It's ironic that despite the myriad security measures implemented to protect air passengers from injury or death at the hands of terrorists, an ostensibly law-abiding U.S. citizen put dozens, if not hundreds of people in harm's way by proceeding with his own personal agenda and ignoring warnings from officials not to carry out his plans to fly. The danger? Not a weapon. The air passenger in question suffered from Tuberculosis. This story, filled with additional irony and a comedy of errors, would be great fodder for a humorous movie if it were not true. But the truth contained herein is indeed a horror story.

The individual, a seasoned world traveler who could certainly be considered a person of "wealth and privilege," released an emotional apology to those who flew with him on two transatlantic flights. The individuals at risk will suffer inconvenience, expense and no small amount of anxiety due to the selfish behavior of a single person whose actions demonstrated that he had not a whit of concern for the health and welfare of others but only for himself.

But I Thought TB Was a Thing of the Past in the United States?

Ask a seventh-grader what "Tuberculosis," or "TB" is, and they might not even have an answer for you. Until 50 years ago a source of dread which created hysteria among entire countries, Tuberculosis is now a treatable, preventable disease that has all but been erased from the roster of diseases affecting residents of the U.S. Sadly, Tuberculosis still exists, particularly in third-world countries, in fact, one in three persons tests positive for some form of TB worldwide.

{Change: I had, due to misinformation and poor research, described Inoculation as a form of TB prevention. Noder doyle pointed out that in fact inoculation is only used for researchers; and that TB is rather difficult to acquire unless one is exposed to a spray of sputum from the coughing or hacking of a TB sufferer who is in an advanced stage of the disease. The TB sufferer who flied was not yet coughing nor displaying other overt signs of infection when he flew - this being good news for those who flew with him.}

TB is not nearly as contagious as, for example, smallpox, which is a virus. The inoculation used for researchers will result in the person inoculated testing "positive" on the Mantoux test (the standard TB test) for the rest of their lives. Mantoux tests merely test for exposure, not active disease. Active disease is determined in a number of ways, typically by observation of a swab of sputum.

Tuberculosis in Africa and Southeast Asia was responsible for the death of a million and a half souls in 2005. The World Health Organization ("WHO") implemented an ambitious plan called "The Stop TB Strategy, the Global Plan to Stop TB 2006-2015." The most disturbing phenomena emerging on the TB horizon are the evolution of MDR-TB (multi-drug resistant Tuberculosis); the cure for which involves surgery and years of chemotherapy, and XDR-TB, a particularly virulent strain of MDR-TB which is even harder to treat, as it is resistant to all currently available TB medications.

Bacterial Terrorism?

The electronic and print news media of late May, 2007 were abuzz with questions regarding a singularly peculiar case of XDR-TB exposure. In fact, the media's attention to the case had plenty of concerned citizens wondering why, with all of the security measures in place to prevent terrorism, could a U.S. citizen with potentially infectious TB could have left the country, flown internationally (on his honeymoon) and returned via a circuitous route. This individual's strain of TB is particularly drug-resistant, to make matters worse. The number of individuals he could have come into contact with is in the hundreds. A comedy of errors and bureaucratic delays, combined with the patient's insistence on repeatedly failing to heed the instructions of public health officials, is to blame.

Andrew Speaker, a personal injury lawyer from Atlanta, Georgia was found to have TB during a routine chest X ray following an injury. His physicians took samples of blood and phlegm, and sent them for analysis. They strongly recommended that Mr. Speaker not fly and to take other precautions until the extent of his infection, and the strain of TB which infected him, were determined. Their strong recommendations, and $1.99, could get one a Happy Meal at McDonald's, legally-speaking. A doctor's admonition to a TB patient has no legal "teeth" as it were, and depends upon the assumed moral integrity of the patient to follow. This is in contrast to the cases now being heard by courts across the country in which a person with knowledge of AIDS infection can be convicted of a crime if they knowingly fail to inform their sexual partners of their health situation.

