Border guard let TB patient cross into U.S.

The Baltimore Sun

DENVER -- A man infected with an extremely dangerous strain of tuberculosis was allowed into the United States at a border crossing even after a routine check of his passport set off a computerized alert, authorities said yesterday.

Andrew Speaker, 31, a personal-injury lawyer from Atlanta, arrived at the border at Champlain, N.Y., from Canada on May 24 after disregarding explicit instructions from the Centers for Disease Control and Prevention to remain in Italy - where he was on his honeymoon - for fear that he might spread the potentially lethal strain of TB.

Speaker's father-in-law, Robert Cooksey, is a microbiologist at the CDC in the Division of Tuberculosis Elimination.

Cooksey issued a statement yesterday saying that he "wasn't involved in any decisions my son-in-law made regarding his travel, nor did I ever act as a CDC official or in an official CDC capacity with respect to any of the events in the past weeks. ... I would never knowingly put my daughter, friends or anyone else at risk from such a disease," he said.

Cooksey also said he had never tested positive for TB and was certain that Speaker did not contract the lung ailment from him or from the CDC's labs.

Speaker knew he had a severe strain of TB before he left to marry Cooksey's daughter, Sarah, on a Greek island in mid-May. He found out later, in Rome, that he had the rarest and most lethal of TB strains, resistant to most antibiotics.

Few hospitals in the country are equipped to handle that strain of TB. Early yesterday morning, Speaker and his wife were flown by private air ambulance to one of them, National Jewish Medical and Research Center in Denver.

Speaker will remain in an isolation room in Denver for months as a medical team tries to wipe out the bacteria in his lungs with powerful antibiotics and, if necessary, surgery.

The antibiotics used to treat him might cause severe nausea, seizures, hearing loss and kidney problems. Nevertheless, said his attending physician, Dr. Gwen Huitt, Speaker is in good spirits.

Speaker has said that his desire to be treated at the Denver hospital - which he had been been told has the best specialists - compelled him to rush back to the United States from his honeymoon, taking a secretive, circuitous route to avoid being flagged as a health risk at American airports.

His actions potentially exposed hundreds of passengers and crew members to tuberculosis.

Authorities said Speaker did not break any criminal laws because at no point during his international travel was he under a court order to stay put.

From Rome, Speaker and his wife flew to Prague, Czech Republic, then to Montreal. They then drove to the border crossing at Champlain, where the passports of both set off warnings when they were scanned into a computer.

The alerts instructed the guard to don protective gear, isolate and detain Speaker, and immediately call health authorities.

The guard, who has since been removed from border duties, apparently concluded that the travelers looked healthy.

The incident at the border outraged Sen. Charles E. Schumer, a New York Democrat, who called for a federal investigation.

"Today, it was one sick and very irresponsible person who slipped through, but tomorrow could bring much worse," Schumer said.

As soon as Speaker crossed the border, he moved to comply with authorities. On May 25, as he and his wife drove south from Albany, N.Y., he answered a cell phone call from the CDC, which had been frantically trying to reach him, and agreed to check himself into an isolation unit in a New York City hospital.

From there, he was transferred to his hometown, Atlanta, where he was kept in a hospital room under armed guard.

When he arrived in Denver yesterday morning, U.S. marshals escorted his ambulance to the hospital. He is the first person to be quarantined by the U.S. government since 1963.

Speaker's medical odyssey began in January, when he injured a rib and went in for a chest X-ray, which showed a lesion in his lung. His physician suspected TB, even though Speaker had none of the classic symptoms.

It took months to confirm the diagnosis through a lab culture.

In a meeting May 10, county officials gave Speaker the diagnosis that he had an alarming drug-resistant strain of TB, which the CDC was working to confirm. He then told doctors of his plan to fly to Europe in a few days for his wedding.

What was said next remains in dispute.

Speaker has said that authorities told him they preferred that he not fly on a commercial plane but did not order him to stay home.

"He specifically asked if he was not permitted to go. They said no, we prefer you not to go, but we're not [telling] you not to go," his father, Ted Speaker, told CNN. Father and son practice law together in Atlanta.

County officials said they expressed more than a preference. "He was advised very strongly not to travel," said Dr. Steven Katkowsky, director of the Fulton County Department of Health and Wellness.

The next day, May 11, the county prepared a written medical directive. It can't be enforced like a court order, but the intent was unmistakable.

"The letter did not say 'We prefer.' It said, 'You are directed,'" Katkowsky said.

Speaker never got that letter.

On May 18, as the couple celebrated their marriage on the Greek island Santorini, the CDC confirmed the diagnosis of multiresistant TB. Other test results on May 22 showed that Speaker had a still more severe strain of TB, known as XDR, for extensively drug resistant.

On May 23, a CDC quarantine officer reached Speaker at his Rome hotel with the news. The officer begged Speaker to turn himself in to Italian health officials while the CDC worked to get him safely back to the United States, said Dr. Martin Cetron, the CDC's director of global migration and quarantine.

Speaker told the Atlanta Journal-Constitution in a phone call Tuesday that he thought he would languish indefinitely in an Italian hospital and feared that he might die without help from the specialists in Denver.

The next day, Speaker and his wife fled.

Jia-Rui Chong, Stephanie Simon and Nicholas Riccardi write for the Los Angeles Times.

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