This story caught my eye. Apparently a man in Phoenix is being detained and quarantined in a prison hospital ward because he has admitted to not taking precautions to keep himself from spreading a untreatable strain of tuberculosis called XDR-TB. It seems strange because the article states he has not been charged with a crime. From the article:





it seems to me that this issue of detaining "infected" individuals is a very tricky one indeed with the likelihood of abuse/misuse very high.


http://my.earthlink.net/article/nat?guid=20070402/46107fc0_3ca6_15526200704021514260534

Tricky, yes, but not unprecedented. Typhoid Mary of the early 1900s was virtually the same situation. What will most likely end up happening is he'll be under house arrest.

When his individual liberties are putting thousands at risk, I'm sure the courts will side with the vast unexposed public.

It's got to suck for him.

I've got a crime to charge him with- reckless endangerment. A super-resistant strain of TB can and will kill you eventually, and if you are a carrier and don't care if you spread it (which it sounds like this person does not), you are basically opening up with an automatice weapon in a crowd.

Then again, I also think rapists who are HIV-positive should be charged with attempted murder. Unless thier victim tests possitive afterwards, in which case we make it murder.

Actually, public health authorities do have fairly extensive powers. These includes isolating and quarantining persons. In a declared emergency, they can do a lot more, based on the police power available to the locality.

From the article:

If they obtained a court order that means he was afforded due process, and that is really all society owes him. Whatever sympathy I have for him would vanish the first time he coughed in someone's face.

There is a such a thing as "in the public interest and for the public good".

state of minnesota
county of hennepin
in the matter of--john doe--
you have the right to leave this medical center in 72 hours
not counting weekends and holidays
you have the right to a hearing before a judge
you have the right to a medical exam
you have the rights expressed in the "notice of patent rights"
you have the right to have the head of this medical center
assist you in these matters.

i read 72 hours holds to patents for so many years that
even after retirement i can still remember with no problem.
a Dr finds you a danger to self or others..fills out a short
form..a hospital administrator reads it to you and your in..

When aids first came to be, the question went around law enforcement circles: if a person states that he/she has aids, and threatens to bit/spit/drool/bleed on you, can you shoot them? The answer: never got one. The legal eagles could not come up with an answer. It always sounded like ADW to me, and that made the bad guy shootable. Thankfully such a situation never came to pass...

I think that you will find that in the case of someone carrying an infectious illness, the Bill of Rights does not even come into the arguement. In fact, you will find that any country has laws that permit them to take any measures nesessary with regards to containment of that infection vector. That includes deadly force and insitu cremation of the remains. And yes, that means exactly what you think it means.
No reasonable person want's to infect others but this gentleman has to be contained.

Also, don't confuse this with early 20th Cent misuse of mental health powers.

Damn, people, have some compassion.


"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."

"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."

I understand the threat for public safety, but this is outragous. If someone must be confined, then at the very least they should be made as comfortable as possible. Depriving this man of communication with the outside world, and entertainment seems cruel to me.
And while not wearing a mask was careless and negligent, maybe he really didn't know better. How would you feel if you were told you could never go out in public without wearing a mask that makes you look like a freak. I can understand that mistake.
I really think its wrong to be treating someone worse than some prisoners simply because he has a disease. They could be treating him a lot better. The house arrest someone suggested isn't a bad idea if he agrees to it, although there is no perfect solution to this kind of ethical dillemma.

"...I really think its wrong to be treating someone worse than some prisoners simply because he has a disease. They could be treating him a lot better...'

Very true...

He is not being treated that way "simply because he has a disease." He is being treated that way because he is willfully being a threat to others. There is no ethical dilemma. If he will not take proper precautions to safeguard his fellow citizens then he needs to be locked up.

Alcoholism is considered a disease too. What do we do with people who insist on driving drunk? We punish them. If his conditions seem harsh well, he has only himself to blame for that. Hopefully he'll come to the conclusion that wearing a mask while out in public isn't such a hardship after all.

I agree with you also. But if murders and rapists get to watch TV or make phone calls (something I do not agree with, but that is a whole other topic), he should be too.

I do not think that house arrest would necessarily work in this (or any) situation (even Martha Stewart violated her house arrest rules). By the time the authorities were aware that he has gone for a walk in the park/playground/mall/whatever, and can locate and contain him, he could have contaminated a whole bunch of people.

His claim of being 26 and not knowing the seriousness of his illness doesn't fly with me either...

Of course we have only his word on the conditions of his confinement. But I agree criminals are given way too much in the way of prison perks. I prefer the way ol' Sheriff Joe handles these things.

