Man Jailed for Having Deadly tuberculosis

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.

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.
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."

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."

www.foxnews.com...

After reading this story I ws unsure of a few things; Was he fully aware of the risks and then still decided to expose the public or was he just realy uninformed? And if thats the case then what kind of doctor does he have that tells you that you have TB but doesnt tell you that you can infect others. Also i wasnt sure if he was not wearing the mask on a regular basis or if he was just caught a couple of times without. But either way, I'm not sure if he should be held in jail. esp. if no charges are being brought. I understand the need for public saftey but why dont they transfer him to some sort of hospital facility that is more trained to take care of him w/o treating him like a criminal, Im sue the CDC can do something for him. BTW i wasnt aware of the fact that people are now allowed to enter the country let alone board planes whie having such a disease. I feel like he didnt tell the proper authorites, oterwise he would have never been let it. But ifeel bad for him considering the fact that he was just trying to make a better life for himself in order to send for his family.

If it's deadly why is he still alive? I'm just glad he's contained, perhaps they can do some research on him, if he is willing, so that this particular strain can be treated in a more efficient manner

I thought our country would have come alot further than this.
As the article stated we used to lock people up when they presented with leprosy or small pox and that was mainly because there wasn't any treatments.

While I agree he needs to be educated about the risks, taking away his TV,radio, computer etc... is IMO extreme. Is he at risk of infecting machines? Why treat him criminally?
I feel really badly for this man. Hopefully this exposure will outrage the right people and he will be get proper treatment both in health and civility.

There's two things going on.

In some states, you are required by law to take your TB meds on schedule, and in order to make sure that happens, you have to present yourself to the health department for each dose. If you don't, jail. For this strain, there IS no effective medication, so he can be confined as if he was not taking his meds. That's also in most state laws, if not all of them.

As far as treating him like a criminal, if you have active TB you have to be isolated or wear a mask, he didn't although he knew to, so he DID commit a crime. Thus the TV, radio etc - he's being treated like a criminal because he allegedly committed this crime.

It sounds like the doctors let him out in public as long as he wore a mask, he decided he didn't want to, therefore they jugged him.

TB is very contagious, and they don't play with it. Nor should they. And it's in the law so it's not like they're making it up just for him.

And where he's from, the doctors DO wear masks if the patient has TB. The patients are also placed in a filtered room so that aerosols from the patient's coughing don't escape into the outside air, the nurses wear masks, gowns and gloves, all the stethescopes, BP cuffs and so on remain in the room and are destroyed in an incinerator, usually with his bed linens. As is all the garbage, Usually they're fed on disposable plates and with plastic utensils so they can be trashed as well.

You can get a case of this if you're in the room with him and he coughs. It generally takes a bit more than that, like exposure of a few hours (you wouldn't want to be on a plane with him!). But with this stuff, the usual TB meds don't work.

The 50 pound weight loss...that's normal. He'll be a bag of bones before it kills him. That's not because they're starving him or something.

But he is NOT a criminal b/c he is NOT being charged with anything. He need to be in and appropriate hospital environment. And just curious how do you know the doctor wore a mask where he is from?? I believe he said he's from Russia and that is a HUGE place. so he could be from some small village and his doctor could be incompetent or just as uninformed as he was.

Ah, he's from Russia, that explains alot. It is common protocol for doctors to wear masks all the time in hospitals in Russia. Also, their medical system is less than scientific. alot of superstition and old wive's tales are mixed up with it.
And I agree, he shouldn't be locked up if they haven't charged him with a crime.

Originally posted by ImpliedChaos
But he is NOT a criminal b/c he is NOT being charged with anything.

Go check out "non-compliant tuberculosis patients" on the net. To refuse to wear the mask when you have active TB is a crime, in some places that's a specific crime and in others it's reckless endangerment. It's the same class of crime as having HIV and not informing your partner. In order to make sure you are taking your meds, you have to show up at the health department and take the meds in front of the nurse. Then they make sure you didn't stick it in your cheek. If you don't show up, they go looking for you, and if they don't find you right away, a warrant is issued for your arrest. You are stuck in the isolation room at the jail, and there you will sit for the remaining course of the medication. Period. To refuse to take the meds on time is a crime.

