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  • Jailing The Sick

    Man With TB Locked Up To Protect Public

    PHOENIX, April 2, 2007
    --------------------------------------------------------------------------------
    (AP) Behind the county hospital's tall cinderblock walls, a 27-year-old tuberculosis patient sits in a jail cell equipped with a ventilation system that keeps germs from escaping.

    Robert Daniels has been locked up indefinitely, perhaps for the rest of his life, since last July. But he has not been charged with a crime. Instead, he suffers from an extensively drug-resistant strain of tuberculosis, or XDR-TB. It is considered virtually untreatable.

    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.

    "I'm being treated worse than an inmate," Daniels said in a telephone interview with The Associated Press last month. "I'm all alone. Four walls. Even the door to my room has been locked. I haven't seen my reflection in months."

    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.

    The World Health Organization warned last year of the emergence of extensively drug-resistant TB. The new strain, which has been found throughout the world, including pockets of the former Soviet Union and Asia, is resistant not only to the first line of TB drugs but to some second-line antibiotics as well.

    HIV patients with weakened immune systems are especially susceptible. In South Africa, WHO reported that 52 of 53 HIV patients died within an average of 25 days after it was discovered they also had XDR-TB.

    How to deal with people infected with the new strain is a matter of debate.

    Dr. Ross Upshur, director of the Joint Centre for Bioethics at the University of Toronto, said authorities should detain people with drug-resistant tuberculosis if they are uncooperative.

    "We're on the verge of taking what was a curable disease, one of the best known diseases in human endeavors, and making it incurable," Upshur said.

    But a paper Upshur co-wrote on the issue in a medical journal earlier this year has been strongly criticized.

    "Involuntary detention should really be your last resort," Harrington said. "There's a danger that we'll end up blaming the victim."

    In the United States, which had a total of 13,767 reported cases of tuberculosis in 2006, public health authorities only rarely have put TB patients under lock and key.

    Texas has placed 17 tuberculosis patients into an involuntary quarantine facility this year in San Antonio. Public health authorities in California said they have no TB patients in custody this year, though four were detained there last year.

    Upshur's paper noted that New York City forced TB patients into detention following an outbreak in the 1990s, and saw a significant dip in cases.

    In the Phoenix area, only one other person has been detained in the past year, said Dr. Robert England, Maricopa County's tuberculosis control officer.

    Daniels has been living alone in a four-bed cell in Ward 41, a section of the hospital reserved for sick criminals. He said sheriff's deputies will not let him take a shower — he cleans himself with wet wipes — and have taken away his television, radio, personal phone and computer. His only visitors are masked medical staff members who come in to give him his medication.

    The ventilation system draws out the air and filters it to capture the bacteria-laden droplets he expels when he coughs. The filters are periodically burned.

    Daniels said he is taking medication and feeling a lot better. His lawyer would not discuss his prognosis. Daniels plans to ask for his release at a court hearing late this month.

    Daniels lived in Russia for 15 years and returned to the United States last year after he was diagnosed. He said he thought he would get better treatment here, and hoped eventually to bring his wife and children from Russia. He said he briefly worked in an office in Arizona for a chemical company before he was put away.

    He said that he lost 50 pounds and was constantly coughing and that authorities locked him up after they discovered he had walked into a convenience store without a mask.

    "Where I come from, the doctors don't wear masks," he said. "Plus, I was 26 years old, you know. Nobody told me how TB works and stuff."

    County health officials and Daniels' lawyer, Robert Blecher, would not discuss details of the case. But in general, England said the county would not force someone into quarantine unless the patient could not or would not follow doctor's orders.

    "It's very uncommon that someone would both not want to take treatment and will willingly put others at risk," England said. "It's only those very uncommon incidents where we have to use legal authority through the courts to isolate somebody."

    University of Pennsylvania medical ethicist Art Caplan said Maricopa County health officials were confronted with the same ethical dilemma that communities wrestled with generations ago when dealing with leprosy and smallpox.

    "Drug-resistant TB, or drug-resistant staph infections, or pandemic flu will raise these questions again," Caplan said. "We may find ourselves dipping into our history to answer them."

    Daniels said he realizes now that he endangered the public. But "I thought I'd come to a country where I'd finally be treated like a person, and bam, here I am."
    CBSNews.com: Print This Story
    Should he be locked up?

    He was told by his doctors that he must wear a medical mask in public to prevent infecting others and he did not. He potentially infected other people knowingly. This is no different than someone with HIV or AIDS going out and having unprotected sex with as many people as they can find with the intention of infecting others.

    If someone has a disease...not just incurable diseases, but ANY disease, they have a moral obligation to do everything they can to not pass that disease on. I think that they should also have a legal obligation. If they blatantly refuse to abide by that, then I think the justice and healthcare systems should team up to protect the rest of.