Michalak writes here in "lawyer" that "While it is popular to heap derision upon lawyers as a class they are critical to the defense of freedom." It will take a long time to discover how much derision will be heaped upon Attorney Speaker.

eliserh pointed out that there's a strong chance that Speaker committed a tort of negligence by exposing people to an infectious disease without their knowledge. (Remember, "a tort is not a cake"*...) There are many ways to construe this legally and ethically, but nonetheless, his goose is cooked from the standpoint of being open to civil actions.

*Comedian Joe E. Lewis.

Jet-Setting Against Medical Advice Does Not Constitute Breaking the Law - But A Horrific Pattern of Immoral Behavior Became Evident

Speaker had scheduled a wedding in a small town in Greece. Prior to his flight, his doctors recommended cancelling his plans to fly to Europe. Speaker opted to go ahead with the wedding plans, against medical advice but absent any legal or regulatory prohibitions. It was only after he, his fiancee and her 8-year old daughter had arrived in Europe that the severity of his condition was determined.

Again, thanks to noder doyle for pointing out that the newsmedia was wrong; TB is one of the few health conditions that will trigger a legal quarantine, executed by Federal Marshals. However, the health officials in Georgia, in concert with Speaker's own doctors, apparently assumed that Speaker would adhere to their recommendations and not fly. Had they notified the CDC, Speaker would've been put on the CDC's "no-fly" list and would not have been allowed by customs to board a plane.

The three flew to Paris on 13 May, 2007 and on to the Greek island of Santorini. Officials on Santorini stated that the couple didn't possess the proper paperwork, so no wedding occurred. Speaker was in Rome when the CDC and his doctors caught up with him and insisted he not take a flight back to the U.S., and to turn himself in to the nearest hospital capable of TB quarantine. Although no laws were broken, Speaker nonetheless opted not to seek treatment in Europe, instead focusing on getting to the United States and to a hospital in Denver which specializes in treating severely drug-resistant forms of TB.

The CDC was notified of Speaker's presence in Europe on 21 May, but it took until 24 May for the CDC to contact the U.S. Customs, who handle the "no-fly" list. Before he made it onto the international no fly list, he was able to board an airliner in Prague.

On 24 May, 2007 the three boarded a flight from Prague to Montreal. Speaker's choice to fly into Canada rather than the United States could certainly be deemed "sneaky," as screening of motor travelers at the U.S./Canadian border is generally less scrupulous than that of U.S. Customs in a U.S. airport. The U.S. airlines all adhere to a "no-fly list," which flags persons with contagious diseases prior to their boarding an airplane.

The lawyer's gamble paid off. The Border Patrol Agent who checked the credentials of those in Speaker's car ignored the computerized warning issued by the U.S. CDC. The warning instructed any Customs or Border Patrol personnel coming in contact with Speaker to don protective gear, hold Mr. Speaker, and contact the CDC. The Border Patrol Agent who ran Speaker's passport through a computer could not reconcile the dire warning on the computer with the ostensibly hale and healthy individual who'd presented him with the passport; and waved Speaker's car right through the border at Champlain, New York. The Agent has since been relieved of duty.

Prognosis is Good for Patient - But His Apology is Not Enough For Some He Flew With

Upon his return to Atlanta, Speaker was quarantined at Georgia's Grady Memorial Hospital while waiting to be transferred to National Jewish Medical and Research Center in Denver. He is now under quarantine at the Denver hospital where doctors say his chances of making a full recovery are very good. Mr. Speaker is a young man in very good health otherwise, who was found to be suffering only very early stages of the disease.

He will, however, be forced to endure weeks, if not months, of quarantine at the hospital in Denver. Speaker is the first U.S. citizen to be quarantined by the government for Tuberculosis since 1963.