Non-compliance is enforceable by putting your ass in jail. Most health departments will go to great lengths to avoid it but that is the punchline. Especially for some idiot with resistant TB.

He need to be in and appropriate hospital environment. And just curious how do you know the doctor wore a mask where he is from?? I believe he said he's from Russia and that is a HUGE place. so he could be from some small village and his doctor could be incompetent or just as uninformed as he was.

Then his doctor will have it as well. This is not like a cold or a case of the clap. If you get this, your life is pretty much shot. Even regular TB is hard to clear up, the antibiotics for it are not pleasant and you have to take them for quite a while. TB spreads by droplet, and it's very contagious. And even after the meds clear up normal TB, you'll still have lung damage.

These masks aren't the white surgical masks either, they're N95 tuberculosis masks, which have a tight fit and a lot better filtration. If you can't seal the mask due to facial hair, the male nurses in a hospital caring for TB patients have to wear positive pressure masks with a backpack air tank. TB doesn't play.

Originally posted by Tom Bedlam


Go check out "non-compliant tuberculosis patients" on the net. To refuse to wear the mask when you have active TB is a crime, in some places that's a specific crime and in others it's reckless endangerment....


.

I KNOW that it can being considered a crime but you are missing my point. They are NOT charging him..so unless he is being CHARGED he doesnt not deserve to be in JAIL. BTW i know that there are specialized masked and things and Im sayinghow do we know his doctor wasnt just reckless...i know that would mean the doctor prob has it now but I'm just posing the question because the man said his doctor didnt wear a mask and im inclined to believe him.

Originally posted by ImpliedChaos

I KNOW that it can being considered a crime but you are missing my point. They are NOT charging him..so unless he is being CHARGED he doesnt not deserve to be in JAIL.

As far as I know, if you fail to show up for meds or demonstrate other non-compliance, they don't put you on trial, they just arrest you and force the meds down your throat. That's the way the non-compliance laws work.

BTW i know that there are specialized masked and things and Im sayinghow do we know his doctor wasnt just reckless...i know that would mean the doctor prob has it now but I'm just posing the question because the man said his doctor didnt wear a mask and im inclined to believe him.

I'm not. TB is not a mysterious disease. The guy's just whining for pity. "Oh, I didn't know what TB was. Oh, my doctor doesn't wear a mask" Total crap.

Tuberculosis laws in the US date back to the early 1900's. The infectious nature of TB has been well known to medicine for about 100 years.

Not only do Russian physicians know to wear masks, Russia has a federal law that is pretty similar to most US state TB laws:

Because of its historical, cultural, and geopolitical
position, tuberculosis-control policies in Russia may
influence strategic approaches to control of the disease
elsewhere. On the June 6, 2001, the Russian Federal
Council adopted a law, supported by WHO and the Council of Europe, on preventing dissemination of
tuberculosis. It provides a legal framework for public
policy in the prevention, diagnosis, and treatment of the
disease and the rehabilitation of patients who have or have
had tuberculosis. It also provides a structure for statistical
monitoring, financing services, and occupational and social
support, as well as details of individual and state
responsibilities. The law makes clear that care will be free,
and it highlights the fact that tuberculosis control is a
government priority. There is little in the law, however, to
encourage a formal shift from inpatient sanatoria-based
care to ambulatory care based on WHO’s DOTS strategy.
Nor is there much to enhance the coordination of services
for those moving between systems (eg, prison and civilian)
or to promote the development of integrated health-care
and social-support structures.

In response to the potential public-health threat posed
by those with tuberculosis, the law provides the state with
the authority to detain for up to 6 months in sanatoria
individuals who do not comply with screening, diagnostic,
or therapeutic regimens. Whether such authority covers
surgical treatment, which is quite widely practised, is
unclear. The law also stipulates, in its article on
tuberculosis patients’ rights, provision of legal advice.

from "Detention and mandatory treatment for tuberculosis patients in Russia", Lancet, vol 358, August 4, 2001

I don't think this is a free link, I get it because we have a subscription access to most scholarly publications here, this one is through Elsevier.

