Should we arrest TB patients for skipping their meds?

Armando Rodriguez was arrested last week for allegedly refusing to take his TB medication. (AP Photo/San Joaquin County District Attorney's Office)

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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