The walking TB problem is in the news again. This time it’s not a well to do lawyer from Atlanta but a Mexican born resident of Norcross, Georgia, a healthy appearing teen ager told last Friday he had tuberculosis and would have to undergo treatment. We don’t know exactly what he was said to him about the nature of the treatment or his disease, but whatever it was, he wasn’t having any of it. He refused treatment and wanted to go home to Mexico. The lawyer was told not to travel while in Europe and he headed home to the US. In both cases a bewildered and scared patient wanted to go home. Only one of them made it (see our coverage here). The teen never got out of Georgia. Gwinnett County Georgia health officials put him in jail:
They put Santos in jail Friday evening, in a rare act of a government agency confining a sick person. Santos is the only inmate in a special medical isolation cell designed for inmates with contagious conditions. The cell, which measures about 15 feet by 20 feet, has a special ventilation system that keeps the air from reaching other inmates.
The 5-foot-5 teenager has a toilet, sink, bed and a mirror made of polished metal. Two deputies guard him and the other medical inmates.
Will, the county health attorney, said Santos was detained because he is a public health threat.
“He has active, contagious TB,” Will said Saturday. “He is at risk of communicating that with anybody he comes in contact with.”
Will said Santos is being held under a court order for confinement. He’ll stay in that cell until either he starts cooperating and accepting treatment, or a judge makes some other decision at a Sept. 5 hearing. At that commitment hearing, the judge could decide to place him in a hospital with security. (Atlanta Journal Constitution)
We don’t know the grounds for the statement he has active TB and is contagious. Most people infected with this organism have neither active disease nor are contagious. But let’s assume it has a solid basis. Let’s also leave aside this young man’s immigration status, (unknown at present) since it is not germane. Authorities don’t want to send a contagious person to another country whatever the status of their paperwork. This still leaves some fairly sticky issues.
How long do you confine someone, and if and when they agree to treatment, what do you do at that point? Release them to the community? Require supervised treatment and surveillance? Release them to a hospital while being treated but still involuntarily confined? At what point do you let them free completely? What safeguards are there for unnecessarily depriving someone of their liberty under the claim they are a public health threat? How is that established? Will everyone be treated the same, or will some people (e.g., those with less resources) be more likely confined than others?
I don’t have answers to these questions. They all present dilemmas. I know from comments left here during the earlier TB discussion that many readers take a pretty hard line. If you are one, here’s what I think you ought to do if you are not to be hypocritical: make an immediate appointment with your health care provider for a TB test. You should be more than willing to face the possible consequences of having it come up positive even though you feel fine: mandatory treatment with drugs with often unpleasant side effects for two years and maybe restriction on travel, movement or employment. In other words, the real possibility your life will be turned upside down. Failure to do this means you are possibly putting the public at risk.
Watching what happens to others with this diagnosis isn’t much incentive to do your duty, is it?