More - here is the law:

Arizona revised statute 36-725 "Orders to Cooperate; Emergency Custody"

A. If the tuberculosis control officer or the local health officer knows or has reasonable grounds to believe someone is an afflicted person who endangers another person or the community and the afflicted person fails or refuses to comply with voluntary examination, monitoring, treatment, isolation or quarantine, the tuberculosis control officer or the local health officer shall issue a written order to cooperate to the afflicted person ....The order may require the afflicted person to participate in education, counseling, examination, medical treatment and supervision programs and to undergo medical tests for monitoring and to verify the afflicted person's status.

(snip)

E. If the afflicted person refuses to comply with an order issued pursuant to this section or if the tuberculosis control officer or local health officer knows that an afflicted person has previously failed or refused to comply with an appropriate prescribed course of medication, treatment or monitoring, and if the tuberculosis control officer or the local health officer has reasonable grounds to believe that the afflicted person poses a substantial danger to another person or the community and that emergency custody is necessary to prevent a substantial danger to another person or the community, the tuberculosis control officer or the local health officer may issue an emergency custody order directing a sheriff or law enforcement officer to take the afflicted person into custody, to take precautions reasonable and necessary under the circumstances to protect the health of law enforcement officers and to transport the afflicted person to an institution or facility specified in the order.

(snip)

L. A petition for public health protection shall be filed with the clerk of the superior court within three business days after the afflicted person's emergency detention authorized pursuant to an order of the tuberculosis control officer or the local health officer. A petition filed pursuant to this subsection shall conform to the requirements of section 36-726.

(snip)

Arizona revised statutes 36-726: Petition for court-ordered examination, monitoring, treatment, isolation or quarantine

A. The tuberculosis control officer, the local health officer or a designated legal representative may petition the superior court for court ordered examination, monitoring, treatment, isolation or quarantine of an afflicted person who presents a substantial danger to another person or to the community and who has failed to comply with a voluntary treatment plan or a written order to cooperate.

(snip)

G. Before the superior court has an opportunity to rule on the petition's merits, the court may order the immediate or continued detention of the afflicted person in an institution approved by the department, the tuberculosis control officer or the local health officer if the court determines that there is reasonable cause to believe that the afflicted person is likely to be a substantial danger to another person or to the community.

H. If the court orders that the afflicted person be immediately detained, the court shall issue orders necessary to provide for the apprehension, transportation and detention of the afflicted person

(snip)

36-728:

A. If the court finds by clear and convincing evidence that a person is an afflicted person and presents a substantial danger to another person or to the community, the court shall order the afflicted person to do any one or more of the following...

(snip)

8. Comply with an order that the afflicted person undergo isolation or quarantine at an approved facility, location or setting for the period and under the conditions set by the court ...

9. Comply with an order that the afflicted person be committed to an appropriate facility for the period and under the conditions set by the court...

Go read it in all its gory detail at :

law.justia.com...

So, again, it's not like they have a civil trial or something to prove you have TB. The health officers just stroke a petition to jug you based on your lack of compliance. The court reviews it, and if they agree, and they always do, your arse is picked up by a Deputy and in the slam you go.

There is a period of time that they can hold you while the docs examine you, against your will and by force if needed, and then they present the petition to the superior court. The court may, with no further procedure, just dictate that you will stay in forced medical quarantine until you are cured. And this guy will never be.

There are all sorts of legal petitions that can be made, but in the end, it's up to the court to decide if you are in there or not. The health officers can call witnesses that the guy wasn't wearing a mask, and this guy seems to have ADMITTED that he did not wear the mask as ordered, and then tried the "oh, what is mask? TB? What is germ?" routine. It doesn't matter. In fact, playing stupid is probably a NEGATIVE here, because the health dept can then say "He's too stupid/uneducated to comply, jug him" and the court will.

