State officials defend handling of hepatitis A outbreak as an additional warning is revealed and legislators voice concern

Health Secretary Adam Meier (center) led a March 1 news conference on hepatitis A. Sen. Ralph Alvarado (left) and Sen. MorganMcGarvey (right) have want to examine the state’s response to the outbreak. (Facebook Live image)
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By Melissa Patrick
Kentucky Health News

State Cabinet for Health and Family Services Secretary Adam Meier called a news conference on March 1 to discuss the state’s hepatitis A outbreak, and spent most of the time criticizing news-media coverage, mainly the Louisville Courier Journal‘s investigation that revealed state health officials had rejected expert advice to mount a stronger response.

Since the outbreak started in August 2017, more than 4,200 Kentuckians have been diagnosed with  hepatitis A, a highly contagious liver disease; more than 2,000 have been hospitalized because of it; and 43 people have died from it. The primary risk factors remain illicit drug use and homelessness.

“I am proud of our coverage and pledge to continue our investigation,” Green wrote. “Kentuckians count on us to do that. The Courier Journal’s reporting has been fair, comprehensive, balanced and most important, accurate. We stand by our stories.”As part of a series of articles about hepatitis A, Courier Journal reporters Laura Ungar and Chris Kenning reported that Dr. Robert Brawley, then chief of the state Department for Public Health’s infectious-disease unit, called for an aggressive response to the outbreak, including $6 million for vaccines and $4 million for temporary workers, plus declaration of a public-health emergency as a way to get more federal assistance.

Instead, Dr. Jeffrey Howard, commissioner of the department, sent $2.2 million to local health departments and did not declare an emergency. He told the Courier Journal that “he was willing to seek more funding if needed,” the paper reported. It also quoted Meier’s support of Howard’s decisions.

Howard told the newspaper, “I wish I would’ve been more bold and said, ‘Let’s move into Eastern Kentucky,’ as opposed to waiting.” He sent all state legislators a letter Feb. 28 to, as he wrote, “provide accurate context for a situation that certainly deserves attention, but has been badly misrepresented.”

At the news conference, Meier said the Courier Journal didn’t report positive comments it received about the state’s handling of the outbreak because they did not line up with a narrative the newspaper had chosen. He said the paper implied, by saying Howard is 31, that he was not competent.

Local health directors defend their commissioner

Meier read comments from several local health-department directors praising Howard’s response to the outbreak. Some said they had given the paper positive comments about the state’s response that weren’t used. The letters dealt mainly with help the state gave them, not the state’s overall response.

Scott Lockard, public-health director for Kentucky River District Health Department, which serves seven Eastern Kentucky counties, a region that has been hard-hit by the outbreak, said he was among those who made such comments that weren’t included.

Lockard wrote, “It is easy to try to place blame on Commissioner Howard for a response that has been less than what some people would … like to have seen. However, I believe Dr. Howard has shown model leadership during this time. The breakdown in the system is a result of many years of underfunding, increasing pension costs, and the erroneous belief that the Affordable Care Act would address our public-health concerns.”

In an article about the state’s complaints, Courier Journal Editor Rick Green said the paper had conducted an extensive investigation into the crisis and “had numerous conversations with state officials, and we’ve gone to great lengths to share their opinions and insights.”

Hours after the news conference, the CJ published another article reporting that the nurse who ran the state’s hepatitis program had urged Meier, the cabinet’s general counsel and the office of Gov. Matt Bevin to “be more aggressive in tackling the outbreak.” She recently quit. The story also reported that the official who gave the first warning, Dr. Robert Brawley, was fired but allowed to resign.

Lawmakers voice concern

Then the paper reported that U.S. Reps. Hal Rogers of Somerset and John Yarmuth of Louisville voiced concerns about the state’s response.

Rogers (Courier Journal photo)

“I am disappointed by reports that clear warning signs and serious alarm bells were not heeded sooner,” said Rogers, a Republican who represents the 5th District, which “is being pummeled by the nation’s largest outbreak of hepatitis A,” reporter Ungar wrote.

Yarmuth, a Democrat from the 3rd District, said “I’m grateful for the Courier Journal’s work to help shine light on this situation, and I hope state officials will take ownership in getting to the bottom of what went wrong to ensure additional lives are not put at risk.”

Two state senators, Republican Ralph Alvarado of Winchester and Democrat Morgan McGarvey of Louisville, filed a resolution to examine the state’s response to the outbreak and appeared at the news conference with Meier. Alvarado is Bevin’s running mate for lieutenant governor.

“We need to find out what happened, why it happened, and to make sure it doesn’t happen again,” said McGarvey, who has a journalism degree. “I didn’t come here today to bash the media. I do know I wouldn’t be aware of this problem if it weren’t for reporting and putting it on the front page of the paper.”

Broader issues

Amid the questioning and finger pointing, health officials seized the opportunity to call attention to the importance of public health and prevention, noting that drastic funding cuts since 2008 have resulted in staff reductions that impact how they are able to respond to public health threats.

They also said that if the state’s pension crisis is not resolved, the resulting payments required form local health departments have potential to force half of them to close in the next two years.

Lockard said, “If there are lessons to be learned from this hepatitis A outbreak, we must invest in prevention to prevent something like this from impacting us again.”