TB Plagues Office of L.A. Coroner

TIMES STAFF WRITER

The Los Angeles County coroner's office is battling a long-standing and "serious" tuberculosis contamination problem that has infected at least seven employees, two of them with full-blown cases of the potentially deadly disease.

The contamination, which originated in the autopsy areas and was spread because of inadequate venting systems and other problems, has forced the department to keep most people off that entire floor of its headquarters near County-USC Medical Center. Normally, scores of people move in and out of the autopsy floor every day, officials said.

Employees working on that floor must wear elaborate anti-contamination masks--even in the corridors, according to documents and interviews with state and county officials familiar with the problem.

"I would not want to work in that building if there are any safety violations--and there are . . . outstanding safety violations," said Troy Swauger, spokesman for the state Department of Industrial Relations' Division of Occupational Safety and Health (Cal/OSHA), which was called in to investigate the problem after complaints by coroner's employees.

According to Swauger and some county and state officials, workers remain at significant risk of being infected with TB if not fully clothed in protective gear.

In a recent memo to top county officials, Coroner Anthony T. Hernandez confirmed that his office "is currently battling a serious TB contamination problem in the autopsy floor area."

But his department is so overwhelmed with a growing number of bodies and a steadily shrinking budget that it hasn't been able to do anything to correct the problem permanently--even though the initial contamination occurred almost two years ago.

Hernandez said the two employees who developed tuberculosis were quarantined and treated for tuberculosis and have no current health problems. But Dr. Paul T. Davidson, director of tuberculosis programs for the Los Angeles County Health Services Department, said that even those employees who have not developed full-blown TB could do so, and that they face health risks for at least three years.

Cal/OSHA ultimately cited the coroner's department in September for a host of what Swauger described as "extremely significant" health and safety violations. They ranged from improper training and testing and failure to take proper safety precautions to a defective ventilation system that was allowing the spread of disease-carrying airborne organisms, according to citation reports obtained by The Times on Thursday.

But since Cal/OSHA cannot levy fines against another government agency, the department--and the Los Angeles County Board of Supervisors, which oversees it--have been left to correct the problem on their own timetable.

And so far, county officials have not done much to eliminate the underlying cause of the contamination except to study it and provide workers with what Swauger described as stopgap measures such as personal ventilators, masks and other forms of "full-body armor" to shield them from any more contamination.

"They have taken steps to correct the safety issues. Those employees in full-body armor are safe," said Swauger. But, he added, "they have not taken steps to correct the safety violations" that caused the contamination in the first place, such as the faulty ventilation system.

Cal/OSHA ordered the county to fix all the problems by last November, and it has not done so. "I won't speak for why it's taking them so long," Swauger said. "We're trying to make allowances as to why it is taking them so long."

In launching their intensive investigation into the contamination incidents, Cal/OSHA inspectors made several visits last year to the two coroner buildings in the shadow of the County-USC Medical Center east of downtown.

Investigators cited the coroner's office for at least eight serious violations, including failure to enact proper "exposure control procedures . . . that will prevent TB exposure, including engineering controls, work practice controls and personal protective equipment."

They also cited the department for not properly decontaminating and disposing of potentially tainted personal protective equipment; for not providing required tuberculosis testing of employees in high-risk areas such as the autopsy rooms, and for not providing employees with some "readily available" safety instructions, including how to use disinfectants that could minimize exposure to TB, the reports show.

Some respirators used by forensic technicians to prevent them from getting tuberculosis when cutting open diseased bodies were not being repaired or replaced despite wear and deterioration; one employee was observed wearing a respirator "with an exhalation valve made from the rubber of a latex glove," one report said. On several other occasions, Cal/OSHA investigators concluded that employees could not obtain replacement respirators and filters.

Hernandez and the county's chief medical examiner-coroner, Dr. Lakshmanan Sathyavagiswaran, said many of the violations have since been corrected.

In addition, most employees are kept off the secured autopsy floor just above the basement of the aging complex, and those who must enter the area are supposed to use portable ventilators and masks to make sure the air they breathe has been filtered.

Bodies that may have tuberculosis are screened before being autopsied to prevent minute particles of diseased blood, skin and bone from spreading, Hernandez said.

But the more significant problems remain, officials conceded.

Of most concern, Hernandez said, is that at least some of the autopsy saws used to cut open bodies and skulls--which Cal/OSHA said were improperly allowing TB bacteria to escape into the air--have not been replaced. And the overall ventilation system that failed to prevent the spread of those pathogens is still in place.

The coroner's office, with help from other county departments, is currently studying whether to fix the apparatus that runs all heating, ventilation and air conditioning systems in the coroner's office. But Hernandez said it may be cheaper to build an entirely new autopsy wing, which could cost in the millions of dollars.

And although he said he believes all his employees are safe for now if they wear the right protective gear, Hernandez conceded that the situation could become "a horrible problem" if allowed to continue.

But Hernandez said his department cannot correct the underlying causes of the problem without help from the Board of Supervisors and Chief Administrative Officer David Janssen. The coroner's office has been given only about $11 million a year by the county supervisors in the last two years, even though its caseload has soared to more than 19,000 bodies annually, Hernandez said. Six years ago, he said, the department had a $15-million budget.

Last year, the department was spared a $2.5-million budget cut only because of well-publicized problems that came up during the O.J. Simpson murder trial, including improper body storage.

In a recent memo to Janssen, Hernandez wrote that he was directing "a department stretched beyond its fiscal means, and a staff that can barely keep the bodies moving."

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