I don't see the issue here. It's a clear cut case of the guy not complying, having a deadly incurable disease that's spread by droplet, the guy intentionally NOT wearing a mask. That mask thing was dictated to him by the health dept, which has the mandate to allow you the least restrictive method you will comply with. He did not. Then he played the dunce card. That was not a good idea.

He needs to be off the street, he refused to adhere to the less restrictive regimen, and he got what he deserved. The law allows for it, it's very clear, they got a superior court order, and there he will stay.

[edit on 3-4-2007 by Tom Bedlam]

Good Job Tom in finding info about the law. Well i guess now that i know what they are doing is Legal. But in my opinon its still wrong and inhumane, I understand the need to confine him and public saftey, But wouldnt a hospital or another CDC type secure site be better for all those involved? Just my opinon

Well, in the beginning, they let him go whereever he felt like, as long as he adhered to his mask restrictions. That was pretty humane, and in fact the law (if you read all the stuff I clipped out) has a number of recourses, and they're required to allow you the least restrictive that you will adhere to.

He didn't comply. He intentionally didn't comply.

Now, is there a better place that he could go? Maybe...I don't know if Arizona has TB sanitoriums. This guy doesn't just have TB, he's got XDR. It's not fair to put him in with "normal" TB patients. So whereever he goes, he's in isolation for the rest of his days unless they come up with some sort of antibiotic that will work. And there aren't a lot that work on TB anyway. That's one reason that they force you to take the antibiotics on schedule under observation...they don't want the common TB becoming antibiotic resistant because you don't take the drugs on schedule. And they always give you two or three drugs at once so that the bacteria can't figure out a simple trick for resistance to one drug.

Also, if he's unable to pay, they're going to put him the least expensive place they have that will do the trick. He's going to be there for YEARS. I wouldn't want to pay for him to stay at a hospital for 40-50 years at several thousand a day. So if Arizona doesn't have a swanky TB quarantine building for XDR, then that may be the only place he has to go.

I don't understand all the other restrictions such as no TV, computer etc. I would expect his lawyers to appeal that. He is in the jail quarantine, but as you say, other than stupidity I'm not sure they're charging him with a crime, it's just court ordered quarantine/isolation.

Originally posted by ImpliedChaos
I understand the need to confine him and public saftey, But wouldnt a hospital or another CDC type secure site be better for all those involved?

I feel it should be pointed out that Daniels actually is in a hospital.

From the origional article:

Daniels has been living alone in a four-bed cell in Ward 41, a section of the hospital reserved for sick criminals.

[edit on 4/3/07 by redmage]

Ah, thank you, I misread it as a section of the jail hospital, it's essentially a jail inside the hospital.

They must feel he poses a risk for leaving the hospital. The court would have to have ordered him to that facility, normally TB patients go into special TB flow rooms, true, but they don't have bars.

Tom is absolutely right about tuberculosis compliance. It is mandatory. I'm curious as to whether this man has gone to Hot Springs, Arkansas for treatment in their sanitoriums there. There are TB treatments using hot springs, massage, etc. that all sound pretty mundane and ineffective but the US government has declared that if you go through their treatments, you can be considered "cured" even if no TB meds are administered. Otherwise, you can be forcibly detained and have the meds shoved down your throat. TB is a deadly serious disease that is easily transmitted by coughing, sneezing, talking, clearing your throat in close proximity to others. Even stirring up dust where droplets have landed can infect another. I feel sorry for this guy who is probably going to die from his disease no matter where he's housed/treated but I'm glad he's off the street.

Ohhhhhh!! I completely overlooked that. I thought he was sitting in a county jail cell somewhere. But since he is in a cell in a hopital, and considering what seems to be his disregard for others.....I have changed my opinon. He should be there. Its only fair. But the man is going to die soon can he at least get his TV back

Originally posted by ImpliedChaos
But he is NOT a criminal b/c he is NOT being charged with anything. He need to be in and appropriate hospital environment.

