Los Angeles tuberculosis unit sees nation's toughest cases

Joe Ordaz curses the day he inhaled the infected droplet of disease that has doomed him to isolation.

“I got it from the street, from the air,” the 51-year-old said through a stiff, pink surgical mask. “I don’t know how else.”

Ordaz, who once worked in shipping and receiving in a warehouse in downtown Los Angeles, has drug resistant tuberculosis and has lived the last few months in a hospital room in Sylmar, inside one of only a handful of such TB wards in the nation. Had he become sick with regular tuberculosis, he would have been given four of 10 drugs for about six months. But because his case is complicated, the Tuberculosis Unit at Olive View-UCLA Medical Center is the only place west of Texas that can help those like Ordaz, who face a potential fatal form of the disease.

“There is a big problem with drug-resistant TB in the United States,” said Dr. Glenn Mathisen, director of the infectious diseases department at Olive View in Sylmar.

Olive View has one of the most aggressive programs in the nation where those with the toughest multidrug-resistant tuberculosis can receive treatment, Mathisen added.

But that means patients must live at Olive View for months, more than a year if necessary, since even the most potent TB drugs available may not always work at first.

“We can confine someone in quarantine until they have a (negative) smear,” he said.

That Olive View is home to one of four such units in the nation means the medical center has not only come full circle from its origins, but it plays an important role on the national public health scene when it comes to infectious diseases.

The hospital was first founded in 1920 as a tuberculosis sanitorium, at a time when the infectious disease had gripped industrialized society, hitting those who lived in crowded conditions and in big cities. The disease is typically spread through the air by a cough or sneeze and those with active TB can experience a chronic cough with blood-tinged phlegm, fever, night sweats, and weight loss. In the early 20th century, patients were referred to the east San Fernando Valley facility from crowded County General Hospital in Los Angeles. Back then, those with consumption were prescribed rest, sunshine and fresh air for several months, even years. Some people stayed so long that the sanitorium had a library, a chapel, radio station, patient newsletter and a post office, according to newspaper accounts. But with better drugs and awareness, TB dwindled and over time Olive View evolved into an acute care hospital. Its TB past was further erased after the 1971 Sylmar Earthquake destroyed several buildings. Olive View remained shuttered until 1987.

In 2011, the hospital opened its $53-million upgraded emergency department. The renovation included the high tech isolation unit that is equipped to withstand a bioterrorism attack.

But a few years before it opened, county officials wondered if it would be used. Reports of tuberculosis continued to decline. Last year, there was a slight uptick — 666 cases in Los Angeles County, or a 7 percent increase from 2012. The cases were primarily among the homeless population.

About 80 percent of all of last year’s cases were among those who were foreign born and who were infected in their home countries, according to the Los Angeles County Department of Public Health.

Many of the cases, were found among those who lived in the San Gabriel Valley.

Those who become ill often have other health challenges, including chronic diseases such as diabetes, said Dr. Caitlin Reed, medical director, Inpatient Tuberculosis Unit at Olive View.

“This is a challenging time because resources for TB treatment are dwindling as the public health ‘safety net’ for TB care is damaged by budget cuts, and because at the same time TB patients are becoming more complex, with multiple medical problems such as diabetes, hepatitis, and kidney problems,” Reed said.

And it’s a challenge to cure someone who has developed multidrug-resistant TB, which are the cases typical at Olive View, Mathisen added. The second and even third line of drugs used to treat those with resistant TB are difficult to tolerate, with harsh side effects, Mathisen said.

One new drug has been developed, but is in limited use. Reed and other experts such as those from Doctors Without Borders want the Food and Drug Administration to approve the drug, called delamanid, so that it can be used more widely.

Delamanid is produced by a Japanese drug maker and has been approved for conditional use by the European Medicines Agency’s Committee for Medicinal Products for Human Use, for only some patients with drug-resistant forms of tuberculosis. It is only the second new TB drug to be developed in 50 years. The other one has harsh side effects, doctors have said, which is why health experts are reluctant to rely on it.

“This is an exciting time to work in TB because for the first time in half a century we have new tools to diagnose TB and new drugs becoming available to treat it — and we have the possibility of curing even the most drug-resistant TB patients,” Reed said. Meanwhile, inside the unit, where the floors shine and the negative air pressure forces even the tiniest infected particle out of the hospital, some patients are allowed to go outside onto the patio to sit in the sun.

Among them is Tamara Moore, 44. Moore was suspected of having tuberculosis while she was at a treatment center, and she was directed to Olive View by a Los Angeles County judge.

“Everyone is very nice,” she said. “But it’s very hard to be in isolation and in your room all the time. I hate soap operas.”

Moore isn’t as ill as some of the half dozen patients currently at the unit, including Ordaz, who has been there since February. But if county health officials find that someone may place the public at risk, he or she is ordered to come to the unit.

“If they can’t comply with the (drug) regimen, the county will go to public health court and that person will be ordered to come here until they are deemed negative,” Mathisen said. “We make sure they are on the correct path until they get better.”