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TB patient insists he was never banned from travel

Story Highlights

• Officials say state law prevented them from banning Speaker's travel
• Andrew Speaker says CDC knew he was traveling to Greece for wedding
• DHS official: Supervisor must now be included in decisions to override directives
• CDC says it's learned a lesson about how to notify agencies during health scare
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WASHINGTON (CNN) -- The tuberculosis patient who set off an international health scare by flying to Europe then Canada before driving back to the U.S. told lawmakers Wednesday that doctors told him he was not contagious.

Federal and local officials contended otherwise during testimony before a Senate Appropriations subcommittee.

Andrew Speaker, the 31-year-old lawyer from Atlanta, Georgia, who is now in isolation in a Denver, Colorado, hospital said that he was never ordered to stay in the United States.

"No one ever wore a mask around me," Speaker told CNN's Larry King. "No one ever told me it was necessary. No one ever gave the impression that I was a threat to anyone. No one ever told me that anyone in my family was at risk." (Watch Speaker explain why he flew to Europe after he was diagnosed Video)

During his Senate testimony on Wednesday, Speaker said he cooperated fully with authorities. "I looked to the people who I believe I should trust to tell me whether or not I'm a threat to those around me, and they told me I wasn't."

He added, "I didn't go running off or hide from people. It's complete fallacy and it's a lie." (Watch Speaker testify from the hospital Video)

A Fulton County, Georgia, health official, however, insisted that Speaker was told he was not highly contagious, rather than not contagious at all. Dr. Steven Katkowsky added that about 17 percent of TB cases are transmitted by people who are considered not highly contagious.

"The patient's chart indicates he was told he was not highly contagious," Katkowsky said.

Federal and local health officials said Speaker took an international flight two days earlier than planned after he was told he had a drug-resistant form of TB and should not travel.

Centers for Disease Control and Prevention Director Julie Gerberding told the panel that state law didn't allow officials to prohibit Speaker from flying. In fact, she said, Speaker would have had to first show that he was going to ignore the advice not to travel before the state would be empowered to do anything.

"In Georgia, if a patient is to be isolated in an involuntary manner, it takes a court order and the patient must first demonstrate that he is not compliant with medical advice," she said.

Katkowsky backed Gerberding's assertion and called the state law a "Catch-22" that prevents local health officials from acting proactively.

Patient: CDC knew about wedding plans

"I can't look at somebody and say they might rob a bank. I have to wait until they rob a bank," he said. "The question that has been asked over and over again: Was Mr. Speaker prohibited from traveling? Was he ordered not to travel? And the answer is no. The local health department does not have the authority to prohibit or order somebody not to travel."

Speaker testified that he decided to leave the country after discussing his plans to get married in Greece with officials from the CDC and Fulton County Department of Health and Wellness, as well as his future father-in-law, who is a CDC microbiologist involved in tuberculosis research.

"CDC knew that I had it," Speaker said. "They were aware that I was going on my travels. Yes, I was told that Fulton County would prefer that I not travel, but I was also told I was not contagious, I was not a threat to anyone, there was no need to sequester me."

Had he been told he was contagious, he said, "I just myself wouldn't have been around my wife or my daughter and taken that risk that I could give them this."

On Tuesday, a Department of Homeland Security official said the TB scare has spurred federal agencies to review their policies.

Border patrol officers will no longer have the discretion to ignore directives barring someone from entering the country, the official said, speaking on condition of anonymity. From now on, a supervisor must be involved in any such decision, the official said.

The House Homeland Security Committee held a hearing Wednesday on what it has called "a poorly coordinated federal response to an incident with homeland security implications." Officials with DHS, the CDC and Customs and Border Protection testified.

Authorities are questioning how Speaker managed on May 24 to enter the United States from Canada at the Champlain, New York, crossing when he was infected with an extensively drug-resistant form of tuberculosis, or XDR-TB. Border agents were told that Speaker posed a risk and to contact public health officials if he tried to enter the United States. (Watch how the case has raised national security questions Video)

A timeline obtained from the homeland security committee showed Speaker was placed on a no-fly list May 24, two hours after he arrived in Montreal, Quebec, on a flight from Prague, Czech Republic.

That Speaker was allowed to enter the country despite his illness has raised concerns about the government's ability to respond to an epidemic.

A Customs and Border Protection official said that the border patrol agent, who has not been identified, allowed Speaker into the country because Speaker seemed healthy and because the agent thought the warning was merely discretionary.