They say he has another hearing later this month. It would be interesting to see what he has to say then.

What's not clear from the couple different articles I've read about this story is whether he was really given a fair shake, first by his doctor and then was he really given due process? Based on what I've read, there's a good case that he wasn't.

It's apparent that he didn't really understand what he had or how it is spread. He even said so himself. Although he's an adult, he grew up in Russia and how do we know what he understands about biology and disease? Maybe he only got through junior high--we just don't know. Plenty of Americans are clueless about disease and health issues.

Although a doctor asked him to wear a mask, was that a quick, not-so-insistent remark made by the doctor during a quick exam in some busy ER? I don't know, but I've been to plenty of doctor's visits which were hurried, directions were not necessarily clear or sounded like suggestions rather than instructions, etc. If that's the case, then I can understand how any young adult would shrug off wearing a mask in public if it didn't seem that important and would "cramp his style". Was there any language problem? Again, maybe he didn't really understand what the doctor was saying and no one really followed up to make sure he understood.

Then his due process--did he speak to anyone before being hauled off to his "cell"? I'm sure the law doesn't require it so in that sense, it was "legal," but for decency's sake, did anyone give him a final chance before locking him up? The articles I've read say that the health officials got a court order to detain him, but nowhere do I find a mention that, for example, he was hauled before a judge and asked if he would wear a mask or face detention instead. From this guy's comments now, it sounds like he would've if he had only been educated properly on his condition and the importance of taking steps to minimize the threat to others in the first place.

His detention conditions sound subpar, too. There's no good medical reason why his TV, phone, computer, etc. need to be taken away. There's also no medical reason why he can't be allowed to take showers. Even hardened criminals in solitary confinement at "supermax" prisons get to take showers and be let outside periodically. Although TB is airborne, it's not terribly contagious. Generally accepted TB isolation guidelines permit patients to leave their isolation wards temporarily if they take simple precautions like wear a mask.

It seems to me that some of the rather harsh comments here stem from ignorance about the particular characteristics of TB. A person with the flu who goes to work, rides the bus, etc. is more likely to directly or indirectly lead to the death of someone from their flu than this guy is of killing someone from his TB. Flu is highly transmissible, people die from it, and there's no cure for it either, so by the "logic" that some people seem to be using, people with the flu who don't cover their mouths when they sneeze, touch objects after touching their mouth/nose, etc. should also be locked up as menaces to society. And if you've ever willfully and knowingly done these things, then you're also a criminal and should be charged with attempted murder, right?

And getting infected with TB is not a death sentence. Heck, a third of the people on the planet right now are infected with TB and most will never develop active TB disease even if left untreated, so we're not talking about the same situation as some guy with AIDS running around injecting people with his own infected blood. I'm not saying involuntary detentions aren't necessary. I'm just saying that the analogy/disease model that some people seem to have is not really applicable.

Also, think about it--the guy has a wife and children, and they just came from Russia the year before. What kind of job did he have? Does he even have health insurance? A lot of jobs don't offer health insurance or its very expensive compared to what he makes. Or if he gets laid off or is too sick to work, then his insurance also disappears. There are a lot of "big picture" questions behind this story, too, that are important and affect all of us. It's easy to demonize this one guy and ignore the other conditions that contributed to getting him where he is.

The article says that "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." Since he had a hearing, has another one scheduled, is represented by counsel, and is not alleging perjury by County officials it's pretty clear he was afforded due process.


True enough, but how many know they are infected with an untreatable strain of TB and continue to act as though they are not contagious? Fortunately very few: the article mentions 17 others in Texas. So his case is by no means unique, but it is rare.


That's really the problem though isn't it? He won't wear one. From the article:
"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."


I'll bet that hardened criminals who have untreatable TB and who refuse to wear a mask are not let out at all. I'll admit the lack of showers has me puzzled. There is probably some medical reason since I'm sure the hospital staff are not sadists. Or even if they are, I'll bet they are as tired of the smell as he is.



So those of us who are not infected with TB, whether the drug-resistant type or not, shouldn't worry about people wantonly spreading it because it likely won't kill us? Forgive me, but that's not a very convincing argument is it?


Normal flu and untreatable TB are entirely different diseases. There are vaccines and treatments for flu. But you do make a good point. If we ever see a Bird flu pandemic and infected people are running around recklessly coughing in the faces of other citizens you may well see them get locked up.


