Fraying at the margins

The best barometer of a nation's soul is how it treats the vulnerable at the margins of society. In terms of public policy, we at least pretended to care about the poor, sick, disabled, and old during the 1960's. Times have changed. No one would accuse present day America of having any heart for those in need of protection.

Lately, our elected officials have become wolves. At a time of very high unemployment and a foreclosure crisis courtesy of the Wall Street casino, the safety net for the less fortunate is the first on the austerity chopping block. Those funds are being diverted to corporate tax breaks. Extreme poverty is on the rise with nearly 7% of the American population living on less than 50% of federal poverty line. And just for good measure, new ordinances have been passed across the nation to criminalize the poor and homeless.

The State of Florida deserves a special award for savagery. Not only has the state been a national leader in shredding the social safety net, foreclosures, high employment, capital punishment, shoot-to-kill gun laws, and criminalizing poverty, they have pioneered wanton disregard for the poor.

The official story goes something like this. Earlier this year, the state health department had evidence of an alarming spike in tuberculosis (TB) with 13 deaths and 99 currently infected, almost all from the homeless population. The same strain has been identified in all cases so there is no doubt this is an infectious cluster. Despite knowing of the problem, officials decided to close the only TB hospital in the state. Funds for the facility had been axed as part of austerity measures but was scheduled to remain open until the end of the year. So despite a sudden increase in TB cases in a population with few other medical care options, the health department closed the facility ahead of schedule. And the best part of all, state health officials kept the outbreak out of the public eye and did little to limit contact with infected people. Thanks to turfing the homeless to shelters and the criminal justice system, people with something like TB come in close contact with many other people, especially others unlikely to have been routinely screened for TB and have impaired immune function due to chronic stress and poor sanitation. Infection, meet juicy vector.

From the Palm Beach Post:

The CDC officer had a serious warning for Florida health officials in April: A tuberculosis outbreak in Jacksonville was one of the worst his group had investigated in 20 years. Linked to 13 deaths and 99 illnesses, including six children, it would require concerted action to stop.

That report had been penned on April 5, exactly nine days after Florida Gov. Rick Scott signed the bill that shrank the Department of Health and required the closure of the A.G. Holley State Hospital in Lantana, where tough tuberculosis cases have been treated for more than 60 years.

It is a little like knowing a potentially deadly hurricane is coming and doing nothing to alert the public or plan for the aftermath. Hurricanes, however, damage private property so few officials are that stupid. TB in homeless population just means death among the poor and disenfranchised.

Of course, the great state of Florida cannot explain how all this happened. Well, that is not entirely accurate. The state refuses to name the officials that fumbled the ball. Everyone is pleading ignorance.

As health officials in Tallahassee turned their focus to restructuring, Dr. Robert Luo’s 25-page report describing Jacksonville’s outbreak — and the measures needed to contain it – went unseen by key decision makers around the state. At the health agency, an order went out that the TB hospital must be closed six months ahead of schedule.

Imagine this. The U.S. Centers for Disease Control and Prevention (CDC) tells state officials that there is a serious TB outbreak and it gets lost in shuffle while the chain of command effectively follows orders from the governor's office. The TB hospital is closed and only 253 of 3000 at-risk people with known contact with TB cases have been located and screened. The public is kept in the dark from April until June when the same TB strain originally identified in Jacksonville is found in Miami. Whoops.

I suppose you could look at this situation as slash-and-burn government policy. You cut government programs and then act surprised when government agencies cannot respond to an emergency. You should see the shocked expression on my face.

Here a few fun facts about TB. You can treat it with a drug cocktail costing about $500, but it has been administered by public health nurses who can insure that it taken systematically over 6 months. If a person discontinues treatment prematurely, the infection can quickly become antibiotic resistant. Now there is a strain you absolutely do not want to see spread. And once a case becomes resistant, public health costs skyrocket into the hundreds of thousands of dollars.

State officials knew a TB outbreak in the homeless population would be difficult to treat. Homelessness, substance abuse, and mental illness tend not to improve patient compliance. And yet they closed the TB hospital and moved ahead with plans to hack up the health department. That is when it starts to feel less like neglect and incompetence and more like reckless endangerment. From the time the cases first started showing up to when CDC investigators arrived, the infection had spread beyond the homeless population.

Furthermore, only two-thirds of the active cases could be traced to people and places in Jacksonville where the homeless and mentally ill had congregated. That suggested the TB strain had spread beyond the city’s underclass and into the general population. The Palm Beach Post requested a database showing where every related case has appeared. That database has not been released.

The contempt for the poor by Florida officials is inexecusable. The TB strain (FL 046) has been on the state's radar since 2008. They knew it was a virulent strain. So when there was a sudden explosion of cases in Jacksonville, they slashed services, knowing that it was mostly confined to the homeless population. It is hard to make this sound benign. The only thing that muddies the waters is that they kept the public in the dark and allowed the disease to enter the general population. Maybe they thought it would not spread outside the homeless population or maybe they thought they could get it under control before the public found out about it. It is hard to spin the fact that the state knew a TB outbreak had already killed 13 people and yet did nothing the CDC warned them to do to contain it when it was confined to the homeless population.

Ask yourself one simple question. Would state officials have responded the same way to a deadly infectious disease outbreak in the general population instead of the homeless? Of course not. That would be political suicide.

State officials in Florida can be described as heartless and soulless when it comes to their treatment of the most vulnerable. However, these officials have satisfied some in the Christian community by passing laws to restrict abortion. It is funny how you can call yourself pro-life if you oppose abortion, yet go out of your way to harm the poor, sick, disabled, and old. The abortion rules are a perfect fig leaf for Florida governor Rick Scott who came under fire from a Christian family group in 2010 because of his investments in the porn industry.

According to this Politifact.com report Rick Scott, his family partnership and a trust in his wife’s name own 2 million shares in a company called Quepasa Corporation.

According to this Network Solutions report Quepasa Corp. owns the web site Quepasa.com which according to this May 26, 2010 Market Wire report recruits latino women to be porn models for Quepasa Playboy Mexico. Certainly, the hundreds of wom! en who are not selected by Playboy have a heightened interest in making money from porn and are subsequently more likely to be recruit subjects for other hedonistic venues. Additionally, Quepasa.com includes a section for homosexual sex partner relationship networking.

There are several morals to this story.

(1) Florida is the perfect illustration of America in decline. The state is run by callous and vicious individuals that hide behind a thin veneer of what can only laughably be called "family values."

(2) TB and mean-spirited social policy in Florida are perfect for the bicentennial celebration of the birth of Charles Dickens.

(3) When the dirty work of kicking the poor in the teeth is done by government officials, it allows the rest of us to pretend our hands and conscience are clean.

(4) Policies like those Florida are becoming the rule rather than exception across America.

(5) The mismanagement of the TB outbreak in Florida has received little national exposure beyond this Associated Press story picked up by a few outlets. It is the wrong narrative for an election year.