    This man says his "rights" were taken away and he is now locked up though he committed no crime...what about the people who would be innocently coming into contact with him?
    "To dream of the person you would like to be is to waste the person you are."-Sholem Asch

    "I always turn to the sports page first, which records people's accomplishments. The front page has nothing but man's failures."-Earl Warren

    "I didn't intend for this to take on a political tone. I'm just here for the drugs."-Nancy Reagan, when asked a political question at a "Just Say No" rally

    "He no play-a da game, he no make-a da rules."-Earl Butz, on the Pope's attitude toward birth control

  • #2
    He was told by his doctors that he must wear a medical mask in public to prevent infecting others and he did not. He potentially infected other people knowingly. This is no different than someone with HIV or AIDS going out and having unprotected sex with as many people as they can find with the intention of infecting others.

    Well, yes and no. Yes, he potentially infected others. But on the other hand ......

    One can have something of a normal life without having sex, without the world knowing that there is something wrong with them. Their disease can be a secret, they can hold a normal job, and so forth.

    If one goes around wearing a mask in the American public, however, especially if they are not of Oriental descent, people are going to assume that something is wrong with them, see them as a leper, or even worse, invite undue attention to themselves if people think that they are wearing a mask because of some contagion, some terrorist weapon they must have realeased.

    In a matter of speaking, it's like wearing a blue Star of David.

    That said, I don't see as there is any other choice. It is regretable and unfortunate, but having one patient or a thousand patients, the simple rational is to have one patient and if it is necessary to quarantine him, then that's the way it has to be.
    --------------------------------------------------------
    (The Halliwell sisters are in medical quarantine. "You can't keep us lockedup here!"--Piper
    "Actually, I can, and not just because you brought illegal fruit into the country. I can hold you indefinitely until I find out why you are immuned to Oroya Fever and why it is spreading."--Dr. Curtis Williamson, (w,stte), Charmed "Awakened")
    So the mask issue isn't that particularly easy.

    Comment


    • #3
      This is not the first time this has happened. If memory serves well a young woman had typhoid,I think it was in New York in the 20s or thereabouts, who was also locked up for the safety of the public.She did indeed spent the rest of her life in "jail"

      Comment


      • #4
        They could at least have the courtesy to treat him well. Maybe a nicer mattress and better food? I agree though that some sort of quarintine is reasonable.
        "you have enemies, good. That means you stood up for something, sometime in your life"

        Comment


        • #5
          I think the line should be drawn by which kind of illness it is, the common cold is one thing but TB and AIDS are very different and legal actions should be taken against those who are instructed to protect others from thier ailment and choose not to heed those warnings.

          Comment


          • #6
            Originally posted by jame$thegreat View Post
            I think the line should be drawn by which kind of illness it is, the common cold is one thing but TB and AIDS are very different and legal actions should be taken against those who are instructed to protect others from thier ailment and choose not to heed those warnings.
            Agree with that JTG we had an incident in the UK as few years ago when a young man who "contracted" Aids went out of his way too infect all his X partners. He was taken to Court but laughed in their faces as he was dying anyway. Within a year or two all involved had died as a result of his revenge

            Comment


            • #7
              Originally posted by dave lukins View Post
              Agree with that JTG we had an incident in the UK as few years ago when a young man who "contracted" Aids went out of his way too infect all his X partners. He was taken to Court but laughed in their faces as he was dying anyway. Within a year or two all involved had died as a result of his revenge
              Things of the sort have been occurring more and more often for the past few years here. First it was small needles left on gas station pumps and car door handles that had contaminated blood left them purposely by a few bitter HIV patients. Again there was another incident a little while back where a yound women went into her college with a hyperdermic needle filled with her own infected blood which she pricked classmates and nearby people in the hall, many of which were infected. The idea that that could happen to me just as easily in school, or my brother made my stomache churn. Its a sick world my friends...

              Comment


              • #8
                With the threat of resistant TB spreading and killing, isolating this person is a no brainer. However, that persons lack of freedoms should be compensated for and he should be able to live a comfortable life until the end. There will be more cases as TB is on the rise. The only way to keep the general population safe is to quickly find infected individuals and isolate them before they can spread TB to others. TB testing should be a part of immigration as TB cases are more common in lessor developed countries.

                Hell, IF I were a terrorist, I would forget the bombs and get a few resistant TB infected people and give them a joy ride on America's transportation system.
                Removing a single turd from the cesspool doesn't make any difference.

                Comment


                • #9
                  Originally posted by bonehead View Post
                  With the threat of resistant TB spreading and killing, isolating this person is a no brainer. However, that persons lack of freedoms should be compensated for and he should be able to live a comfortable life until the end. There will be more cases as TB is on the rise. The only way to keep the general population safe is to quickly find infected individuals and isolate them before they can spread TB to others. TB testing should be a part of immigration as TB cases are more common in lessor developed countries.
                  yes, no brainer, just don't treat them like criminals, as you say, unles they are deliberately infecting people.
                  Insanity is doing the same thing over and over
                  and expecting a different result.
                  Albert Einstein.

                  Comment

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