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NYC Department of Health TB comic book (NYC DOH)

NEW YORK, NY July 20, 2006 —Despite a big drop in recent years, tuberculosis is still a major public health challenge. The Health Department annually provides free drugs to hundreds of patients with the highly contagious lung disease. Health officials also get court orders to lock up about a dozen people each year who can't - or won't - take their medication. WNYC's Fred Mogul visited the TB detention center at Bellevue Hospital and files this report.

REPORTER: The soundtrack from West Side Story crackles out of a boombox for the residents of the tuberculosis detention ward in Bellevue Hospital. Actors Peter Frumkin and his wife Miho are presenting the show to non-contagious patients. They’re reading from a script, playing music, reading …

MIHO: Te adora, Anton.

FRUMKIN: Te adoro, Maria.

RECORDING: There’s a place for us...

SUSAN: They’re big on arts therapy at Bellevue, especially on the TB ward. They say it helps the detainees pass the time, discuss issues that are bothering them, and explore deeper problems. After the show, lead arts therapist Irene Rosner David asks the TB detainees whether they think they’ll “find a new way of living.” A woman we’ll call Susan isn’t so confident about her prospects.

SUSAN: It’s like mourning. I’m in mourning because heroin was my husband, you know. It was my life -- the only thing that comforted me and consoled me. And it’s like losing part of me.

REPORTER: Before Susan came, she was getting substance abuse help, and, at the same time, was also ordered to treat her TB with what’s called Directly Observed Therapy, or DOT. That’s when someone from the Health Department comes and watches you take your drugs every day for 6 to 24 months. If you don’t, they can put you in Bellevue for that full period. Susan felt herself slipping back toward shooting heroin.

SUSAN: So I just didn’t comply with the DOT program. This way, I’d have some kind of security here, and give me a little bit of space, until I can really get my feet more firmly planted.

REPORTER: Health Departments around the world offer DOT, because it’s so hard to take daily drugs for so long -- and so easy to skip them. People start feeling better, so they give up. Then, they’re asking for trouble: there’s a good chance they’ll once again get active, infectious TB. Maybe even drug-resistant TB. And then, once again, just by coughing, they can spread it -- especially to those living in close quarters with them. Health officials don’t want to wait for this to happen. So what they do in New York, and a handful of other places, is lock people up – not just those who are contagious, but those who are just potentially contagious. That’s the part that takes so long – curing people not just to the point they’re no longer sick, but to the point they can’t re-lapse. Dr. Eric Leibert at Bellevue says detention is a last resort.

LEIBERT: Before a patient is detained, they’ve been educated about TB: what it is, how it’s transmitted, how they can avoid infecting others. They’ve been offered opportunities to take their medication in dramatically less restrictive ways.

REPORTER: Holding people for TB and other illnesses has a long history, but in modern New York, it goes back to the early 1990s, when TB emerged alongside the HIV-AIDS epidemic. The city’s T.B. rate is now down by 75-percent since then, though it’s still more than twice the national average. So is detention still necessary? Dr. Sonal Munsiff, the city’s TB chief, says the city needs to be able to forcibly hold people up who repeatedly drop out of D.OT. – and needs the threat of lock-up for lots of others who might.

MUNSIFF: They know that’s the next step. They are clearly told if they do not complete the treatment, they can be detained. Then a lot of them realize: This is serious, and most of them actually finish treatment.

REPORTER: T.B. for almost everyone here is just the latest way their life has gone off the rails. Many of the Bellevue detainees have drug addictions or other psychiatric and behavioral problems. Some are homeless. Hector Garcia has spent 17 years of his life in various prisons for different crimes. He’s been here four months, and says the boredom can be pretty overwhelming.

GARCIA: We’ve got a pool table. We’ve got a computer. We’ve got all kind of games. But after a while, you get bored, doing the same thing, the same thing, the same thing.

REPORTER: At a quick glance, the TB area looks like your average hospital ward. There’s a nurse station. Some rooms are open. Some are closed. Staff members and patients walk by. But you start to notice differences, like the I.D. you need to come and go, the security officer guarding the corridor outside the ward, the orderlies inside the ward guarding some of the closed isolation rooms. Garcia says it’s better than prison – except for the food, that is. But you wouldn’t want to end up here.

GARCIA: They give you candy. They give you a lot of things in here – but it’s nothing compared to freedom.

REPORTER: Patients get those candy bars -- or Chinese food or visits to a roof deck -- when they take their daily medicine and behave well. They lose their privileges, when they act badly, And they do occasionally lash out, though generally more with words than violence. They’ve also been found smuggling in cocaine and paying for sex with money. They bring their problems from the outside world into the TB ward with them. And Nurse case manager Pat Kunka says Bellevue tries to help them improve on lots of different fronts.

KUNKA: TB is kind of like the impetus to get you to the hospital, but it’s not going to kill you. All of the other behavior and all of the other illnesses that they have might. We get our substance abuse referral people involved. We have psychiatry come and talk to them. We have psychologists come and talk to them.

REPORTER: But Kunka says patients have to want to tackle their problems. Legal Aid Society lawyer Mary Beth Anderson, who represents every detainee, says it’s not so simple. She says several of her clients are not getting the thorough drug and alcohol addiction treatment they were promised.

ANDERSON: If they offered a more structured regimen of drug and alcohol regimen, they might be able to ascertain who would be more likely to both abstain from their substance of choice and complete treatment, and they may be able to give early release to more people -- and they would also save the tremendous inpatient cost.

REPORTER: TB patient Hector Garcia hopes he’ll be able to get out early – October, instead of December. He’d like to get a job, one with a social purpose. Garcia says he has a certificate as an HIV educator and would like to pursue a career as a counselor.

GARCIA: [So I can] help people, especially young people, like that so they can not go through everything that I go through in my life.

REPORTER: There’s no way to gauge how likely it is he’ll succeed. The odds are he’ll beat T.B., though a very small number do re-lapse or die of something else during or not long after treatment. But Bellevue has no figures on its success rate for curing social and psychological ills among the TB patients who spend long months in the historic hospital. Those take much more than a series of pills to cure.

LINKS:

New York City Health Department Bureau of Tuberculosis Control
U.S. Centers for Disease Control Division of Tuberculosis Elimination
NYC Dept. of Health TB comic book (pdf)