From: Haddad, Maryam (CDC/OIDjNCHHSTP)

Sent: Friday, November 18, 2011 2:04 PM

To: Grant, Gail B. (CDCjOIDjNCHHSTP); Walton, Wanda (CDCjOIDjNCHHSTP); Fraire, Maria (CDCjOIDjNCHHSTP);
Ruggiero, Dan (CDCjOIDjNCHHSTP); Keller, Jimmy R. (CDC doh.state.fl.us) Cc: Cavanaugh, Joseph S. (CDCjOIDjNCHHSTP); Mitruka, Kiren (CDC/OIDjNCHHSTP); Powell, Krista (CDC/OID/NCHHSTP); Navin, Thomas R. (CDCjOIDjNCHHSTP) Subject: RE: Release of Epi-Aid exit meeting slides with preliminary findingsjrees FSEB and CEBSB colleagues, (Should we involve Jennifer Horvarth or our OGC?) I haven't thought through all this properly, but I would want to point out that the attached presentation was *not* our trip report but rather a preliminary set offindings given in an exit meeting, so that should probably be clarified within Florida. The actual trip report sent to the state health department is attached. At the end of the day, it is Florida and Duval's decision, but it seems to me that a better approach might be to sit down with the reporter to provide her as much education as possible about the county's general approach to TB control and then figure out what additional information about these specific situations she still wants, then reconvene internally to figure out what is appropriate to divulge (such as a list of basic findings, like the epi curve, and the steps the county took in response, perhaps). There is no point in being evasive, but forwarding a bunch of internally intended documents (and difficult to interpret without a TB or epi background) --- not to mention the patient confidentiality issues --- is not the answer, either. I agree that this represents a rare opportunity to work with a veteran reporter to educate the community about the wonderful work that Duval County's TB program does. From CDC's perspective, OGC has previously explained to us in other similar situations that exit meeting materials are "pre-decisional" and not considered FOIA-able (if a FOIA request were sent to CDC). The trip report, on the other hand, did complete CDC clearance before being sent to the state, and is FOIA-able. However, even if we were to receive the FOIA request, we would be legally able to (and would) suppress the trip report's identifiable sections, such as appendix B. Exit meeting slides 3 and 4 show locations with pretty close geographic resolution, which might lead to inadvertent disclosure ofTB patient identities. In the trip report, appendiX B is definitely worrisome in terms of identifiable data. The manuscript that Sean, Krista, and Kiren wrote with Ozzie, Kevin, Aaron, and Cynthia, "An Outbreak of Tuberculosis among Adults with Mental Illness," was recently accepted by the American Journol of Psychiotry. I'm not sure what the publication date is. It does a great job of describing the outbreak and the response without going into patient identifiers. Once that is published, that would be the sort of report that I'd rather point the reporter to. Although the name of the facility is in neither the trip report nor the exit meeting presentation, the reporter from Folio Weekly mentions it in her email, so there is enough information in the trip report (particularly appendix B) about individual patient characteristics that their identities could, conceivably, be inadvertently divulged to the public. They already deal with so much stigma from mental illness: do the public health authorizes involved really want to be responsible for adding to that burden by talking openly about noncompliance, what percentage had HIV infection, drug dependence issues, and so forth? i don't know whether it makes any difference in county/state communications and decisions about this matter, but the trip report was addressed to the state, not the county, and CDC Epi-Aid was officially invited by the state epidemiologist. So far the reporter is only addressing questions toward the county, and she has not mentioned or requested wanting to see any state or CDC reports. My preference would be not to share more details than necessary, particularly when patient identities are at stake. The slides and trip report also list many recommendations from CDC, and the county and state would be setting itself up for additional questions about whether and how each one was addressed.
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CEBSB's perspective? Thanks, Maryam

From: Grant, Gail B. (CDC/OID/NCHHSTP) Sent: Friday, November 18, 2011 12:39 PM To: Waiton, Wanda (CDC/OID/NCHHSTP); Haddad, Maryam (CDC/OID/NCHHSTP); Fraire, Maria (CDC/OID/NCHHSTP) Cc: Ruggiero, Dan (CDC/OID/NCHHSTP); Grant, Gail B. (CDC/OID/NCHHSTP); Keller, Jimmy R. (CDC doh.state.f1.us) Subject: Release of Epi AID reportlFL Importance: High
AIIJimmy sent this while I was in travel status I spoke with him today, and he indicates that while Duvall county (Jacksonville) would like to release this Epi Aid report, the state will advise the county to hold back on this. See e-mail traffic below.
I indicated that I would share this e-mail with you for your information and also for the purpose of you weighing in. I am copying our senior PHA, Jimmy Keller (assigned to state office, FL), on this e-mail.

Thanks, Gail

From: Keller, Jimmy R. (CDC doh.state.fl.us) Sent: Wednesday, November 16, 2011 5:42 PM To: Grant, Gail B. (CDC/OID/NCHHSTP) Cc: Keller, Jimmy R. (CDC doh.state.fl.us) Subject: FW: tuberculosis data Importance: High
Gail, the attached report is a draft prepared by the CDC Epi-Aid team in 2009 when they were in Duval County providing technical assistance for an outbreak investigation. As can be seen by the bottom email, a media organization is asking for information about the 2009 investigation and the current outbreak investigation involving the homeless population in Duval County. Duval County legal counsel is leaning toward providing the attached draft document to the media based on the idea that it is releasable under FOIA. I have asked Duval County to hold off on releasing the document or data and until CDC has advised on the matter and whether CDC staff names should be redacted before release, etc. So, please advised. Thanks, Jimmy Jimmy R. Keller, DHSc Senior Public Health Advisor Deputy Chief, Bureau of TB and Refugee Health Division of Disease Control Florida Department of Health Phone: 850-245-4311 BlackBerry: 850-251-4621 Fax: 850-921-9906 E-mail: jimmykeller@doh.state.fl.us Under Florida law, e-mail addresses are public records. If you do not want your e-mail address released in response to a public-records request, do not send electronic mail to this entity. Instead, contact this office by phone or in writing.