A Timeline of Andrew Speaker's Infection
TB Patient Ordered into Isolation
June 06, 2007 -- Officials were summoned to two separate hearings on Capitol Hill Wednesday to explain how Atlanta attorney Andrew Speaker was able to leave and re-enter the United States despite a diagnosis of drug-resistant tuberculosis.
Speaker, 31, was placed under a federal isolation order on May 28 after traveling to Europe against the recommendations of public health officials.
Speaker is now undergoing treatment at the National Jewish Medical and Research Center in Denver. By telephone, he told a Senate subcommittee Wednesday that he was never told by local and federal health officials he was contagious until he returned to the United States from a European honeymoon. Health officials contend they repeatedly told Speaker he should not to fly.
"We gave the patient the benefit of the doubt, and in retrospect we made a mistake," said Dr. Julie Gerberding, head of the Centers for Disease Control and Prevention. "We failed to take the aggressive actions we could have."
Here, a timeline comparing Speaker's account of events with those of local and federal public health officials:
Andrew Speaker, a 31-year-old lawyer in Atlanta, has an X-ray for a rib injury. The X-ray shows a mass, suggestive of TB, in the lung on the opposite side of his chest.
According to a recounting by CDC Director Julie Gerberding, Speaker has two tests for TB. One, a quick test called a sputum smear test, examines lung secretions under a microscope and turns up negative for tuberculosis. The other, in which the secretions are cultured over a period of weeks in a lab, shows a small number of TB bacteria.
Speaker's private doctors tell Georgia's Fulton County Health Department he has TB, as required by law. Speaker says he met with a CDC official and Fulton County health officials, informing them he had started on a standard drug treatment for TB. Speaker tells Fulton County of his overseas travel plans for his wedding in May. Another smear test was performed, with again negative results.
Dr. Steven Katkowsky, director of Fulton County Health Department, says his office was notified of Speaker's case on April 23, and Speaker was seen at the county's TB clinic on April 25. Speaker was treated at the clinic by a CDC-employed physician who is a TB expert, but who at the time was on loan to the county, not acting as a CDC representative.
Lab analysis by the CDC shows that Speaker has a dangerous form of TB: It's resistant to the most powerful first-line drugs. Speaker, along with his father, Ted, his fiancee, Sarah Cooksey, and her father, Robert Cooksey, who is a CDC TB expert, meet with Fulton County health officials. Speaker is officially told he has multidrug-resistant TB (MDR-TB) and advised to seek treatment at the National Jewish Medical and Research Center in Denver. Speaker is told to stop taking his medicines since they are now known to be ineffective against his strain of TB.
"I was repeatedly told I was not contagious, that I was not a threat to anyone," Speaker later said. Nor was he told to cancel his travel plans or wear a protective face mask, he says.
Dr. Eric Benning, head of communicable diseases for Fulton County Health Department, attended the meeting. He says that at least three times during the meeting, Speaker was told he should not travel. He also says Speaker's physician, who was at the meeting, agreed with that recommendation. The public health department begins investigating its legal authority to prevent Speaker from traveling.
Speaker is scheduled to fly to Europe on May 14. He moves up his departure date to May 12.
Dr. Eric Benning says county health officials drafted a letter to Speaker specifically outlining their recommendations against travel. They attempt to hand deliver the letter to the addresses they had for Speaker, but he wasn't at the office and he had moved out of his home.
On a long transatlantic flight -- 13 hours, including delays -- Speaker flies from Atlanta, Ga., on Air France flight 385 to Paris, arriving on May 13.
Sarah Cooksey, taking their originally scheduled flight, joins her fiance in Europe.
Fulton County is unable to locate Speaker or talk with his immediate family members.
CDC Director Julie Gerberding says the agency first learned Speaker's identity when Fulton County called on May 18 to say they may have located Speaker in Greece. The CDC contacts Delta, his originally scheduled carrier, to try to trace Speaker's flight path. The CDC begins tracking down Speaker's family members to try to locate him.
MAY 22 - May 23
The CDC lab determines Speaker has a form of TB that is extremely dangerous because it can't be cured by most first- and second-line drugs. It's called extensively drug resistant TB, or XDR-TB. Treatment options are severely limited at this point; only 30 percent of XDR-TB cases are curable. The CDC talks with Speaker by phone late-night in Rome. Speaker says they presented him with two options: charter a private flight back to the U.S., which could cost up to $140,000, or check into a chest hospital in Italy.
Speaker says he had been told earlier his best shot for curing his TB was at National Jewish Medical and Research Center in Denver. He decides to immediately end his trip and head back to the United States to check into National Jewish. He later insists he still had not been told he was a health risk to others.
The CDC tells Speaker not to fly back to the United States, while they investigate options. Concerned his TB may have progressed, the CDC asks him to report to a hospital in Rome for a medical evaluation. The CDC contacts U.S. Customs and Border Protection at the Department of Homeland Security, asking the agency to issue an electronic border alert for Speaker. The alert reads, "If you see this individualů place mask on subject, place in isolation, in a well-ventilated room, if possible."
Without alerting any health officials, Speaker books a flight from Rome to Prague, and then takes his second long transatlantic flight, this time from Prague to Montreal on Czech Airlines flight 0104. In Montreal, Speaker rents a car to drive to the United States. At Champlain, N.Y., Speaker's passport is scanned by a U.S. Customs and Border Protection agent. The agent sees the isolation alert for Speaker, but clears him to cross the border anyway.
Once in the United States, Speaker calls the CDC and checks into Bellevue Hospital in New York City at the CDC's request.
The Department of Health and Human Services, in the process of putting Speaker on a no-fly list, learns he is already on a flight to Montreal.
The Public Health Agency of Canada is notified by the CDC at 5:49 a.m. that Speaker was traveling through Canada. Meanwhile, Speaker is undergoing tests at Bellevue in New York and is put under a provisional quarantine order for 72 hours.
Speaker is transferred by a CDC plane to a hospital in Atlanta, and a federal isolation order is issued -- the first since 1963.
Speaker's smear test results remain negative and his physicians say he is at low-risk of infecting others.
Speaker is flown by an air ambulance arranged by his insurer, Kaiser, to National Jewish in Denver. Speaker's father-in-law, microbiologist Robert Cooksey, denies that Speaker's TB is in any way connected to him or his CDC lab. The CDC's Julie Gerberding later confirms the specific strain infecting Speaker is not in the CDC's data bank. Though officials still don't know where Speaker contracted his infection, they say it wasn't from Robert Cooksey or his lab.
In an interview with ABC's Good Morning America, Speaker apologizes for possibly infecting others. "I don't expect those people to ever forgive me. I just hope they understand that I truly never meant to put them in harm. I hope they can find a way to forgive me," he said.
Speaker begins drug treatment for his XDR-TB. At its peak, the treatment will involve at least 12 pills a day. Dr. Gwen Huitt, his treating physician at Denver Jewish, says she expects Speaker to have a full recovery, with a possible discharge from the hospital within a few months. After that, he will likely be visited by public health officials almost daily for up to two years to ensure his medicines are taken properly. This is standard procedure for patients with multidrug resistant TB; one way TB becomes resistant is when medications aren't taken properly.
With reporting from Julie Rovner, Deborah Franklin and Anil Mundra.