Tarrant health department was ‘consistently’ late reporting syphilis cases as rates soared

Tarrant County Public Health has been “ consistently ” late to investigate and report cases of congenital syphilis, at a time when new new syphilis infections have surged.

The health department did not have enough staff to handle the cases and report them to the state last year, according to an audit report from Deloitte & Touche LLP . The reports help answer critical questions about why syphilis cases were not caught and treated earlier in pregnancy, and provide local and state health officials with information about where the pregnant person lives, whether the pregnancy ended in stillbirth or miscarriage, and whether treatment was available.

Congenital syphilis, which are cases of syphilis that are passed from a mother to child during pregnancy, is a growing crisis in the United States, and especially in Texas. During pregnancy, the disease can cause miscarriages, stillbirths and early infant death. For the children who survive, untreated syphilis can lead to meningitis and other brain infections, blindness, deafness, liver disease, severe anemia and more. The disease is easily treatable if caught early enough in pregnancy and if the parent can receive adequate treatment.

The disease caused two stillbirths in Tarrant County in 2021 and one stillbirth in 2022, according to data released to the Star-Telegram.

Every case of congenital syphilis is considered “a dramatic and tragic indicator of public health failure,” according to a consensus study report from the National Academies of Sciences, Engineering and Medicine.

Cases of congenital syphilis are increasing as rates of syphilis and other STIs in adults are increasing as well. In 2011, there were 6.7 cases of syphilis for every 100,000 Tarrant county residents, according to state data. Ten years later, the rate increased to 57.4 cases for every 100,000 residents, according to state data.

In the 2023 fiscal year, Tarrant County Public Health reported just 25% of syphilis case investigations within a grant-required 30-day period, according to Deloitte’s audit. Funding to investigate congenital syphilis is funneled to Tarrant County by the state, and in turn Tarrant County has to report information back to the state so state officials can understand the landscape of syphilis and other sexually transmitted infections. High staff turnover meant the department “did not have enough personnel to carry out the required investigations and reporting in a timely manner,” the report said.

In a response to Deloitte’s findings, management wrote that they would increase the frequency of meetings.

In an email, a spokesperson for the state health department said that Tarrant County Public Health actually had been meeting its grant requirements, but that the county health department was not meeting the recommended timeline for following up with a pregnant mother after a case of syphilis has been identified.

Dr. Brian Byrd, the new Tarrant County Public Health director, said a new system was put in place to improve grant management about two months ago. Byrd started his job Monday, taking over after former director Vinny Taneja resigned in February.

The issues with congenital syphilis case investigation and other problems with state and federal grants were outlined in a report from the county’s auditor, Kimberly Buchanan, at a commissioners meeting Tuesday.

The delays in reporting congenital syphilis information to the Department of State Health Services were one of multiple problems Buchanan identified. Buchanan wrote in a May 31 letter to public health leadership that her office “continues to observe significant issues” in the department’s management of state and federal grants that require immediate attention. She said the department did not have adequate monitoring of budgets for grant-funded positions or of supplies purchased using grant money.

At Tuesday’s meeting, Buchanan said her office was meeting with public health officials regularly to improve the department’s management of grants.

“I appreciate Kim Buchanan and her team very much for helping us identify those problems, because if we can’t identify them we can’t fix them,” Byrd said Tuesday.

This story was updated with information from the Department of State Health Services.