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TB scare limits border officers' authority on entry rules

Story Highlights

• 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
• Timeline: CDC notified Speaker returned to country more than 7 hours after fact
• Doctor says Speaker not very contagious, but "that does not mean zero"
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WASHINGTON (CNN) -- Border officers will no longer have the discretion to ignore directives barring someone from entering the country after a man crossed the border with a rare form of tuberculosis last month, a Department of Homeland Security official said Tuesday.

From now on, a supervisor must be involved in any such decision, said a DHS official, speaking on condition of anonymity.

The move is in response to a May 24 incident in which Andrew Speaker of Atlanta, Georgia, entered the United States from Canada at the Champlain, New York, crossing. Speaker, 31, was infected with what is known as an extensively drug-resistant form of tuberculosis, or XDR-TB, and border agents were told he 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 of events obtained from the House 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.

The committee will hold a hearing on the matter Wednesday.

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

Officials briefed on the case told The Associated Press 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.

A Customs and Border Protection official confirmed the claim. The border agent who let Speaker cross is on administrative duty and under investigation.

"It is unclear to us" why officials with the Centers for Disease Control and Prevention didn't disseminate its warning regarding Speaker via the National Operations Center, the DHS official said. 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)

CDC says it's learned a lesson

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 attorney took a commercial flight, he has said, 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 Department of Justice 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."

The border patrol office issued a lookout for Speaker, urging its agents to contact a CDC doctor if he tried to enter the country, but the case was not reported to the Customs and Border Protection operations center, which would have distributed it to all necessary federal agencies, the DHS official said. (Watch a doctor explain whether Speaker's fellow passengers should be concerned Video)

In higher-profile cases, it would have been "pro forma" to share the information with the operations center, the official said, using the Latin phrase meaning as a matter of form or protocol.

It is unclear whether the border patrol office dropped the ball. "I couldn't say," the DHS official said.

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 U.S. 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 considering it was 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 U.S. 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.


story.champlain.wcax.jpg

Andrew Speaker passed through this border crossing in Champlain, New York, after a border agent allegedly determined he did not appear ill.

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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