TB odyssey exposes border gaps

WASHINGTON — The government is investigating how a globe-trotting tuberculosis patient drove back into the country even after his name was put on a "no-fly" list provided to border guards.

The failure exposed a major gap in a system that is supposed to keep the most dire diseases from crossing borders.

But the communications breakdown at a U.S.-Canada border crossing was only one of a series of missed opportunities to catch the Atlanta man and his wife, who seemed determined to elude health officials.

Worried infection specialists say it shows how vulnerable the nation is, from outdated quarantine laws and the speed of international flight, to killer germs carried by travelers. What if, they ask, the man, now quarantined, had carried not hard-to-spread tuberculosis but something very contagious such as the next superflu?

"It's regretful that we weren't able to stop that," said Dr. Martin Cetron, of the Centers for Disease Control and Prevention (CDC), of how the man, reportedly in his 30s, fled when U.S. health officials tracked him down in Rome and told him not to get on an airplane.

Should the CDC have asked Italian health authorities to put the man in isolation there? That was under discussion when the CDC learned the man had fled, Cetron said.

"We need to rely on people to do the right thing," Cetron said, saying the CDC hesitates to invoke its quarantine powers. "Can we improve our systems? Absolutely. There will be many lessons learned from this."

The man has a rare but exceptionally dangerous form of TB, a type international health authorities are desperate to curb because it is untreatable by most medications. The CDC was a step, or more, behind the man on his multiple-country odyssey. His name didn't get on the no-fly list until he apparently already was en route to Canada, Cetron said.

But the CDC did get word to U.S. Customs and Border Patrol before the man and his wife crossed into the country at Champlain, N.Y., a Department of Homeland Security (DHS) spokesman said Wednesday.

Customs "is reviewing the facts involved with the decision to admit the individuals into the country without isolation," DHS spokesman Russ Knocke said.

DHS reassigned the Customs and Border Protection officer who allowed the couple to enter the country to administrative duties pending an internal investigation.

Homeland Security's inspector general and internal-affairs officials are investigating, reflecting the seriousness of the case, Knocke said. The investigation will seek to determine whether the officer asked the man for his identification, asked whether he had been to Europe and checked his name against information given by the CDC.

Congress is investigating, too.

The House Homeland Security Committee has scheduled a June 6 hearing.

Sen. Charles Schumer, D-N.Y., said the case "shows that something is wrong with the training and supervision of our border agents. We put all this time and effort into identifying those who shouldn't enter our country, but what good is it if it can be brushed aside by a border guard? I shudder to think that this individual could have been a terrorist."

Border security isn't the only issue. While the man now is cooperating with CDC investigators, he remains in federally ordered isolation in a guarded room in an Atlanta hospital. His identity is being withheld to protect his privacy.

But the nation's quarantine laws are so outdated that if the TB traveler challenged that order, "he would probably win in court," said Lawrence Gostin, a public-health law expert at Georgetown University who has advised the CDC's effort to update those laws.

"There is a hole" in the nation's disease-security system, Gostin added. "The person's instinct to get back to the United States in this case is understandable. But that's exactly what the law's there for, to prevent a person from endangering other people. ... We need to update the entire process."

Adding to the complexity is the tracking down of roughly 80 passengers and 27 crew members who were close enough to the man on two trans-Atlantic flights to potentially have been exposed to TB.

The no-fly list is primarily intended to prevent potential terrorists from boarding flights bound for the United States, but people who pose health risks can be included.

The department does not get real-time passenger data for flights ending in Canada, Knocke said, making it "very difficult for us to know who might be traveling there."

The CDC has pushed for years for faster access to electronic lists of air passengers to trace their locations in disease emergencies and hopes to have new regulations to ease that access in place later this year.

Cetron said the patient broke no laws, but some argue he should be held accountable anyway.

"It wasn't as if this guy had an illness nobody knew about," says Dave Streitwieser, medical director for MedLink, which helps commercial airlines around the world deal with up to 17,000 in-flight medical emergencies each year. "He had been told what he should and should not do and ignored that. I think that is criminally wrong. It's negligence."

Michael Osterholm, an infectious-disease expert who advises the government, said, "There's a whole body of public-health law that's going to be closely scrutinized and redefined with this case.

"It's going to be looking back at what do you do when you have a noncompliant carrier of some infectious agent [who] is border-hopping."

Material from The Washington Post and USA Today is included in this report.