State health department officials have refused to comply with a subpoena for information on a deadly virus that killed a state worker, setting the stage for a possible legal showdown with the Missouri House.
The subpoena is the latest in several attempts by the House to force the Missouri Department of Health and Senior Services to disclose the number of people statewide who have tested positive for antibodies associated with Bourbon virus, a tick-borne illness discovered in Bourbon County, Kan., in 2014. Missouri lawmakers are poised to cut about $800,000, or eight employees, from the department's budget.
The agency has consistently refused, citing privacy concerns.
"It was just kind of a last attempt to give them the cover they felt like they needed to give us the information that we were requesting before we had to make a decision one way or the other on if we were going to cut their budget for not responding," said Rep. Scott Fitzpatrick, R-Shell Knob, chair of the House Budget Committee.
The last-ditch attempt was unsuccessful. When the subpoena deadline came at noon on Monday, health officials again refused to supply the data. The agency's general counsel, Nikki Loethen, raised the specter of litigation in a letter back to lawmakers, saying the department "understands and appreciates" that some members think the information can and should be disclosed.
"Because our two branches of government have been unable to resolve this matter, the department respectfully suggests that it may be appropriate for the third branch of government to determine whether the info can be lawfully disclosed," Loethen said in the letter.
Missouri lawmakers began threatening the department's budget earlier this year in an effort to force health officials to disclose the number of people statewide who have tested positive to having the antibodies indicative of a Bourbon virus infection.
In the hours-long debate Wednesday over the state's budget for next year, some House members decried the cut to health department funds. Rep. Peter Merideth, D-St. Louis, said the department was following its best legal analysis.
Rep. Justin Alferman, R-Hermann, originally proposed the cut and pushed back against criticism. He said as a co-equal branch of government, the General Assembly deserved information from the department.
“I don’t know how some of you sleep at night defending this department," Alferman said.
Symptoms include fever, fatigue, rash, headache, body aches, nausea and vomiting, according to the Centers for Disease Control and Prevention.
The House's search for information came after Tamela Wilson died of Bourbon virus last year. She was exposed while working at Meramec State Park in eastern Missouri.
The department tested the blood of some state parks employees in September after Wilson's death. It said in a December press release that those results would remain confidential because of their status as "protected health information," but it said none of the 7,000 ticks it collected had tested positive for Bourbon virus.
"They just said they couldn't do it because it was against the law, which we disagree with. And they basically said you're going to have to sue us if you want it," Fitzpatrick said.
House Speaker Todd Richardson signed the subpoena. His office is still obtaining information, a statement said.
"I think there is a chance that we will go to court to attempt to enforce the subpoena," Fitzpatrick said.
For its part, the department has continually cited state law and the Health Insurance Portability and Accountability Act, or HIPAA, which protects personally identifiable medical information. The department claims enough is known about the people who were tested for the virus to put them at risk of being identified if the results were revealed.
"A (department) statistical expert has confirmed that there is more than a small risk of identifying individuals if (the department) releases the number of positive test results," Loethen said.
Lawmakers who want the information have argued the department should be transparent about a potential public health crisis.
"There are so far five cases nationwide of people dying from the Bourbon virus," Fitzpatrick said. "Two of those have been in Missouri."
Fitzpatrick criticized the department's director, Randall Williams, for his involvement in North Carolina's decision to reverse a warning to well owners that their water was contaminated by a cancer-causing chemical.
Rep. Deb Lavender, D-Kirkwood, objected to the threat.
"I think punitive behavior does not belong in our budgetary process," Lavender said. "The department feels they are abiding by the law."
The General Assembly's budget for the fiscal year starting in July would cut eight positions, including legal staff and a legislative liaison, from the department unless it supplies the data.
In a background document supplied along with Loethen's letter, the department said the risk of Bourbon virus is low.