TUBERCULOSIS: New Yor City, Board of Health rules

The city’s Board of Health passed a regulation Tuesday strengthening the city’s control over the treatment and monitoring of tuberculosis patients.
The regulation requires hospitals and other health care centers to consult with the Department of Health and Mental Hygiene at least 72 hours before discharging tuberculosis patients, and to wait for the department to determine that the patient is not a danger to public health before letting the patient out of the hospital.
It also requires doctors to submit treatment plans for new patients within one month of beginning treatment.
The new regulations are intended to help the city make sure that patients take their required course of medication, usually for six months, even after they are feeling better, said Dr. Chrispin Kambili, assistant city health commissioner in charge of tuberculosis control.
When patients fail to finish the course of medication, Dr. Kambili said, the disease can become drug resistant and much more difficult and expensive to cure.
“When patients who have unstable situations get discharged, they can get lost,” he added. “Patients in homeless situations, patients living with friends — no one really knows where they went. When they reappear, they may have infected more people because they weren’t on treatment.”
He said the city provides free medication as part of its monitoring program.
Although there is a global tuberculosis epidemic, Dr. Kambili said, New York City’s tuberculosis cases are at their lowest — 760 in 2009 — since the city began counting them in the 1800s. The number has declined by a third since 2003, when the city had 1,140 newly reported cases.
But Dr. Kamibili said that those who do have TB, primarily immigrants who bring it from other countries, are going to private doctors rather than to hospitals and clinics — perhaps, he theorized, because of some cultural mistrust of authority and institutions.
This makes new TB cases much harder to track, he said, and also means that the doctors treating those patients may not have the experience they need to give them the most effective treatment.
“Now a lot of tuberculosis care is being provided by private physicians in the neighborhoods where people live,” he said,”and some providers may not actually have the experience that we would like people to have.”
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