Who has the ultimate authority to test school children for tuberculosis when an index case is identified in a public school? That's a central question in the case of three South Carolina nurses who say they were wrongfully terminated after a tuberculosis outbreak got out of hand in Greenwood County. According to the South Carolina Department of Health and Environmental Control (DHEC), 74 people associated with Ninety Six Primary School in Ninety Six, South Carolina, had tested positive for the disease as of mid-July. (A positive result means the person has the tuberculosis infection, but it's dormant and not contagious, according to the DHEC.) Of those 74, about 55 were children. Ten children and two adults connected to the school have developed active cases of the disease.
The nurses have filed suit against the South Carolina DHEC for wrongful termination, alleging that they had asked for permission and resources to test teachers and children at the school but were put off or ignored-and then fired for not responding quickly enough. The DHEC claims the RNs placed the public at risk and violated agency rules, regulations, or policies.
Malinda Martin, the program manager for tuberculosis for the Upstate Public Health Region of the DHEC since 2008 and an employee of the agency since 1992, was fired on May 30. That firing was quickly followed by the others on June 11: Latrinia (Nikki) Richard, site supervisor for the Greenwood County Health Department, and Anne Ashley, a tuberculosis case manager with 10 years of tuberculosis investigation experience.
According to public documents filed with the court by the nurses' attorney, John G. Reckenbeil, testing the children would have "required an unlawful act without authorization" on the part of the nurses. The nurses did follow protocol, Reckenbeil told AJN, and "they were doing their jobs."
After appealing to Governor Nikki Haley to reinstate the nurses and being turned down, Reckenbeil says he is taking the cases to the "governor's boss-the people" and demanding a jury trial.
The issues. Patient privacy and parental notification were clearly issues of concern for the nurses, according to the court documents. But some would argue that the nurses could have disclosed health information because the Health Insurance Portability and Accountability Act (HIPAA) allows disclosure to public health authorities without a person's consent to prevent or control disease, and the Family Educational Rights and Privacy Act (FERPA) allows reporting of illnesses without specific parental permission in the setting of a health or safety emergency. The lawsuit, however, asserts that the plaintiffs did not have the authority to declare when exceptions to these rules could be made. Such exceptions, says Reckenbeil, can be made only by the central DHEC office in Columbia or by the Centers for Disease Control and Prevention. Compounding the situation was that there were simply not enough staff or tuberculosis tests to conduct testing, although the nurses had requested both from their superiors at the DHEC.
In response to the nurses' lawsuits, attorneys for the DHEC have filed court documents that deny "each and every allegation" made by Martin, Richard, and Ashley. And at a public hearing held by lawmakers on August 8 to examine the outbreak, DHEC director Catherine B. Templeton stood beside the terminations and maintained that the nurses "never told us they wanted to test the children."-Gail M. Pfeifer, MA, RN, news director