According to a series of emails obtained Friday by the Associated Press, Indiana health officials knew a week before notifying the public that six clinics in the state received a tainted back pain medication linked to a nationwide outbreak of fungal meningitis.
The AP public records request resulted in the release of documents, including emails indicating that officials at the Indiana State Department of Health were racing to keep up with information as the disease rapidly spread.
As Amy Reel, a spokesman for the state health agency, told the Associated Press, “A lot of new information was coming in regularly over the weekend of September 29 and 30 from the Centers for Disease Control and Prevention as the situation began to take shape.”
Randy Snyder, acute care director for the agency, wrote in an October 3 email to other state health officials, “This is a fast breaking and fluid situation.”
On the night of September 28, the emails reveal the CDC informed officials at the ISDH it was investigating a cluster of fungal meningitis cases in Tennessee and North Carolina that it suspected were connected with injections of a contaminated steroid. An attachment to the email identified the six Indiana health facilities known to have received the suspected medication from a Massachusetts specialty pharmacy, which has since recalled all its products and shut down.
The CDC email also urged state health agencies to contact those clinics receiving the contaminated steroid, and to monitor patients for signs of meningitis symptoms. The six Indiana clinics receiving the tainted steroid are located in Elkhart, Evansville, Fort Wayne, South Bend, Terre Haute and Columbus.
On Saturday, September 29, Snyder sent an email stating that he had received no reports of meningitis cases. That same morning, state epidemiologist Pam Pontones sent an email to CDC intelligence officer Rachel Smith that said, “We’ll focus on contacting the facilities on the list first.”
“We’ll contact the patients,” Kristi Williams, pharmacy director at Union Hospital in Terre Haute, told state health officials in an email the following Monday. That same day, October 1, Snyder said in an email that the state health department had contacted by phone and email all six of the health facilities that received the tainted lots of medication. The agency also distributed a “script” for the clinics to read from when notifying patients who may have been exposed.
Reel said Indiana and other states didn’t receive data defining how to recognize cases that would be considered part of the outbreak from the CDC until October 2, and the state agency immediately alerted physicians.
“It’s critical physicians are made aware of signs and symptoms prior to any public announcement so they can be prepared to discuss those signs and symptoms and appropriately treat patients,” said Reel.
According to documents obtained by the AP, health officials weren’t aware of any meningitis cases in Indiana as of early morning on October 4. Shortly after noon, however, they knew that one case had been confirmed and two more were suspected in the Hoosier state.
As Pontones said in an email, “One case has been identified in Indiana, and we probably have at least two more.”
That same day, the ISHD informed the six clinics that the state epidemiologist would be contacting them for a list of the patients who had received the tainted medication, and to find out how many patients the clinics had already contacted.
In the same email, Snyder told the clinics that the agency intended to announce the outbreak to the public and planned to identify the facilities that had received the contaminated steroid.
Reel said the state health agencies coordinated the release of information with a CDC press conference on October 4, the same day the first Indiana case was confirmed.
As of today, the CDC meningitis website was reporting 44 cases and three deaths connected with Indiana.