A state report obtained by NBC 5 Investigates questions whether the Dallas County Health Department failed to notify people who may have been exposed to HIV because the county failed to track and follow-up on hundreds of HIV cases as the state requires.
The report expresses “deep concern” about Dallas County’s HIV surveillance program. Texas Department of State Health Services officials wrote, "Throughout the past year, Dallas has demonstrated an inability to manage routine HIV surveillance workload."
"It's extremely troubling if it occurred as laid out," said Kirk Myers, who runs a nonprofit, Abounding Prosperity, that offers HIV testing in neighborhoods with the highest infection rates. "We see a lot of people that are impacted by HIV daily, and so we need all of the resources in Dallas County we can get to respond to this epidemic appropriately."
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When someone tests positive for HIV, the lab typically notifies the state. The state then assigns the case to the local county health department for follow-up. The county is supposed to collect detailed information about the patient and report back to the state.
But in Dallas County, the state found 209 adult HIV cases and 139 pediatric cases went "unreported" from 2009-2012; the largest number of unreported cases in Texas. By "unreported," they mean Dallas County did not collect required patient information and send it to the state. That information is crucial because it also helps the county begin notifying the HIV patient's previous sexual contacts to warn them of the risk.
The state now worries Dallas County's unreported cases "may represent newly diagnosed HIV cases for which no public health follow-up was ever initiated."
A spokeswoman for the Department of State Health Services said the state is still analyzing records to see if anyone who was exposed was not notified as they should have been.
"Knowing who has been diagnosed with the disease, newly reported with the disease, gives you a chance to find that person's contacts to see if they're infected," said Dr. George Rutherford, an HIV researcher with the University of California at San Francisco.
Rutherford once served as California's state epidemiologist and said quick notification is even more important today because drugs can now be given immediately to fight the virus.
When local health departments do not report cases to the state in a timely manner they also miss out on additional federal funding to treat patients.
"You lose opportunities. It's the land of missed opportunities. You lose opportunities for prevention. You lose opportunities for treatment," Rutherford said.
The Dallas County Health and Human Services Department turned down our requests for an interview. But a spokeswoman did tell NBC 5 Investigates that some cases are "problematic and more time-consuming," because patients give incorrect information, they move, decide they don't want to be contacted or labs make errors inputting information.
The spokeswoman said, "All unreported cases and any cases in which a public health follow-up was not initiated have been addressed and will be closed at some point depending on when the public health follow-up is completed."
This not the first time the health department has come under fire in recent months.
"If our data is wrong then we're screwing up all over the place — that's how serious this is," said Ben Martinez, AIDS activist.
In June, NBC 5 Investigates uncovered another state report that found Dallas County health workers "admitted to entering false (STD) data" in order to "increase the agency's performance numbers."
The Dallas County district attorney's office is now conducting a criminal investigation.
A state inspector general found that false data was entered "under the direction of Lashonda Worthey," the county's STD-HIV prevention manager.
A Dallas County Health Department letter we've obtained shows Worthy was demoted in June even though the county health department's own review "did not substantiate that (Worthey) gave such a directive (to enter questionable data)." The county did find she "failed to effectively supervise staff." Worthy has not responded to our attempts to reach her.
It turns out Worthy was also responsible for supervising the HIV surveillance program that's now accused of falling behind on hundreds of cases.
As of last month, the state said Dallas County was down to about 85 unreported HIV cases. The state said it should know by the end of the year if anyone exposed to HIV in Dallas County was not notified in a timely way. The state's analysis of records is still underway.
In June, the state put Dallas County's HIV surveillance program under heightened state monitoring for at least six months.