In Florida, a Lifeline to Patients With TB

As state legislators debate its future, one of the nation's remaining sanitariums for tuberculosis sustains a routine that some might view as a health care anachronism.

In a complex that once held 500 patients, no more than 50 now live in the main building at the A.G. Holley State Hospital in Lantana, Fla. An uncomplicated course of TB treatment usually lasts about six months, but many of Holley's patients have resistant TB cases requiring a longer stay.

Holley, a leader in drug-resistance studies, grapples with some of the more difficult to treat TB cases. Of 31 patients at the hospital on a recent day, seven had multidrug-resistant tuberculosis (MDR TB), including one who had extensively drug-resistant tuberculosis (XDR TB). Overall, Holley reports a cure rate of 93 percent.

Care for Holley's patients is paid mostly by federal and state programs such as Medicaid. State officials who consider the facility as too costly are considering a variety of alternatives, including privatization.

Until then, supporters of the sanitarium say the state's investment in A.G. Holley is a public health bargain.

The traditional sanitarium ethos of offering much more than just TB care helps to transform many of the patients. While they are there, many Holley patients are able to address alcoholism and other factors that complicated their lives and recovery.

"It's not uncommon, as patients get better, for them to see this as a second chance at life," said Dr. David Ashkin, Holley's medical director. "It's very spiritual and life changing to go from nearly dead to alive."

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