In the case of the jet flying traveler with TB a great deal of criticism has been leveled at U.S. authorities.
At two congressional hearings this week the Centers for Disease Control and Prevention (CDC) has conceded mistakes were made that exacerbated an international health alert regarding an Atlanta lawyer who, while on his honeymoon flew to and from Europe with a rare form of tuberculosis.
The actions of the CDC, along with those of U.S. health and border security officials, have raised public concern over just how competent the authorities are when it comes to dealing with such circumstances and protecting the public.
The fugitive, 31-year-old Andrew Speaker has clashed with health officials at the hearings over the facts of the case.
Mr. Speaker is adamant he was never told he posed a risk to others and that health officials with whom he met never wore protective masks.
Health authorities insist he was told he had a rare, hard-to-treat form of TB and was asked not to travel and then flew to Europe earlier than scheduled.
A global health alert was triggered last month when he and his new bride flew around Europe and to Canada before driving back into the United States at a border crossing into New York state.
The wedding party had traveled to Paris then onto Rome, Athens, the Greek islands and then Prague before flying to Montreal.
They then returned to the United States via the Canadian border.
Dr. Julie Gerberding, director of the CDC told the Senate hearing that the CDC failed to take the action necessary to restrict his movement more effectively and in retrospect all kinds of alerts should have been sent.
Testifying to a Senate panel by telephone from a Denver hospital where he is being treated, Mr. Speaker insists he was never barred from traveling, was repeatedly told that he was not contagious and that he did not represent a threat to anyone.
Speaker says everyone concerned knew he was about to fly and he did not run off or hide from authorities; he says comments he behaved in such a manner are untrue and a complete fallacy.
Speaker says CDC officials knew he was planning to travel to Italy and Greece for his marriage and honeymoon, and they knew he had a form of TB that was resistant to several drugs.
The CDC admits that while Speaker was in Europe for his wedding and honeymoon, further tests revealed he had extensively drug resistant tuberculosis, or XDR-TB and say he was advised of this but say he was not barred from traveling as local health departments do not have the power to prohibit or order somebody not to travel.
The CDC says they explained the need not to travel or use commercial air carriers, and to isolate himself and make alternative travel arrangements.
A U.S. Senate committee is asking why the CDC didn't use one of its emergency jets to bring Speaker home from Europe after it was discovered that he had dangerous drug-resistant tuberculosis.
The CDC apparently has three private jets available for emergencies which were used nine times in the last year.
Prior to queries in Congress the jets were used regularly for political travel by U.S. Health and Human Services Secretary Michael Leavitt; the aircraft cost taxpayers $7 million a year.
Speaker said he was not told that a private CDC plane was an option.
Ralph Basham the Commissioner for Customs and Border Protection has pinned the blame on one U.S. border agent in Champlain who chose to ignore the computer alert and allowed Mr. Speaker to re-enter the country.
Basham says the agency has now implemented new procedures to ensure people who were flagged were stopped and could not enter the country freely and customs and border patrols will now need approval from a supervisor before overriding such warnings.
Dr. Gerberding has called for clarification in the federal quarantine statute to allow authorities to prevent a patient from taking a health threat abroad rather than bringing one into the United States.
Speaker is currently being treated for extensively drug-resistant tuberculosis, or XDR TB, which is invulnerable to most antibiotics at the National Jewish Medical and Research Center in Denver.
Health officials there said on Tuesday that a third-consecutive sputum smear test for tuberculosis had come back negative, confirming results from his previous tests.
A person who tests positive is considered infectious, while three consecutive negative sputum smears may be considered non-infectious in most settings but when he will be able to leave isolation has not been decided.