The Star Beacon; Ashtabula, Ohio

October 31, 2012

Ashtabula County commissioners approve more cash to cover tuberculosis cases

By CARL E. FEATHER - cfeather@starbeacon.com
Star Beacon

JEFFERSON — Extraordinary expenses associated with the diagnosis and treatment of tuberculosis cases are costing the county’s general fund nearly twice as much money as originally appropriated.

Commissioners on Tuesday approved an additional appropriation to cover patient bills that the Ohio Revised Code mandates the county to pay. The $8,800 appropriation is expected to cover all outstanding bills plus a little extra that should fund the line item through the end of the year, said County Administrator Janet Discher.

Total appropriations for 2012 are around $28,000, or nearly double the $14,500 in the original budget. Commissioners approved a $5,000 additional appropriation last week.

Discher told commissioners that the latest round of bills was largely due to the specialized care required by the patients rather than a rise in the number of cases. Commissioners contract with ACMC to provide the services, which include radiology, lab tests and the physician’s fee. The Ashtabula County Health Department serves as control unit for the cases.

Health Commissioner Raymond Saporito said there is just one confirmed active case. Because of the disease’s highly contagious nature, family members/other contacts require follow, as well. The county’s single active case has 10 contacts, Saporito said. And the county has four or five latent cases that must be monitored and treated as necessary to make sure they don’t become active.

An active case must receive “direct observe therapy” every day for at least six months. That involves having the public health nurse witness the patient take the medication each day. Saporito said the department probably provides between $75,000 and $100,000 of nursing care and other expenses to these patients.

“I want to emphasize that while the commissioners pay for the medicine and the diagnostic work, they are not paying for any of the public health nurses’ time. We’ve probably accumulated some 500 work hours this year alone,” Saporito said.

Ohio law requires commissioners to fund the tuberculosis services.

“This (mandate) stems from when it was a very specialized disease and they wanted to ensure public safety by making sure these people received the treatment they needed,” Discher said.

Even patients who have medical insurance can submit the uncovered portion to the board for payment.

“We are the payer of last resort,” Discher said. The county knows the patients only by number and reviews every bill before paying.

Saporito said that while there is only one confirmed case, that situation can “change on a dime” if one new case with multiple contacts is confirmed. Saporito said some of the extra expenses incurred by the county this year are the result of some bills that were carried over from 2011.