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Last Updated

26 Jun 2003

Source: Washington Post, March 29, 2002

Memo on Florida Case Roils Anthrax Probe

Experts Debate Theory Hijacker Was Exposed

By Steve Fainaru and Ceci Connolly, Washington Post Staff Writers

In January, outside of formal channels, an FBI official asked biodefense experts at Johns Hopkins University to examine a curious lead in the federal government's investigation into last fall's anthrax attacks.

The experts were to evaluate the diagnosis of a Fort Lauderdale, Fla., emergency room physician who had treated one of the Sept. 11 hijackers last June. The physician, Christos Tsonas, initially thought the man had a minor infection, but after the wave of bioterrorist attacks he told the FBI that, in retrospect, he now believed the black lesion on the suspected hijacker's lower left leg was consistent with the skin form of anthrax.

The FBI official told the Hopkins experts, Tara O'Toole and Thomas V. Inglesby, he was concerned the FBI had not pursued the Florida case aggressively enough. The two-page memo they prepared is now circulating among senior government officials, and its findings have stirred up debate over their accuracy and the focus of the FBI's investigation, now in its sixth month.

O'Toole and Inglesby, who head the Hopkins Center for Civilian Biodefense Strategies, concluded that Tsonas's diagnosis of cutaneous anthrax was "the most probable and coherent interpretation of the data available." Since the contents of the memo became public last week, that conclusion has been endorsed by D.A. Henderson, the top bioterrorism official at the Department of Health and Human Services, and Richard Spertzel, who presided over the inspection of Iraq's bioweapons program as part of a United Nations team.

However, upon closer inspection, the Hopkins finding raises its own questions. The hijacker, Ahmed Ibrahim A. Al Haznawi, was examined days after he entered the United States, an indication that the infection -- whatever it was -- developed before his arrival. In addition, a Florida man who said he examined and treated Al Haznawi's calf before sending him to the hospital described the injury last September as a "gash" -- a description that appears to vary significantly with lesions associated with cutaneous anthrax.

Although law enforcement officials said they have not ruled out anthrax as a possibility, they said there was not enough information to draw a specific conclusion. That view was shared by Thomas W. McGovern, the leading authority on anthrax for the American Academy of Dermatology's bioterrorism task force, who said it was "highly unlikely" for someone to contract cutaneous anthrax on his lower leg.

McGovern said Al Haznawi's infection -- described as a one-inch black lesion with raised red edges -- could have been anything from an encrusted boil to a common scrape that received improper medical attention.

"So far there's just no there there," said one law enforcement source involved in the investigation.

But O'Toole and Inglesby remain concerned that the FBI is not taking the case seriously enough. In interviews this week, both insisted that Al Haznawi's symptoms -- in an absence of pain or underlying illness such as diabetes -- were in fact specific to cutaneous anthrax and "should be treated with high suspicion," Inglesby said.

"It would be reassuring and useful to know how investigators in the anthrax investigation have determined that this is unlikely to be anthrax," he said.

The debate comes as the FBI remains stymied in its efforts to trace the source of the anthrax attacks, which killed five, sickened 13 others and wreaked havoc on the federal government before stopping, abruptly, in November. If true, the findings would raise questions about the investigation's focus on a domestic source and the FBI's publicly stated profile of the elusive suspect: an adult male, schooled in bioweaponry, with access to the material and equipment to manufacture the lethal spores.

The Al Haznawi memo also follows a number of other reports from South Florida suggesting possible links between the hijackers and anthrax. In October, a pharmacist in Delray Beach, just north of Fort Lauderdale, told the FBI that Mohamed Atta, the suspected leader of the Sept. 11 attacks, bought medication for his hands, both of which were red from the wrist down -- a report that law enforcement officials said has not been confirmed. Al Haznawi and other hijackers reportedly lived and attended flight school near the Boca Raton headquarters of American Media Inc., where the first anthrax case surfaced (case 5 and case 7).

In addition, on more than one occasion last year, Atta led a group of men described as Middle Eastern to inquire about crop dusting at the Belle Glade State Municipal Airport, about an hour northwest of Fort Lauderdale. Those reports raised concerns that the hijackers might have been researching a means to deliver biological or chemical weapons.

But like those reports, the information surrounding the hijacker's infection is at once intriguing and inconclusive. Al Haznawi entered the United States on June 8, records show. Sometime that month, he moved into an apartment in Delray Beach with another suspected hijacker, Ziad Samir Jarrah, according to statements last fall by the building's landlord, Charles Lisa.

Lisa told a Washington Post reporter that Jarrah and Al Haznawi, who spoke little English, later came to him seeking advice about a "gash" that appeared on Al Haznawi's left calf. Lisa said he applied some peroxide, wrapped the leg and directed the two to Holy Cross Hospital in Fort Lauderdale.

Law enforcement officials said Al Haznawi, accompanied by Jarrah, was examined June 25 at Holy Cross. Tsonas declined to comment through a hospital spokeswoman, but he recently told the New York Times that the men told him that Al Haznawi had sustained the injury bumping into a suitcase two months earlier. He said he treated the lesion with Keflex, an antibiotic.

Keflex is mostly ineffective against cutaneous anthrax, studies have shown, but the illness is only 10 percent to 20 percent lethal if it remains untreated, meaning Al Haznawi likely would have survived even if he had it.

O'Toole and Inglesby declined to name the FBI official who later contacted them informally about the case. A government official said the individual was "not involved in the investigation in any way and had no standing" to raise his concerns with the Hopkins experts. Those concerns were based on "partial information," the official said, adding that the FBI official "never voiced his concerns internally or raised those issues from proper channels."

After the exchange, the Hopkins team interviewed Tsonas, reviewed his notes, consulted with other experts and wrote the memo. "We wanted to make sure the heads of the intelligence agencies knew the specificity of the diagnosis," O'Toole said. "I was afraid they didn't understand that almost nothing causes a black [lesion] in an otherwise healthy young man. Apparently they didn't know that and that's upsetting."

Law enforcement officials rejected that suggestion, saying they have consulted not only on the Florida case but throughout the investigation with leading experts in microbiology, analytical chemistry, pathogens and public health.

Staff writers Joby Warrick and Walter Pincus and research editor Margot Williams contributed to this report.