Family balked at keeping TB patient from traveling, emails show

ATLANTA — They balked. They squawked. And some of them flew where they weren't supposed to go.

Such was the behavior of tuberculosis-infected lawyer Andrew Speaker, his father, Ted, and his future father-in-law, a federal TB expert, according to health officials' e-mails obtained today. Health officials trying to stop Andrew Speaker, a globetrotting honeymooner with an exceptionally dangerous form of TB, got little assistance from his lawyer father, according to the e-mails released after a public records request by the Associated Press.

And his future father-in-law, Centers for Disease Control and Prevention microbiologist Robert Cooksey, not only refused to stop the Greek wedding but went to the ceremony himself, according to the e-mails.

Some of the 181 pages of e-mails suggest Ted Speaker was clipped and combative in phone conversations with health officials.

E-mails from Fulton County officials portray Cooksey as initially unhelpful, at least before May 22, when tests showed Andrew Speaker had a more dangerous form of TB than previously understood.

"This is terrible news. I hope the father-in-law will be more forthcoming now," reads a May 22 e-mail written by Beverly DeVoe-Payton, director of the Georgia Division of Public Health's tuberculosis program, to other state health officials regarding the new test results.

CDC spokesman Tom Skinner said Tuesday that Cooksey had already begun to cooperate at that point and provided the agency with Speaker's phone number in Europe.

Andrew Speaker sparked an international scare when health officials tried to find and isolate him because he was infected with a form of TB that is highly resistant to drugs. He knew when he left Atlanta that he had TB and that it was resistant to some drugs, but he did not find out until he was in Europe that it was the highly dangerous form.

In his conversations with health officials, Speaker "placed a lot of emphasis on contagiousness. He asked questions in a way so he could hear what he needed to hear to justify his leaving," Skinner said.

When federal health officials eventually reached him by phone in Europe with the new test results, they warned him not to fly aboard commercial aircraft, and urged him to turn himself in to local health officials.

Instead, Speaker and his bride flew to Montreal, rented a car and managed to drive across the border, even though officials had flagged his passport. A spokesman at the Denver hospital where Speaker is being treated said the 31-year-old was feeling well enough Tuesday to do some legal work for clients.

Dr. Andrew Vernon, a TB researcher at the CDC who sees patients at the Fulton County Department of Health and Wellness, had appealed to Cooksey to help stop the planned wedding in Greece, according to a May 30 e-mail from a Fulton County physician. Cooksey did not put a halt to the plans; instead, he went to the wedding.

Calls to Cooksey's office and home were not immediately returned today. Ted Speaker also could not be immediately reached for comment.

Officials at the county and state declined to answer questions today about the family's level of cooperation.

CDC officials are reviewing Cooksey's conduct as part of an internal review of the case, and the inspector general of the Department of Health and Human Services is conducting a separate review, Skinner said. Dr. Julie Gerberding, head of the CDC, has said that Cooksey did help health officials contact Speaker and his new wife in Italy.

Ted Speaker did not provide needed information, according to e-mails from state and Fulton County health officials.

In one e-mail, Dr. David Kim of the CDC summarized a May 22 phone conversation with Ted Speaker this way:

"'I need your assistance to reach out to (Andrew) to get him back to U.S. quickly and safely,"' Kim said he told the elder Speaker.

"'I can't do that. I don't know where he is ... I appreciate your call.' End of call," Kim wrote, summarizing Speaker's response.

Kim, the CDC's lead investigator on the case, learned of Cooksey's relationship to Andrew Speaker around May 19, Skinner said. Kim contacted Cooksey, and Cooksey called Andrew Speaker in Italy and provided Kim with Speaker's telephone numbers.

Andrew Speaker told a congressional hearing by phone last week that in a meeting he said his father taped, health officials had told him May 10, a few days before he left Atlanta for the wedding, that he wasn't contagious. He has also apologized for the scare, which put dozens of other airline passengers who sat near him through the need for TB testing.

Health officials have said Speaker was "not highly contagious." But they noted that because he had stopped taking medications, his condition could have changed quickly, possibly making him more contagious.

Right after the May 10 meeting with Speaker, his fiancee, and their fathers, county health officials began researching legal measures to stop the trip to Europe, according to information released Tuesday.

On May 13, Dr. Eric Benning of the Fulton County Health Department got a call from Speaker, who said he had already flown to Greece — a day earlier than planned. He promised to call May 14 with contact information.

But Speaker did not check in until May 20, when he sent Benning an e-mail that said: "We have tried to use the cell phone and things just don't seem to work."

Speaker also sent a photo from the wedding, held May 18 on the Greek island of Santorini.

When Kim finally reached Speaker in Italy, Speaker said he was planning to return to the U.S. on June 5.

Speaker wanted to go to Denver for treatment and was concerned about being isolated in an Italian hospital. Kim said hiring a private air ambulance was an option, but it was not well received.

"Family are very upset that these public health demands are placed on them but there is no assistance — air ambulance from Rome to Atlanta is US $60,000-140,000," according to a May 23 e-mail from Kim.

The couple left Italy on May 24 to travel through Prague and Montreal to sneak back into the U.S. by car. Speaker surrendered in New York, was placed under a federal isolation order — the first since 1963 — and was taken to Atlanta on May 28.

Doctors at National Jewish Medical and Research Center in Denver had not determined whether Speaker would undergo surgery to remove the infection, hospital spokesman Williams Allstetter said Tuesday.

U.S. health officials said this week it's unlikely they will be able to trace the origin of Speaker's tuberculosis. They think he caught it during earlier travels to Peru, Vietnam and Cambodia, but many of the TB cases in those countries and some in the U.S. have not been genetically identified, so it will be difficult to confirm a match, said Patrick Moonan, a CDC epidemiologist involved in the testing of Speaker's TB.