DHS spokesman Russ Knocke told The New York Times last week that his department ordered any border control agents who encountered Speaker to "isolate, detain and contact the Public Health Service."

The border agent who let Speaker cross is on administrative duty and under investigation.

CDC says it's learned a lesson

"It is unclear to us" why CDC officials didn't disseminate a warning regarding Speaker via the National Operations Center, the DHS official said Tuesday. The CDC instead reported its concern to the Customs and Border Protection office in Atlanta, the official said. (Watch Speaker's parents complain about how the case was handled Video)

Had the CDC used the operations center, the official said, the information would have been automatically shared with all relevant federal agencies, including the Transportation Security Administration.

CDC spokesman Glen Nowak said officials thought that if Speaker returned to the United States, he would go to his home in Atlanta, the city from which he departed, but the agency has realized that making that assumption was a mistake.

"One of the lessons we've been learning from this are what are the best places to notify," Nowak said.

Speaker and his fiancee flew to Europe for their wedding May 12 after a Fulton County (Georgia) Health Department official told Speaker that the department would prefer he not fly because he had a drug-resistant strain of tuberculosis. (Watch Speaker ask for forgiveness Video)

Once Speaker was in Europe, however, test results showed his strain of tuberculosis was even rarer than originally thought, leading public health officials to try to persuade Speaker to turn himself in to Italian health authorities.

Speaker was afraid he would die if he didn't return to the United States for cutting-edge treatment, he has said. He ignored what he said was a recommendation not to travel back to North America because, he has said, he was told he was not contagious.

The Atlanta lawyer said he took a commercial flight because he couldn't afford a private jet.

Speaker's placement on the no-fly list was delayed because of a discussion that lasted between two and four hours among DHS, CDC and Justice Department officials trying to determine if DHS had the authority to put him on the list, the DHS official said. The quandary arose because the no-fly list is meant to be a counterterrorism measure.

The official said Speaker's placement on the list came quickly "if you are considering that you are talking about attorneys from multiple agencies in federal government determining legal authorities." (Watch a doctor explain whether Speaker's fellow passengers should be concerned Video)

Timeline: Hours passed before CDC notified

About six hours after Speaker entered the country, DHS officials were told that he had been allowed into the United States. It took another 90 minutes before DHS notified the CDC, according to the congressional timeline.

The DHS official said it is "impractical and unrealistic" to expect that notification should have come within minutes, especially in the middle of the night.

Once across the border, Speaker and his new wife drove a rented car to Albany, New York, spent the night in a hotel and drove to New York City the next day, where Speaker was placed in isolation at Bellevue Hospital.

According to the timeline, Speaker told the border agent he was crossing into the United States only for the day. An investigation is under way to determine whether Speaker lied to the border agent, the DHS official said.

On May 28, Speaker was flown aboard a CDC jet to Atlanta's Grady Hospital, where a federal order placed him in isolation, the first such order in more than four decades.

Three days later, Speaker was flown aboard a private jet to Denver, Colorado, where he checked into National Jewish Medical and Research Center, which specializes in treating drug-resistant cases of TB.

He has since been undergoing a series of tests there and has been placed on antibiotic therapy. On Tuesday, his attending physician, Dr. Charles Daley, said he is "doing quite well" and that a third and last sputum test had come back negative. (Watch a profile of Speaker Video)

The result means Speaker is not very contagious, Daley said but "that does not mean zero."

Meanwhile, other passengers aboard the transcontinental flights Speaker took have been urged to be tested for the illness.


HEALTH LIBRARY

In association with MayoClinic.com

HEALTH VIDEO LIBRARY

In association with Healthology.com
  • Healthology
  • TB 101

    • Tuberculosis is caused by germs that are spread from person to person through the air. It usually affects the lungs and can lead to symptoms such as chest pain and coughing up blood. It kills nearly 2 million people each year worldwide.

    • Because of antibiotics and other measures, the TB rate in the United States has been falling for years. Last year, it hit an all-time low of 13,767 cases, or about 4.6 cases per 100,000 Americans.

    • "Multidrug-resistant" TB can withstand the mainline antibiotics isoniazid and rifampin. The man at the center of the current case was infected with something even worse -- "extensively drug-resistant" TB, also called XDR TB, which resists many drugs used to treat the infection.

    • There have been 17 U.S. XDR TB cases since 2000, according to CDC statistics.

    Source: The Associated Press

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