Microsoft word - multidrug resistant tb

Hey! We just landed…
…exposed to tuberculosis!

The infected international traveler was detained at Detroit Metropolitan Airport (DTW) by US Customs
and Border Protection officers from the US Department of Homeland Security and CDC Quarantine Station
staff in Detroit (a division of Global Migration and Quarantine). He was placed in isolation at Oakwood
Annapolis Hospital (Oakwood) in Westland.
The Disease Control manager from the Wayne County Department of Public Health (WCDPH) was notifiedthe moment the patient was contained. WCDPH immediately served the federal quarantine order to keep theman hospitalized for 72 hours.
Under the Public Health Code Chapter 333.2453 Epidemic; emergency order and procedures; involuntary
detention and treatment, Section 2453 (1) if a local health officer (HO) determines that control of an
epidemic is necessary to protect the public health, the HO may issue an emergency order to prohibit the
gathering of people for any purpose and may establish procedures to be followed by persons, including a
local governmental entity, during the epidemic in insure continuation of essential public health services
and enforcement of health laws. A local health department or the Department may provide for the
involuntary detention and treatment of individuals with hazardous communicable disease in the manner
prescribed in certain sections of the Public Health Code.

As such, the MDCH’s TB program manager, Oakwood’s Medical Director, WCDPH’s Health Officer andcourt counsels, the State of Michigan, and the US Centers for Disease Control collaborated to issue a courtorder to ensure that the man remained hospitalized at Oakwood until medically certified for discharge.
Oakwood’s Medical Director oversaw the patient’s inpatient therapy. The WCDPH Directly ObservedTherapy (DOT) nurse regularly monitored the medication/treatment regimen to ensure adherence to the correcttherapy. (The World Health Organization [WHO] now strongly advocates the use of DOT, to ensure that thepatient is seen swallowing their medication by a trained individual.) DOT monitoring also ensures thatpatients take the prescribed medications for the appropriate periods of time, thus, greatly reducing a drugresistance strain of TB.
The DOT nurse collaborated on a regular basis with the WCDPH’s Disease Control manager, programsupervisor, and Oakwood’s Medical Director. Meetings/communications, on cohort review, occurredfrequently between WCDPH’s DOT nurse and Disease Control Manager, MDCH, Detroit Quarantine Stationstaff, Custom Border Protection officers, and Oakwood medical staff.
Upon discharge (after being hospitalized for 7 months and over $350,000.00 spent) and relocation to aCalhoun County holding/detention facility, an on-site visit was made by the WCDPH DOT nurse to certifythat the patient was transferred with correct medication dosage/regimen, which will result in therapycompletion.
A month’s worth of medication was provided by WCDPH to the patient. Many countless hours were spent bythe WCDPH staff and Oakwood, managing the case and taking precautions to ensure this patient’s safety andtransition into the general population.
P.O. Box 13276 * Lansing, Michigan 48901* 426 South Walnut * Lansing, Michigan 48933 * (517) 485-0660 * (517) 485-6412 Fax Estimated Medical Care Costs Associated
with Treating Antibiotic Resistant Tuberculosis
3. Cycloserine (Seromycin 250mg x2 daily) *Supplied by Lincare; awaiting COBRA for billing $ 4,909.35
LinCare Visiting Nurses weekly home visits $9,200.00
*Lincare Infusion Company supplies Capreomycin,IV supplies and PICC line maintenance *$4500-4600 biweekly; awaiting COBRA for billing 3. Cycloserine (Seromycin 250 mg x2 daily - 4. Capreomycin (Supplied by Lincare awaiting COBRA for billing)5. PAS (Paser granules 4gm x2 daily - $1,650.59
Grand total of current expenditures (excluding 3 day hospital stay) Two weeks of visiting nurses outpatient care: Discharged medication cost for one month supply: $9,509.35
Grand total of anticipated monthly expenditures:Visiting nurses outpatient care: Medication cost (ordering from ICHD supplier Amerisource) $10,850.59



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Post-operative instructions

Benjamin Domb, M.D. Discharge Protocol for Hip Replacement and Resurfacing • Take 10 deep breaths each hour • Get up and walk every hour. Walk as much as possible. • Use walker only as needed. Progress to full weight-bearing as quickly as • Keep incision dry until 5 days after surgery. Then may begin showering. • Do not bathe or swim until incision completely healed.

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