Brewster school district TB testing singles out migrant workers' kids

Action taken without state, county consultation

Kevin Graman
Staff writer
February 8, 2006

The school district in Brewster, Wash. – already named in a federal civil rights lawsuit brought by the parents of Latino students – now has singled out the children of migrant workers for tuberculosis testing as a condition of enrollment, without consulting state or county health officials, according to those officials.

Selectively testing one population is not standard practice, especially when no one shows symptoms of tuberculosis, said Dr. Kim Thorburn, Spokane County health officer.

"If you are insistent (on testing), it should be all students," Thorburn said. "There are all these policy considerations that should have been worked out. It's just not the way we do TB control."

Concerned about October news reports of a case of tuberculosis at Coeur d'Alene High School, Brewster school Superintendent Jim Kelly kept at least four students who tested positive for tuberculosis out of school "until a doctor can assure us in writing that they do not actually have TB," according to a Jan. 17 e-mail Kelly sent to Kim Field, tuberculosis program manager for the Washington Department of Health.

Kelly wrote Field that "13 of my migrant students" were tested, and seven tested positive. Of those, three students had transferred to another school district, leaving four in the Brewster district. It's unclear whether more than the 13 have since been tested.

"I assume we will get letters from doctors indicating it is safe for these students to return to school," Kelly wrote. "If so, we may not have a problem. If not, what steps should we be taking in order to protect the rest of our students? Notification of parents? Testing of all students?"

The testing, apparently done by a local health care provider, occurred without consulting either the Department of Health or the Okanogan County Health District, Field said. Only migrant students were tested.

Kelly was out of town on Tuesday and unavailable for comment. Brewster school board member Dina Divas declined to comment other than to say, "We are testing."

According to Kelly's e-mail to the Department of Health, 80 percent of the Brewster School District's student body is Hispanic and 40 percent are the children of migrant workers.

Mexico has a higher tuberculosis rate than the United States. For this reason, Mexican children often are inoculated with the Bacillus Calmette-Guerin, or BCG vaccine, which can cause skin tests to read positive. According to the Spokane Regional Health District, there are other reasons for false positives, and a positive test does not mean an individual has active tuberculosis or can infect others.

More than 30 students, faculty and staff of Coeur d'Alene High School showed positive reactions to tests after a student was hospitalized with an active case of tuberculosis believed to have been contracted outside the country, The Spokesman-Review has reported. None of those has shown symptoms of the bacterial disease, and none was kept out of school.

In a follow-up telephone conversation with Field, Kelly spoke of steps the Brewster School District took to protect its students against tuberculosis. Field summarized the conversation in a Jan. 19 e-mail to other public health officials including Thorburn:

"Community members raised the issue of concern for TB when they heard about the Idaho student."

"The school decided to screen all migrants (from Mexico)."

"This individual (Kelly) excluded all the students from school initially – and said they had to be released back to school."

"The individual went to our DOH Web site to 'learn' about TB and discovered the difference between infection and disease."

"He stated he has allowed the children to return to school unless they 'have symptoms.' "

"He stated that as a school district they will continue to screen all migrant children for school entry."

Field said that she thought Kelly called to say he had reversed his decision to continue screening, but that was not the case.

"I referred him to the local health officer and local health department," said Field, adding that Kelly still had not notified the Okanogan County Health District.

"I was a little upset that we weren't notified," said Lauri Jones, public health nurse for the health district.

Jones said she knew of no other school district in Okanogan County testing students, but that Brewster has the largest Latino population in the county.

Field, who has been with the state's tuberculosis program since 1993, also said such testing is not standard practice in Washington state. Because positive tests for TB are not required to be reported under state law, the Department of Health has no record of who was tested or who did the testing.

None of the district's three clinics contacted by The Spokesman-Review provided the tests, according to their spokespersons.

The Brewster School District, Kelly and high school Principal Randy Phillips were named as defendants in a civil rights lawsuit filed in U.S. District Court in Spokane in October. Eight Latino parents allege the district discriminated against their children by singling them out for disciplinary action not imposed on non-Latino students.