Should we arrest TB patients for skipping their meds?
Reports last week of a San Francisco area man arrested on two misdemeanor counts for not taking his tuberculosis medication is shedding light on a little-known and rarely used public health policy - the power to arrest people who may endanger the public's health.
Should we arrest TB patients for skipping their meds?
Michael Yudell, Associate Professor, Drexel University School of Public Health
By Michael Yudell
Reports last week of a San Francisco area man arrested on two misdemeanor counts for not taking his tuberculosis medication is shedding light on a little-known and rarely used public health policy — the power to arrest people who may endanger the public’s health.
According to San Joaquin County health officials, 34-year-old Armando Rodriguez refused to take antibiotics for active pulmonary tuberculosis (TB), an infectious airborne disease, which can become resistant to antibiotics when treatment protocols are not followed.
In the request for Rodriguez’s arrest, county health officials claimed that he had become noncompliant with his treatment and was a risk for becoming contagious and spreading the illness. Allegedly, Rodriguez did not want to take his medication following a drug and alcohol binge as he was concerned that the antibiotics used to treat the disease, in combination with the drugs he was taking, might damage his liver. He also reportedly refused treatment on one other occasion, and missed an appointment with health officials before the arrest.
TB rates in the United States have declined significantly since the early 1990s, when they were fueled by the HIV pandemic, illicit drug use, and poverty; cases peaked at 25,000 in 1993. In 2010, there were about 11,000 cases of TB across the United States.
The arrest and incarceration of noncompliant tuberculosis patients is exceeding rare, though news coverage suggests that San Joaquin County has been more aggressive in its use of public health police powers (30 arrests since 1984) than other counties.
Are these actions justifiable?
There are few public details of the Rodriguez case, but it is fair to ask whether an individual in his situation was given the support needed to help with the completion of his course of treatment. Public health police actions, including arrest or forced detention, should only be an extraordinary measure.
According to Karen Furst, a San Joaquin County public health officer, “the county arranges transportation and other services to help patients stick to their drug regimen and turns to the legal system only as a last resort.”
Is that enough? Have public health officials exhausted less-restrictive measures before engaging in coercive actions, especially because those who seem to be prosecuted in San Joaquin County are not only sick with tuberculosis, but are also struggling with drug addiction and other debilitating conditions?
Let’s hope that’s the case here. There should be ways to protect the public’s health without placing an onerous burden on the most vulnerable among us.
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Should have quarantined AIDS patients when the disease was first diagnosed. could have nipped it in the bud right then. Politics got in the way however putting everyone at risk. Civil rights don't apply when there is a risk to everyone at large.— JohnnyB.- @Barbouze Stop politicizing this. It doesn't matter who the President is, this is responsible policy. If there was suddenly an outbreak of antibiotic resistant TB, you would likely be the first person on here commenting how Obama is a terrible leader for allowing that to happen.
This isn't about a totalitarian regime. This is about public health. If some citizen (not terrorist) were dispersing Anthrax on the streets of NYC, would you not want this person arrested? While the motive may not be the same, one thing that both Republicans and Democrats should be able to agree on is the federal government's role in protecting its citizens.
This man's excuse for not wanting to take this medication makes no sense. If he were so worried about his liver, he would be more concerned about the effect of binge drinking on his liver as well. Furthermore, if his concerns were brought up to a physician, I am certain they would have weighed the pros and cons of taking the antibiotic. If there is some sort of alcoholic addiction here, I hope that they find him the help he needs. Nevertheless, we can't allow his addiction to be an excuse to put other people in harms way of a potentially deadly infection especially if it becomes resistant to antibiotics.— DIT1018 - Comment removed.
- @songsrme2 I'm not quite sure what you are implying but it seems you are confusing an antibiotic with a vaccination. In this case, the patient was refusing the antibiotic, not a vaccination. In fact, in the United States the TB vaccine is used rarely. If you want to hang out with someone with an active TB infection who isn't taking their medication, that's all you. This article has nothing to do with vaccinations, so troll elsewhere. @JohnnyB if we had known more about HIV/AIDS when it first started to appear, we could have controlled it better. Nonetheless, comparing to TB and HIV/AIDS is comparing apples to oranges. HIV/AIDS is not an airborne disease, and does not require quarentine.— DIT1018
Eh, with some of the really nasty and drug-resistant strains of TB running around these days, I think they'd be remiss in not taking a hard line with these cases. I'm not especially comfortable with forcing medicine on unwilling people in most cases but TB? Sorry pal, but I'm not willing to risk infection and death just because you suddenly have a new-found concern for your liver (which was damaged by your drug and booze binge anyway). I mean, I felt bad for Typhoid Mary too but she still killed people because she was unwilling to avoid exposing others to the disease. You can easily make the "citizens who need help, not punishment" argument in her case too. Doubt the families who died because of her would have found much comfort in it though.
And God, will the pycho anti-vaxers ever just go away? They destroy my faith in humanity as an intelligent species...— Ilmare- Bacteria can be eliminated by going to a naturopathic doc who will administer colladial silver, which bacterial cannot live in.— LJM
- As other commenters have noted, severely absent from this story is an explanation of MDR-TB (multi-drug resistant TB) and its growth worldwide over the past decade-plus. No less than the Harvard-educated international medical lion Dr. Paul Farmer has spent his entire career developing innovative public health projects to address TB outbreaks in Russia, Haiti, and numerous parts of Africa.
Asking whether a city is justified in attempting to coerce a citizen through arrest is a very valid question. From this short article, it sounds like the city did not undertake anywhere near the careful process they should have followed before simply escalating to an arrest.
But you do your readers an extreme disservice by not explaining MDR-TB and just *why* American public health officials would be so concerned about a noncompliant patient.— AmandaWBS - The article is written from some region in Lala land. "The most vulnerable among us" are the kids and elderly, and the immunocompromised that this idiot's actions could infect and kill. If the guy was waving a gun and shooting at people, the author would applaud police for shooting him dead. But his weapon of choice for killing people is a deadly disease, so he's a hero of civil rights movement? BS.
I say, he doesn't want meds? Put him in a cell WITHOUT the meds. Put meals and a book or two through a slot. Filter the air leaving the cell with a HEPA filter. Ensure waste leaving the cell is sterilized and safe. And let nature take it's course. Oh, and provide him with a revolver and a flag of his choosing to wrap himself in, should he wish to be considerate and expedient.
Idiots choosing not to take meds for TB are killers, pure and simple. In fact, patients who take some meds, then stop, then start are giant culture vessels for developing new forms of MDR-TB. They need to be out of circulation, and either forced to take meds, or denied all meds (except palliative).
We are going to have an influenza-epidemic-like holocaust, and idiots like the author will be wringing their hands and worrying about the civil rights of these Typhoid Marys.— WizardofBoz - @Wizard - Yes, MDR-TB is scary, but it's not "lock everyone who skips a dose of isoniazid up in a HEPA-filtered cell and to hell with human rights" scary.
It's certainly scary enough to warrant directly-observed therapy, intensive patient interventions and education, and, as a last resort in extreme cases when reasonable attemps at behavioral interventions and education have failed, enforcement. But missing a dose of antibiotics isn't enough to trigger the apocolypse, and it's not enough to warrant the abuse of police power. The question here is whether this is one of those extreme cases where enforcement is warrented, or whether officials are jumping to extreme measures too hastily.
Shrugging off the preservation of human rights as if it's a non-issue does not historically yield positive results.— Izzy812