Sorry, the only thing that put him where he is was his unwillingness to take the one basic precaution (wearing the mask)that would prevent the spread of a virulent disease. I sincerely hope his attitude has changed sufficiently so they can let him out later this month.

I wonder if, when he was diagnosed here in the U.S., anyone TOLD him he had to wear a mask in public? If the medical personnel there are as inept as the Providence chain is here on the west coast, I wouldn't find it hard to believe that they 'forgot' to tell him. If they did tell him, they should have made sure that he knew and understood why.

Still, it sounds like they're overdoing the security a bit, almost to the point of vindictiveness. He could have a small TV and a phone; they could just put them out in the parking lot when he leaves and burn them. Or is that too difficult for them to figure out?

There is a HIV-infected guy here who deliberately had unprotected sex with dozens of women, and several are now positive for the disease. The last I heard, he isn't being charged with attempted murder, or murder. What are they going to do with him? Jail him for 3 months and let him loose to continue? Probably.

Between the medical profession and the legal profession, we're pretty well screwed anyway.

Sue

If he's been combative, removal of those items is a common method of dealing with disruptive inmates. And I"ve never seen a media outlet that wouldn't lie, misquote and omit to make law enforcement look bad.

The problem with house arrest is how to enforce it. If he won't comply, a house arrest program is as good as a restraining order- neither one protects people from getting hurt, it just means that the aggressor (which he is) has been warned.

As for "nobody told me", I can forgive it until he is diagnosed. Once the doc has told him what he has, which has happened, and he has made a willful and conscious decision to NOT take measures to contain his infection, which he has, and after being reinformed makes statements to the effect that he chooses not to take those measures even though he now knows better, he can not use the "I didn't know I was loaded" excuse. He knows he can kill people with what is in him, and he does not seem to care based on the statements attributed to him. So he is making a choice to endanger others through willful negligence, thus ignoring his responsibilities to society.

If you give up your responsibilities, you give up your rights; they are two halves of the same equation.

OK, I finally found an article that fills in some details. Most news outlets are just repeating or paraphrasing the same AP report, which leaves out a lot of details.

Sounds like Daniels had ample, repeated instructions to wear a mask. He was hospitalized in the US for a while for his TB, then put in residential care. OK, so it's clear that he was instructed on at least more than one occasion that he needed to wear a mask in public and he chose not to. It was probably one of his caregivers that turned him in to the health authorities. So he was definitely uncooperative and it wasn't just a case of not really understanding things or hearing something only once and not really getting it.

Wow, he's been in there longer than I thought. I thought this was a recent thing, but he's been in there roughly eight or nine months, I reckon. OK, so this is actually a rather old, on-going story.

Well, based on this new information, he knew what he was doing and had it coming to him. That's quite clear now. However, the conditions of his confinement are still troubling. He's a patient, not a convict.

Hi Arney, I don't know the conditions of his incarceration, but I would bet he's being isolated in the hospital wing. Even in prison, they won't knowingly expose the population to active TB.

I don't know what type of TB he has, but based on his history of non-compliance, I wouldn't be surprised if it was some form of resistant TB and weather or not it's resistant, it is contagious and folks can still die from TB.

He is incarcerated as a result of his own choices, and on a personal basis, I wouldn't want him free in society. His irresponsible behavior simply presents too much of a danger to be allowed to continue.

Regards, Jim

Sheriff Joe is my hero...

"...There is a HIV-infected guy here who deliberately had unprotected sex with dozens of women, and several are now positive for the disease...'

Makes him shootable if he comes at me threatening to bite/spit/whatever on me, or anyone else...

what cracks me up is this guy saying "I was 26 and didn't know any better." Hmm.. adult at 18, he'd (legally) better know better!

Plus, if he's only locked up for roughly 9 months, is 27 that much smarter?

Your comparison of this case with Mary "Typhoid Mary" Mallon is valid. About a week ago I caught a program on PBS about her case. She simply could not or would not understand how she could possibly be a carrier without herself being ill. When a doctor tried to explain it to her she went after him with a large serving fork! She was incarcerated for a time, and then released on her promise to never work as a cook again. She broke that promise and sparked another deadly outbreak. This time she was locked up for 20+ years until her death.

Hi, Jim. Yes, he's in the secure ward at the county hospital, but the thing is, he's being treated like a prisoner in solitary confinement. He/his ward is under guard. He has no windows, is never let out of the room, has to use bath wipes for personal hygiene because they won't let him go to the showers, and had his TV, radio, computer, phone taken away. He has no visitors, but it's unclear if that's because they aren't allowed or because he just doesn't have anyone to visit him.