Shortly after his arrival, he issued his somber apology to his co-passengers on the two airliners. "I've lived in this state of constant fear and anxiety and exhaustion for a week now, and to think that someone else is now feeling that, I wouldn't want anyone to feel that way. It's awful," he said from his Denver hospital room. The bulk of his apology focused on his insistence that he thought he posed no danger to others upon embarking on his European trip. He explained away violating the recommendation that he stay quarantined in Europe by stating that he thought that the CDC had "abandoned" him and was afraid that if he didn't get to the Denver hospital for treatment he'd end up dying at the hands of less capable caregivers in Europe.

Irony Abounds

A morbid humor can be found by iterating two common adages here: "Physician, heal thyself." and "He who represents himself has a fool for a lawyer." They refer to the two most significant examples of irony applicable to this case.

Members of a college group who flew with speaker on his flight to Paris were outraged that someone could be so careless and selfish. Had Speaker exposed an individual with a compromised immune system with Tuberculosis, the result would almost certainly have been fatal, according to the WHO. The exposure of HIV-positive individuals and AIDS patients to Tuberculosis is the leading cause of Tuberculosis mortality. At this writing, it's too early to tell if any of the passengers or flight workers planned on taking legal action against Speaker. Now, that would be ironic, as speaker's legal specialty is personal injury law; civil suits. A health law expert quoted by MSNBC stated that there are plenty of cases where the plaintiff prevailed after being infected by another person who had knowledge of his/her medical condition.

Another incredible irony in this story is that Speaker's future father-in-law is a doctor employed by the CDC, who specializes in research on Tuberculosis and other infectious diseases. The doctor made it clear that it was impossible for Speaker to have contracted the disease from him or from any other CDC employee. But this information is enough to make the coincidence spooky.

It's too early, at this writing, to answer the multitude of questions raised by this case. It's not the first time serious illness has been carried by air travelers into a foreign country (e.g., SARS). This case also brings to mind the vilification of the gay flight attendant Gaetan Dugas who was for some time named "AIDS Patient Zero" however the story of Dugas's being single-handedly (more correctly, single-penisedly) responsible for the U.S. AIDS spread among gay men in the early 1980's has now been debunked.

Air travel has indeed made the world much smaller. But not without problems that could never have been foreseen by the airlines nor any regulatory agency. Would that the international spread of disease via air travel be a figment of some science fiction writer's imagination. But it's not and is real and will be an issue of major concern to the WHO and similar organizations for some time to come.

This is also not the first time Homeland Security efforts have been foiled (intentionally or by accident). As answers to the questions raised herein are found, this writeup will be updated.

UPDATE 7/29/07: my sincere thanks to perhapsadingo8yrbaby who reminded me that "TB or Not TB: That is The Question That Foiled Homeland Security: You've probably already heard (if so, I apologize), but National Jewish discharged Speaker a couple days ago, after he recovered from surgery conducted earlier this month to remove part of a lung (illustrating the severity of his condition). Although his doctors determined that he was no longer contagious, they elected to fly him back to Georgia on a private air ambulance instead of a commercial flight. He's still on antibiotics and starting 2 years of directly observed therapy, meaning he has to take his medication in full view of a licensed health care professional every day, since he has demonstrated some problems with compliance, to put it mildly.


  • World Health Organization TB Factsheet: (Accessed June 1, 2007)
  • Investigation Into U.S. Air Passenger With XDR-TB (Accessed June 2, 2007)
  • "TB Patient: 'I Hope They Forgive Me'" Yahoo News/Associated Press:;_ylt=AsgoOXzKhp8M5r12Ao9LR3FkM3wV (Accessed June 1, 2007)
  • "Bizarre Tale of TB Traveler Reveals Border Security Gaps" Yahoo News/USA Today;_ylt=AtCKenb8CYebYZHrNdLnGRxa24cA (Accessed June 1, 2007)
  • Questions and Answers: CDC Investigation of Contacts of the Traveler with XDR Tuberculosis: (Accessed June 1, 2007)
  • Border Agent Ignored Warning for TB Traveler (Accessed June 2, 2007)
  • The Origin of HIV and the First Cases of AIDS: (Accessed June 3, 2007)