A Washington state woman faces electronic home surveillance and possible jail time after spending the last year willfully violating multiple court orders to have her active, contagious case of tuberculosis treated and stay isolated during this time.
Last week, the Tacoma-Pierce County Health Department announced it was “monitoring” a case of active tuberculosis in a woman in the county who had refused treatment.
“Most of the people we contact are happy to get the treatment they need,” Nigel Turner, division director for communicable disease control, said in a news release last week. “Sometimes people refuse treatment and isolation. When this happens, we take action to help keep the community safe.”
But reports from The News Tribune found that the woman’s refusal to follow public health advice is a long-standing challenge for local authorities. Documents filed in Pierce County Superior Court and reviewed by the Tribune revealed that the woman’s first court order for involuntary isolation was over a year ago, on January 19, 2022.
Mortal threat
Tuberculosis is a bacterial infection caused by Mycobacterium tuberculosis, which mainly causes disease in the lungs, although it can invade other parts of the body. It can easily become fatal without proper treatment. M. tuberculose spread through the air when an infected person coughs, sneezes, spits up, or releases bacterial cells around them. Although transmission occurs primarily through close and prolonged contact, inhaling just a few of these microscopic germs is enough to trigger an infection. Tuberculosis is one of the world’s leading killer infectious diseases, causing 1.6 million deaths in 2021, according to the World Health Organization.
Treating TB is not easy – in uncomplicated cases it takes a four or six month course of four types of antibiotics to effectively clear the infection. But M. tuberculose is becoming increasingly drug-resistant, even ultra-drug-resistant (XDR-TB), both of which are considered a global public health crisis and a threat to health security. These drug-resistant cases can take up to 20 months of courses of antibiotics to shake off the help of alternative treatments that can be expensive and toxic. But drug resistance develops or increases if patients don’t complete or follow prescribed antibiotic treatments properly, as is the case with the Washington woman.
Court documents from January 2022 noted that “the local health officer ordered [the woman] self-isolate and self-medicate; which she refused to do. [The woman] has not complied with these efforts, discontinued treatment, and is unwilling to resume treatment or voluntarily self-isolate. [the woman] self-isolate in one’s residence [and] cooperate with tests and treatments recommended by medical providers. »
The court issued an involuntary isolation order, but it did little good. The woman continued to refuse treatment and isolation, pursuant to an order issued on January 26, 2022. The order was renewed on February 14, 2022, then again on February 24, then again on March 24, April 19, , May 17, June. July 28, 27, August 25, September 27, October 21, November 18 and December 16.
Breaking point
Last month, the health department, it seems, reached a breaking point. Not only was the woman nearing the one-year mark for violating court orders, but she was also in a car accident, which seems to underscore her negligence. According to an additional court document filed by the health department on January 11, the woman had been involved in the car accident as a passenger, meaning she had not been isolated at the house where she was. supposed to be and that she was in close contact with the driver. , who would have run the risk of contracting tuberculosis during such close and confined contact.
In addition, she went to the emergency department the day after the accident, complaining of chest pains and did not inform her treating doctors of her case of active tuberculosis, putting them and other members hospital staff at risk. When they took x-rays of her chest and saw the condition of her lungs, they initially suspected she had cancer. But in fact, x-rays revealed that his tuberculosis case was getting worse.
Additionally, she also tested positive for COVID-19, “which also strongly suggests that she is not self-isolating pursuant to the order of this court,” the health department court filing said.
The court renewed its order on January 20, 2023, adding that failure to comply this time “could result in a contempt conviction whereby the court orders further action, up to and including electronic home surveillance and detention in the Pierce County Jail or other lawful orders the court may issue, in accordance with the applicable code. »
In a statement to the Tribune, the health department’s Turner said: “We are weighing that balance between restricting someone’s liberty and protecting the health of the community. We also want to make sure we have time for the person to comply and try a lot of different options that don’t require someone to be detained,” he added. “Incarceration is the very last option we want to take and we don’t do it lightly. But it sometimes becomes necessary if there is a risk to the public.”
According to the latest data from the Centers for Disease Control and Prevention, there were 7,882 cases of tuberculosis in the United States in 2021 and 600 tuberculosis-related deaths in 2020. The Tacoma-Pierce County Health Department reported that Washington state averaged about 200 cases a year, and Pierce County, south of Seattle, averaged about 20.