Man With Drug-Resistant TB Locked Up

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Man With Drug-Resistant TB Locked Up

 

 

Apr 2, 9:35 PM (ET)

 

By CHRIS KAHN

 

 

PHOENIX (AP) - Behind the county hospital's tall cinderblock walls, a

27-year-old tuberculosis patient sits in a jail cell equipped with a ventilation

system that keeps germs from escaping. Robert Daniels has been locked up

indefinitely, perhaps for the rest of his life, since last July. But he has not

been charged with a crime. Instead, he suffers from an extensively

drug-resistant strain of tuberculosis, or XDR-TB. It is considered virtually

untreatable.

 

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.

Specifically, he said he did not heed doctors' instructions to wear a mask in

public.

 

" I'm being treated worse than an inmate, " Daniels said in a telephone interview

with The Associated Press last month. " I'm all alone. Four walls. Even the door

to my room has been locked. I haven't seen my reflection in months. "

 

Though Daniels' confinement is extremely rare, health experts say it is a

situation that U.S. public health officials may have to confront more and more

because of the spread of drug-resistant TB and the emergence of diseases such as

SARS and avian flu in this increasingly interconnected world.

 

" Even though the rate of TB in the U.S. is at the lowest ever this last year, we

live in a globalized world where, if anything emerges anywhere, it could come to

our country right away, " said Mark Harrington, executive director of the

Treatment Action Group, an American advocacy group.

 

The World Health Organization warned last year of the emergence of extensively

drug-resistant TB. The new strain, which has been found throughout the world,

including pockets of the former Soviet Union and Asia, is resistant not only to

the first line of TB drugs but to some second-line antibiotics as well.

 

HIV patients with weakened immune systems are especially susceptible. In South

Africa, WHO reported that 52 of 53 HIV patients died within an average of 25

days after it was discovered they also had XDR-TB.

 

How to deal with people infected with the new strain is a matter of debate.

 

Dr. Ross Upshur, director of the Joint Centre for Bioethics at the University of

Toronto, said authorities should detain people with drug-resistant tuberculosis

if they are uncooperative.

 

" We're on the verge of taking what was a curable disease, one of the best known

diseases in human endeavors, and making it incurable, " Upshur said.

 

But a paper Upshur co-wrote on the issue in a medical journal earlier this year

has been strongly criticized.

 

" Involuntary detention should really be your last resort, " Harrington said.

" There's a danger that we'll end up blaming the victim. "

 

In the United States, which had a total of 13,767 reported cases of tuberculosis

in 2006, public health authorities only rarely have put TB patients under lock

and key.

 

Texas has placed 17 tuberculosis patients into an involuntary quarantine

facility this year in San Antonio. Public health authorities in California said

they have no TB patients in custody this year, though four were detained there

last year.

 

Upshur's paper noted that New York City forced TB patients into detention

following an outbreak in the 1990s, and saw a significant dip in cases.

 

In the Phoenix area, only one other person has been detained in the past year,

said Dr. Robert England, Maricopa County's tuberculosis control officer.

 

Daniels has been living alone in a four-bed cell in Ward 41, a section of the

hospital reserved for sick criminals. 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.

 

The ventilation system draws out the air and filters it to capture the

bacteria-laden droplets he expels when he coughs. The filters are periodically

burned.

 

Daniels said he is taking medication and feeling a lot better. His lawyer would

not discuss his prognosis. Daniels plans to ask for his release at a court

hearing late this month.

 

Daniels lived in Russia for 15 years and returned to the United States last year

after he was diagnosed. He said he thought he would get better treatment here,

and hoped eventually to bring his wife and children from Russia. He said he

briefly worked in an office in Arizona for a chemical company before he was put

away.

 

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. "

 

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. "

 

University of Pennsylvania medical ethicist Art Caplan said Maricopa County

health officials were confronted with the same ethical dilemma that communities

wrestled with generations ago when dealing with leprosy and smallpox.

 

" Drug-resistant TB, or drug-resistant staph infections, or pandemic flu will

raise these questions again, " Caplan said. " We may find ourselves dipping into

our history to answer them. "

 

Daniels said he realizes now that he endangered the public. But " I thought I'd

come to a country where I'd finally be treated like a person, and bam, here I

am. "