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Three bills were introduced in Springfield this year to dissolve the Cook County Tuberculosis Sanitarium District, rolling its services into the county's Public Health Department.

But officials with the district, which serves suburban Cook County, warn the county wouldn't adequately address TB, creating danger of a serious outbreak.

One of the bills sponsored by state Sen. Don Harmon, D-39th, of Oak Park, SB2200, is moving forward, he said. The others are stuck in committee.

For now, SB2200 is a shell bill stripped of its original terms, he said. New wording for the bill, now being negotiated, would be added as an amendment.

It's unclear whether the bill would set aside existing sanitarium funds for TB treatment and prevention only, or allow the county to spend the money however it sees fit.

The district should be dissolved because it treats only one illness and has accumulated a large surplus of tax funds, Harmon said. But the county's Health Department deals with all communicable diseases.

"Tuberculosis, while still a real health threat, is far more often connected with other diseases, especially HIV," Harmon said.

The sanitarium district has accumulated "unusual surpluses," he said, as pointed out in an October report by the Chicago Civic Federation.

In that report, the Civic Federation said the sanitarium district continues to levy a property tax even though it has accumulated a fund balance of more than $10 million, more than double its annual operating budget of $3.8 million.

Since that report, the sanitarium district has cut its tax levy in half, Civic Federation President Laurence Msall said. The tuberculosis district reported its levy for 2003, to be collected on 2004 tax bills, is $1.96 million, 48 percent less than the prior year's levy.

Msall called that a half victory because the sanitarium district did not cut the levy entirely.

"There's not a real justification why this dramatic change in the levy, except more people are paying attention to it as a result of our report and the legislation pursued in Springfield," Msall said.

Sanitarium district Executive Medical Director Dr. James Gallai called the Civic Federation's report "ignorant and misrepresented, at the least. At the most, I think it's fairly dishonest."

The report concludes the district spent nearly $37,000 per tuberculosis patient. An outside auditor hired by the sanitarium district, in contrast, concludes it spent $6,700 per active case of tuberculosis and $1,100 per latent case.

"I would challenge anybody to do it cheaper," Gallai said.

But Msall questions the figures, saying some clerical and management salaries were left out of the computation.

The number of tuberculosis cases in suburban Cook County has remained stable, Gallai said, but the county population has not, meaning the disease remains a problem.

The Illinois Public Health Department reports suburban Cook County had 123 cases of active tuberculosis in 2003. The number has remained between 165 and 123 active cases a year since 1993.

New York City saw an outbreak of 3,000 tuberculosis cases a year in the early 1990s, Gallai said, after funding to tuberculosis control agencies and health departments was cut because tuberculosis cases were down the previous decade. A quarter of those drug resistant, and the outbreak has cost $1 billion to bring under control.

"If you would have had the resources to treat it in the beginning, my guesstimate is it would have cost $50 to $75 million," Gallai said.

But the City of Chicago's tuberculosis district dissolved in the 1970s, Harmon said, with no such crisis emerging there. Chicago's Health Department has since handled TB treatment.

"The fact that the tuberculosis district continues to treat tuberculosis in isolation, and does not integrate its services with broader health services is troubling," Harmon said. "I think it poses a greater health risk."

The Cook County Public Health Department, which would take over the sanitarium district's services if state legislation were successful, welcomes the task, Chief Operating Officer Dr. Stephen Martin said.

The Centers for Disease Control has named tuberculosis as one of the diseases to watch for in a bioterrorist attack, Martin said, and the county Health Department is responsible for emergency preparedness in Cook County.

"Its integration into our services fits naturally," he said.

The county would pay for tuberculosis treatment with money transferred from the sanitarium district once dissolved, Martin said.