Identifying patients with tuberculosis and then ensuring those patients complete treatment is a longstanding public health problem. An Alabama county health department’s decision to pay patients to be screened and treated reignited national interest in TB patient screening. We asked public health experts Ray Barishansky and Catherine Counts to debate, from an EMS perspective, this controversial decision. Make sure to read Catherine Counts’ view and share your thoughts in the comments.
By Raphael M. Barishansky
A tuberculosis outbreak has caused the Perry County, Alabama, Health Department to take an interesting approach to testing, and possible treatment, by offering money to patients who complete TB screening and treatment.
Obviously, there are elements of this newsworthy story that may not have been reported, but there are several questions that immediately come to mind. These questions include:
- Has the county health department exhausted all other public health remedies to assure these patients are tested and/or treated?
- Have the public health officials thought of utilizing their emergency powers, which the vast majority of state and local health departments have codified in statute, to get this campaign accomplished?
- Have EMS providers been utilized as an additional resource for identifying patients suspected of TB for screening?
- Has a quarantine been proposed for the exposed or isolating the ill been explored?
The move to pay people, although well intentioned, sets the worst type of precedent in public health. What’s next, paying the public to become vaccinated against seasonal influenza?
Then what happens when a pandemic or epidemic, such as H1N1 occurs, and we need herd immunity to protect the general public, but we have conditioned that same public that they need to be reimbursed for vaccination?
Most state and local health department’s budgets have seen significant reductions in recent years. With additional reductions expected, can public health departments absorb this additional financial hit? And what happens when they simply can’t afford to pay people to become tested and/or vaccinated and the people then refuse?
There are downstream consequences here to consider as well. For example, this could financially impact other public health programs such as maternal and child health or epidemiology and disease control.
I am aware of the significance of a TB outbreak and the potential implications on the remainder of the community. I just feel that this is a move that should only be taken when all others have been exhausted and, even then, very carefully.
About the author
Raphael M. Barishansky, MPH, MS, CPM, is a solutions-driven consultant working with EMS agencies, emergency management and public health organizations on complex issues including leadership development, strategic planning, policy implementation and regulatory compliance. He has previously served as the Director of the Office of Emergency Medical Services (OEMS) at the Connecticut Department of Public Health.
He has a Master of Public Health degree from New York Medical College and a Master of Science in Homeland Security Studies from Long Island University. He has also earned a Certified Public Manager (CPM) certification through Arizona State University. He is a regular contributor to EMS and homeland security publications, as well as a frequent speaker at regional, state and national EMS and Public Health conferences.