TB patient in jail

I believe one of the reasons many physicians take up anonymous blogging is to complain about non-compliant patients. If a patient does not follow my recommendations, it's pretty simple. We agree to disagree and I ask the patient to find another physician. Most of the time, that works out.

Here's a story which I find very interesting. It definitely has public health implications, and is sparking quite a debate about an individual's civil rights verses the health of the public.

Robert Daniels has been in an Arizona jail since last summer. (Associated Press) He has not been charged with a crime, but what he does have is a drug resistant case of tuberculosis. It is so resistant, that it is considered untreatable. Why is he in jail? Here's why:

County health authorities obtained a court order to lock him up as a danger to the public because he failed to take precautions to avoid infecting others. Specifically, he said he did not heed doctors' instructions to wear a mask in public.

Though Daniels' confinement is extremely rare, health experts say it is a situation that U.S. public health officials may have to confront more and more because of the spread of drug-resistant TB and the emergence of diseases such as SARS and avian flu in this increasingly interconnected world.

"Even though the rate of TB in the U.S. is at the lowest ever this last year, we live in a globalized world where, if anything emerges anywhere, it could come to our country right away," said Mark Harrington, executive director of the Treatment Action Group, an American advocacy group.

So, the debate is what to do with this guy. On the one hand, you have a non-compliant patient who refuses to be treated. An individual has the right to refuse treatment, right? And, on the other hand, you have someone with a highly contagious disease which is incurable. You let this guy out of jail, and he will definitely infect the public, and then what do you do?

I'm all for personal sovereignty, but if this guy was in my little county jail, there would be no way that I would let this guy out. I mean, he is choosing not to be treated. There are consequences to choices, and I think remaining locked up is a small price to pay for preventing a TB epidemic.