Whistleblower: State and county leaders fail to stop syphilis from spreading

A former health department employee says a lack of staffing and outreach is fueling a spike in syphilis and STD cases.
Kristi McCray says she warned health leaders that a backlog of cases for county employees would add fuel to a syphilis outbreak.
Published: Jul. 20, 2023 at 6:00 PM EDT|Updated: Jul. 21, 2023 at 10:22 AM EDT
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CHARLOTTE, N.C. (WBTV) - A surge in syphilis cases across Charlotte and North Carolina is being fueled by a health staffing shortage and a failure to trace cases, according to a former county employee.

The former employee sat down with WBTV to blow the whistle on what she said is a growing problem jeopardizing residents’ health.

The whistleblower said Mecklenburg County and state health leaders aren’t doing enough to warn people about the spike in STDs she said she warned them about.

Records obtained by WBTV show North Carolina syphilis cases in women have risen 538% while congenital syphilis, where a mother passes the disease to an unborn child, rose 4,100%.

“I kept saying women are going to start getting it. Babies are going to start getting it, and this is what we’re seeing now,” Kristi McCray told WBTV.

McCray has worked in public health for 40 years. The last eight years of her career were spent working on STD and HIV surveillance and case management for Mecklenburg County Public Health. She says she left because county and state health leaders weren’t doing enough to stop the rapid spread of the communicable disease.

One of McCray’s job titles was disease intervention specialist. The role of a DIS employee is to help connect positive patients with available health resources and track down other people who might have been exposed in order to stop the spread.

David Hodges talks Meck Co. Health Dept. report

Records obtained by WBTV show there’s a critical shortage of DIS staff in the Charlotte area. McCray says the shortage is causing a backlog of cases, which means those investigations are delayed.

“Last I saw, it’s anywhere from six months to a year on some of these cases,” McCray said.

McCray said, normally, DIS staff should open a new case one to two days after they’re made aware of a patient’s positive test result.

“I felt totally handicapped. I felt abandoned. I felt like there was no one that was going to support me,” McCray said.

The abandonment, McCray said, came from the North Carolina Department of Health and Human Services.

Traditionally, DIS staff across North Carolina are employed by both county health departments and the state. State DIS employees are assigned to regions and work in virtually the same capacity as county employees.

WBTV obtained a copy of an email from the HIV/STD medical director at NCDHHS that shows there are no DIS staff employed by the state operating in Charlotte’s region. The state typically has five DIS staffers working in the Charlotte region.

In the email, Dr. Victoria Mobley wrote to county health directors claiming the state was “facing an unprecedented number of vacancies” and as a result “there may be delays in outreach to client.”

When asked about the staffing shortage and Mobley’s email, a spokesperson for NCDHHS wrote in an email the state data from 2021 through 2022 “do not show delays in the time between the report of a positive HIV or syphilis test to the state’s surveillance system and when DIS performed outreach to those individuals.”

WBTV requested copies of state reports to verify the claim from NCDHHS. Those records have not been made available yet.

McCray isn’t the only local health advocate who says there’s a delay in typical DIS services.

Wesley Thompson, who has been treating HIV patients for 37 years and founded Amity Medical Group, told WBTV the work done by DIS staffers is critical to the community, but he’s observed a delay in partner notifications and other DIS services.

“We still haven’t recuperated from the loss of staffing, and you really do need people to do this,” Thompson said. Thompson says the COVID-19 pandemic also also has had a negative impact when it comes to contacting clients and people who’ve been exposed.

Notifying partners who have possibly been exposed, in a timely fashion, has a major impact on treatment, according to Thompson.

“Knowledge really is power,” Thompson said.

“The challenge is getting that knowledge to the communities most at risk.”

According to McCray, getting that knowledge to the community is where Mecklenburg Public Health has fallen short. Syphilis and HIV numbers are rising nationwide, but McCray said it’s essential for local health leaders to bring attention and awareness to the issue.

“My take on what needed to be done was totally different from management’s take,” McCray said.

“My intention was to ensure that we let the public know what was happening, let the Board of County Commissioners know what was really happening and stop the spread of infection.”

WBTV requested interviews with both NCDHHS and Mecklenburg Public Health leaders. Both agencies denied that request and sent lengthy statements instead. Neither agency has provided WBTV with actual numbers of current DIS staff or case backlogs.

When asked what extra steps health officials had taken to raise awareness about syphilis, a spokesperson for Mecklenburg County provided a short list of activities that included plans.

- Ongoing screenings offered at various locations through Outreach.

- Screenings at three locations on June 27, which is National HIV Testing Day.

- Test kit distribution at Have Life Church on July 15.

- Screenings are planned for the weekends of Charlotte Black Pride and Charlotte Pride.

The handful of regularly scheduled plans from the county isn’t enough, according to McCray. Backing her position, she said, is the exponential increase in congenial syphilis cases, something that is completely avoidable with detection and treatment.

“I have not spent 40 years of my life for nothing. I love what I do. I love the people that I served, and I want them to know that there’s an outbreak out there, and I want them to be tested.”

Statement from Mecklenburg County Public Health

In late 2021, Public Health was notified by NC DHHS of a backlog of DIS services provided to Mecklenburg County by the state due to extreme staffing shortages (5 out of 5 state DIS positions were vacant in our region) and notice of activating an EOP. Mecklenburg County, in close partnership and consultation with NC DHHS, activated a local version of the EOP to fill the gaps. We added additional staff, reassigned staff from other HIV/STI programs and shifted workflows to clear the backlog. Details on the EOP and our response efforts due to the backlog were presented to the BOCC in January 2022 as a part of the state of the county health report.

Despite the many effects and disruptions of the pandemic, Public Health and our partners are making progress towards our goals towards Ending the HIV Epidemic. Our implementation efforts have yielded increased PrEP access points and utilization, particularly for underinsured residents; increased access to community-based HIV testing, and vital support and services for persons living with HIV. HIV incidence data has been affected by lack of testing during the pandemic and we anticipate more reliable trend data now that the emergency phase has ended and residents are re-engaging with healthcare.

Statement from NCDHHS

Due to shortages in state Disease Intervention Specialist staff, whose primary responsibilities are to provide partner notification services to individuals diagnosed with HIV or syphilis, we notified the local health departments of the potential impact on providing these services in a timely fashion. However, review of statewide partner notification outcomes for 2022 compared to 2021 do not show delays in the time between the report of a positive HIV or syphilis test to the state’s surveillance system and when DIS performed outreach to those individuals.

North Carolina, like rest of the nation (Workforce Brief_web (apha.org)), has been experiencing significant shortages in the public health and healthcare workforce. Unfortunately, but not unexpectedly, the critical staff responsible for providing partner services to individuals diagnosed or exposed to HIV and syphilis, are not immune to these recruitment and retention issues. Governor Cooper’s recommended budget for the current biennium includes several meaningful efforts to address our workforce challenges, including 8% salary increases over 2 years; 3% labor market adjustment reserve fund to further increase salaries of hard-to-fill positions; and a one-time bonus of $1,000 – 1500. In addition, the Governor recommends expanding the number of employees eligible to receive an annual longevity payment. These efforts would do a great deal to address those challenges, but delays in adopting the budget only worsen our ability to attract and keep staff, including DIS workers.

In addition, we also rely on federal funding to support this and other critical public health programs. Recent notification of federal funding cuts due to the debt ceiling deal will negatively impact the capacity of states to reduce the incidence of sexually transmitted diseases. One article on that is here. Another article on that is here: https://www.cnn.com/2023/07/14/health/cdc-funding-cuts-debt-deal