Future of Olive View TB Ward in Doubt

photo courtesy LA County Supervisor Zev Yaroslavsky's blog

This post originally appeared on the website of LA County Supervisor Zev Yaroslavsky:

Los Angeles County is spending more than $16 million to build a dedicated tuberculosis ward that also could serve as a treatment center to isolate victims of a bioterrorism attack.

But something’s missing: people to staff it.

With construction on the ward almost done and an opening to the public possible by January, 2011, there’s been no appropriation of the $2.4 million it would take to operate the facility in its first six months. The project is part of the effort to build a new emergency room at Olive View-UCLA Medical Center, at an overall cost of $53.2 million.

A lot has changed since the project to build the ward was launched in 2004. Tuberculosis cases have continued a steady decline while money’s gotten a lot tighter, with the county Department of Health Services now facing a $400 million deficit in the coming fiscal year.

The health department did not include a request to staff the unit as part of its 2010-2011 budget proposal “because of the fiscal issues at the moment,” said the department’s interim director, John F. Schunhoff.

Still, two supervisors—Zev Yaroslavsky and Michael D. Antonovich—have indicated they want to make sure there is funding to get the unit up and running when final changes to the county budget are made in September. Both Supervisors have advocated for full funding by including the TB ward’s staffing in their “unmet needs” lists submitted as part of the budget process. (For all the supervisors’ full lists, click here and scroll down.)

Unless funding is found, the 15 new Olive View isolation rooms will likely sit idle. That, in turn, could place pressure on hospitals elsewhere in the system, which must provide bed space to some infectious TB patients until they are medically cleared to leave.

Consolidating TB care in one facility would be an efficient way to make day-in, day-out use of a facility that would have an important mission during a disaster like an anthrax attack, said Carolyn Rhee, chief executive officer of the county’s ValleyCare Healthcare Network, which includes Olive View. The ward also would free up isolation beds at other county facilities for patients who need them.

The county hospital system currently has 295 isolation rooms—in which negative air pressure keeps infectious airborne particles from spreading beyond their walls.

Schunhoff noted that a dedicated facility could offer better care to TB patients because of its specialized nature. However, facilities to treat the disease—once widely feared and commonly known as consumption—have become increasingly rare, as noted in this recent New York Times article about a Florida facility that is the last of the country’s original TB sanitariums.

Los Angeles County lost its only dedicated tuberculosis ward when High Desert Hospital in Lancaster closed to inpatients in 2003. Olive View itself started off as the county’s tuberculosis sanitarium when it first opened in 1920.

But times have changed. In a June 7 letter to supervisors, County Chief Executive Officer William T Fujioka said the years-long decline in TB cases means that the number of patients eligible to be transferred to the new Olive View facility, which would have a capacity for 30, “is calculated to be as low as 6 and rarely more than 12.” The letter estimated that the county would receive some reimbursement from Medi-Cal or Medicare for treating a majority of the patients but said that would not be enough to offset the costs of operating the facility.

TB Cases and Rates in LA County 1990-2009
TB Cases and Rates in LA County 1990-2009

Tuberculosis, which preys on people with weakened immune systems, was on the rise during the worst years of the HIV epidemic, hitting a peak of 2,198 cases in Los Angeles County in 1992. As the HIV crisis was brought under control, TB steadily declined, with 706 cases reported countywide last year.

Public health officials say that’s good news—but no reason to be less vigilant about a disease that infects one-third of the world’s population and kills nearly two million people a year. “When I trained at County Hospital in the ‘80s [when the AIDS epidemic was raging] people died left and right, like flies,” said Dr. Rashmi Jan Singh, assistant director of the county’s Tuberculosis Control Program.

“It’s still around, and just waiting for opportune conditions to create problems.”

So vigorous efforts are needed to keep TB in check, including making sure that patients continue treatment long enough to get well and avoid infecting others.

That can be a challenge, particularly when dealing with homeless people with substance abuse problems, who are among those likely to contract TB in Los Angeles.

“It’s really complex,” Singh said. “Patients take off to use drugs, to use alcohol. We have to bring them back.”

The disease is curable, but patients with active pulmonary tuberculosis must remain isolated until they are no longer infectious—which can present a problem both for the public health workers trying to make sure they take their medicine and get well, and for the hospitals that need that bed space for acutely ill patients.

Most hospitalized TB patients can leave the hospital once the acute phase of their treatment is concluded, and finish taking their medicine at home. But that’s not an option for some, including the homeless and those who live with small children and people with compromised immunized systems, like those with HIV and diabetes, who are most vulnerable to the disease. For them, an extended hospital stay is often unavoidable.

And even now, with effective treatments available, the disease can take a devastating toll.

“Its social impact is sometimes incredible,” Singh said, recalling a case in which a 28-year-old woman who hadn’t acted on her symptoms early enough died after spending weeks in intensive care at Olive View. The woman’s 10-month-old baby was infected as well, but survived and is still being treated.

“It devastated this family,” Singh said.

So from Singh’s vantage point, a dedicated TB ward at Olive View would be an invaluable weapon in an ongoing war.

“For us, as TB control,” she said, “it would be a great thing.”

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