Ever see the episode of the TV show 30 Days where the host volunteers to be put into prison for a month, including solitary confinement? He was in solitary for only 72 hours, but even in such a short time, he really noticed how it messes with his mind by the end of the 72 hours. This poor Daniels guy has been by himself roughly 8-9 months like this! Remember, he's not convicted of any crime. He's a patient in a hospital. At least in Typhoid Mary's time, there were entire hospitals set up for quarantine, so Mary Mallon could interact with other people, walk around, look out the window, etc. (Not that I would want health conditions where entire hospitals are necessary for quarantine purposes, of course. )



I agree. I was just making the point, based on the limited information in the original news story, that there was the possibility that he was locked up rather..."unfairly" is the only word I can think of at the moment. I mean, based on the original article we were referring to in the original post, it wasn't clear if he really clearly understood the need to wear a mask, was he ever warned and given another chance to comply before being locked up, etc. But after reading some more articles, it's pretty clear that he understood the instructions, was told more than once, but still didn't comply. So, I agree, for the public's sake and his own sake, detention and treatment seem warranted.

I certainly hope this guy has a good attorney or one in his state hears about his story and tries to help him. Speaking as an attorney myself, assuming that your descriptions of the treatment and conditions that this man is being held under are correct, it could very easily be argued to be cruel and unusual punishment and a violation of his civil rights. I am NOT saying that he should be free to walk around in public to contaminate everyone else however I know death row felons that have more rights and liberties than this man is being shown and this guy has never been convicted of a crime. For that matter, most of the GITMO detainees have more rights and liberties than this man.

He isn't isolation. He sees a medical team that is trying to find a better facility to move him to, but no one who is better equipped to house him wants to take him. They have him in an isolation ward that was designed to contain patients that were circling the drain, not someone who might live for a couple of years, so it wasn't designed with cuddly commodities in mind. He's probably straining that facility's decontamination capabilities as it is.

As for cellphones, anything transmitting may interfere with the care of other patients. Iso rooms are usually part of or next to the ICU. If someone's life support gets screwed up by this yabo's cellphone, who's responsability is it? I don't know when the last time you were in a hospital was, but if you look around you'll see that in most of them, cell phones are banned for that very reason.

And the one thing I haven't heard is who is paying for this? BCBS or another major insurance provider who pay about 70 cents or less on the dollar? No. Medicare/Medicaid who pay about 26 cents or less? No. If had all the stuff that people seem to want him to have, it's coming out of your pocket as a tax payer. You want to pay his bills? Make a donation.

I was curious about being quarantined at home with TB, and I found a brochure about "home isolation" from my very own Orange County public health agency here.

You'll note that special high efficiency filtration systems are NOT required. The brochure advises you to open your windws and get good ventilation, but that's it. Notice that the brochure does NOT require care givers or the patient to wear a mask at home around each other. As I was saying before, TB is not a terribly infectious disease, relative to something like influenza. Of course, the risk is still there, and in the case of crowded conditions like a prison or health care setting, then the consquences and risk of multiple people getting infected (especially with a drug resistant strain) outweighs the relatively small risk of spreading it. However, in the home setting, the expense and hassle of using multiple masks a day outweigh are generally thought to be too high a "cost" compared to the protective benefits to the single care giver, like a spouse.

Actually, doing a bit more digging, I was surprised to find that there is almost no evidence that high filtration ventilation systems significantly reduce the risk of spreading infectious TB. Interesting. Theoretically, it should, which is why it is done, but it hasn't been proven yet. In general, what seems to be shown to increase your risk is time spent in the same room, or being in a poorly ventilated area with someone with active TB. As far as official recommendations go for a TB isolation ward, a ventilation system that can do nine air changes an hour, venting to the outside, is optimal, but filtration is not required.

Anyway, read this brochure and then think about what Mr. Daniels is going through. Yes, he knowingly appeared in public without a mask and he does have a dangerous, drug resistant strain of TB and for that, he should be forced to do certain things to protect the public. But it's not like he had Ebola or smallpox, and it's not like the movie Hot Zone where everyone in your neighborhood drops dead with blood gushing out of every bodily orifice within a few hours either.

By the way, extensively drug resistant TB (XDR-TB) is not synomymous with "incurable". It varies by individual set of circumstances, of course, like whether powerful antibiotics are available, but best case, roughly a quarter to a third of people with active XDR-TB disease can be cured. So, Mr. Daniels could walk out in public again some time down the road.