate.comAugust 8, 2013 

— Inside:

Her voice cracking as she stared across the crowded meeting room, Robin Cobb recounted Thursday how her 8-year-old son came down with tuberculosis and what she thinks of the state health department’s efforts to protect him from the disease.

At a state Senate hearing in Columbia, Cobb said the Department of Health and Environmental Control failed miserably in investigating a tuberculosis outbreak that sickened her boy and infected about 50 other schoolmates in Ninety Six, a tiny town in western South Carolina.

The youngster must take daily medication for much of this year to help stop the potentially fatal illness – and even when he recovers and reaches adulthood, he’ll always have to tell employers and insurance companies that he has had tuberculosis, she said during testimony.

“It was heart-wrenching to my 8-year-old, who is experiencing painful and nauseating side effects from TB medication, to ask ‘Mom, is this going to kill me?’” she said.

“Like so many, I too want answers. But most of all I want this nightmare to be over. Unfortunately, for those that have been affected, it will never be.’’

Cobb was one of about a half-dozen speakers who testified at the more than five-hour Medical Affairs Committee meeting, which sparked heated exchanges between state senators and DHEC’s chief, Catherine Templeton. Democratic Sens. Brad Hutto of Orangeburg, Joel Lourie of Richland, Floyd Nicholson of Greenwood and Clementa Pinckney of Jasper, as well as Republican Tom Davis, grilled Templeton on why her agency made mistakes – and what she and top officials knew about the problem before taking action.

The committee held the hearing to learn why the department didn’t test schoolchildren for tuberculosis or tell their parents about the threat in their school until late May, more than two months after learning that a school janitor likely had developed a contagious form of the disease. The agency tested about a dozen adults who worked at Ninety Six Primary School in early April, finding that eight of them were positive for TB.

At the hearing, Templeton told senators her agency had made mistakes, saying “I assure you, that will not happen again.” She has previously said the department “screwed this up.” But she also told senators she does not believe any of DHEC’s foibles caused children to get sick with tuberculosis. They likely were infected before DHEC learned of the problem on March 8, she said.

DHEC officials said two adults who were found to be infectious carriers of tuberculosis no longer are a threat to the community. In the meantime, the agency plans to retest children this weekend who were positive in May.

The Ninety Six tuberculosis issue has rocked the community of about 2,000 people, some 75 miles northwest of Columbia. All told, more than 100 people have tested positive for the TB germ, including 53 schoolchildren. Of that, 10 children have actually developed a full case of the disease.

Tuberculosis is primarily a lung disease that can cause people to cough heavily, spit up blood and have chest pain. It is spread through the air, and in extreme cases, can be fatal. It is not as common today as it was decades ago, but still is a persistent health threat in the United States.

While Thursday’s hearing left plenty of questions on the table, it did provide more details on how Templeton’s agency handled the situation. The most prominent discussion focused on DHEC’s health division director, Jamie Shuster, a former governor’s office staffer who supervises more than 1,000 employees.

Shuster was aware of the Greenwood tuberculosis probe in mid-April, but dismissed requests to notify the public about the disease threat, arguing that DHEC did not have a confirmed case, according to internal agency emails discussed at the meeting.

The department’s then-state TB director in Columbia, Shea Rabley, said there was not a confirmed case, but the agency’s then-regional TB director, Malinda Martin, said eight adults who worked at the school had tested positive for tuberculosis, according to April 17 emails.

Hutto asked Templeton and Shuster why they didn’t take that information, as well as requests by field staff to tell the public, as a sign that something was amiss with the investigation and their involvement was needed. Shuster said that when Martin did not challenge Rabley’s assertion that no one had tested positive, the health director did not recognize a problem.

Hutto also pressed Templeton on how she could not have known about problems with the TB probe until the third week in May, since Shuster is one of her most trusted advisers. Shuster has an office near Templeton’s and rode in a car with Templeton to DHEC’s clinic in Greenwood on May 20 – the time when the director said she first learned of the investigation’s slow pace from a clinic worker.

“Your deputy director, she has an office very near you, y’all rode in the car together, and just happened to be going to Greenwood out of all the counties in the state,” Hutto said. “I would think that if I was going to Greenwood, and I had an hour to get up there, I’d have a lot to chat about. And I might say .... ‘Director, I might want to tell you this, I’ve been getting a lot of email traffic about the situation in Greenwood.’

“She never mentioned a word to you about it?’’

Templeton, for the first time, acknowledged that she was aware a TB investigation was under way before her May 20-21 clinic visit to Greenwood, but said she didn’t know there was a problem until a clinic worker pulled her aside during the trip. Templeton said she routinely pops in at health clinics to see how operations are going.

“I knew that there was an investigation,” Templeton told Hutto. “There are investigations all over the place.”

As soon as Templeton realized the probe was not moving ahead swiftly enough, she stepped in, ordering tests for children, notification for parents and firing four employees who she said were responsible for the mistakes. Those included Martin and two other field staffers in the Upstate, as well as Rabley, who worked in Columbia.

“It seems like everybody locally was let go, but it seems like all this falls under Miss Shuster,” Pinckney said. “Why not fire Miss Shuster?”

He later backed away from that statement but remained concerned about the investigation.

Thursday’s hearing produced plenty of tense moments, highlighted by accusations that Democrats were taking political shots at Templeton because she was the top choice of Republican Gov. Nikki Haley for the DHEC director’s post in 2012.Committee chairman Harvey Peeler, R-Cherokee, and GOP Sens. Lee Bright of Spartanburg and Danny Verdin of Laurens, joined Templeton in suggesting the hearing had become too political.

“There is a political undercurrent here to paint me as incompetent because I am part of the governor’s detail,” said Templeton, who told senators the U.S. Centers for Disease Control and Prevention had praised DHEC’s response after she stepped in.

In addition to Shuster, Templeton and Cobb, others testifying at the hearing included Ninety Six School superintendent Mark Petersen; DHEC’s former health chief, Lisa Waddell; and agency TB medical consultant Richard Ervin. The meeting was crowded with Greenwood County parents and former DHEC health officials, some of whom have been critical of Templeton’s efforts.

But it was Cobb who provided the most emotional testimony. Also a teacher at Ninety Six Primary School, Cobb said she believes children were being exposed to tuberculosis through the end of the school year on May 31 – despite assurances by DHEC that no on was at risk after the janitor was ordered not to return to the school on March 8.

She said a second adult who worked at Ninety Six Primary has been diagnosed with infectious tuberculosis and continued to work there until the end of the academic year. The second person likely contracted tuberculosis from the janitor, but didn’t know it until after the school year ended, said Cobb, who said she knows the second infectious TB patient and had contacted the person Thursday.

She also blasted DHEC for initially saying it would not test some kindergartners, even though they used a room near the infectious janitor’s work space, and for failing to test children soon after finding that eight Ninety Six Primary workers had been infected in early April. She said agency officials could not answer basic questions during a community meeting in May.

Cobb, a petite woman who likened the Senate committee to a group of kindergartners, said she continues to be frustrated by DHEC. She said the agency has used a plethora of different nurses to provide medication to her son, has not made doctors available as needed and has provided conflicting information about treatment this summer. She said her family has been affected in every way by her son’s exposure and resulting infection from tuberculosis.

“It’s a little upsetting this has gone on for as long as it has and some of the paths that have been taken, have not been about the children,” she said.

Senators seemed unwilling to hold a second hearing in Greenwood, saying DHEC could do so.

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