I dion't understand. The article clearly states that the man is kept in a hospital ward that is intended to house criminals. If he were a compliant patient, such measures would be unnecessary, but he is not compliant and the stakes are very high with an incurable, communicable disease.

Also, he is not the only patient that is being involuntarily quarantined because of TB, as the article clearly states.

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. [emphasis mine]

www.foxnews.com...

I feel sorry for the guy, but if he does not comply with medical advice, he is not only putting himself in danger, but the whole world.

We've spent a lot of time on this board discussing the implications of bird flu, which so far has killed a very small number of humans.

TB has killed millions worldwide and even thought it had become a curable disease, now we have an incurable strain in a world that is more mobile than at any time in history.

One nincompoop could created a catastrophic pandemic. This is not a time to make nice.

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.

www.foxnews.com...

A little history to put it all into perspective.

Rates of death from tuberculosis in the United States decreased from 194 per 100 000 persons in 1900 to 40 per 100 000 persons in 1945, in part because the epidemic of tuberculosis in the western world was running its course and in part because of public health initiatives and improved socioeconomic conditions. In 1945, 63 000 persons died of tuberculosis and 115 000 new cases of the disease emerged. Streptomycin and para-aminosalicylic acid had just been discovered; the discovery of isoniazid followed, in 1952. Sanitarium care, nonsurgical and surgical collapse therapy, and resectional surgery were in widespread use. By the middle of the 1950s, it was evident that bedrest did not add to the benefit produced by effective chemotherapy, and sanitariums began to close, a process that was completed by the 1970s. As mortality and morbidity due to tuberculosis rapidly decreased, the U.S. government decreased funding for tuberculosis and many states and cities downgraded their tuberculosis control programs.

After 1984, the rate of new cases of tuberculosis, which had decreased to 9.4 per 100 000, began to increase and focal outbreaks of multidrug-resistant tuberculosis were reported. Noncompliance with drug therapy, homelessness, immigration to the United States from developing countries, and human immunodeficiency virus (HIV) infection were invoked as explanations. With the reinstitution of federal funding, improved case-finding and surveillance, and the practice of having patients receive therapy while under direct observation, the rate of new cases of tuberculosis decreased to 8.7 per 100 000 in 1995, the lowest rate since national surveillance was begun in 1953. However, at the end of the 20th century, the worldwide burden of tuberculosis, which is engrafted onto the pandemic of HIV infection, is enormous: an estimated 7.6 million new cases in developing countries and 400 000 new cases in industrial nations.

www.annals.org...

en.wikipedia.org...

www.who.int...

In developed countries, such as the United States, many people think tuberculosis (TB) is a disease of the past. TB, however, is still a leading killer of young adults worldwide. Some 2 billion people-one-third of the world's population-are thought to be infected with TB bacteria, Mycobacterium tuberculosis.

www.niaid.nih.gov...

[edit on 2007/4/3 by GradyPhilpott]

Originally posted by ImpliedChaos
But he is NOT a criminal b/c he is NOT being charged with anything. He need to be in and appropriate hospital environment. And just curious how do you know the doctor wore a mask where he is from?? I believe he said he's from Russia and that is a HUGE place. so he could be from some small village and his doctor could be incompetent or just as uninformed as he was.

He's moved back after living 15 years in Russia.....he returned after being diagnosed......sounds like he's a 'former' local. Somewhat less of an excuse.

The way TB was nearly wiped out, was that people were locked away when they were diagnosed. They went to TB hospitals, and were under quarantine till they were not a danger to the public. They took their medications, underwent surgery, and stayed there till they either got over it or died from it.

The reason it's returning and resistant to the drugs is, those hospitals don't exist any longer....they became 'unfashionable', and made for bad PR....oh, yeah and they cost the gov. too much money.

So sick people were sent home with their medicines and a 'promise' that they would take them. But they weren't supervised very well that way.....and that helped create a resisitent strain of the bug.

TB most definitely is a killer, even the non-resistant kind will kill if not treated in time. IN the late 70's, I saw one young man, just 19 years old......who died within weeks of being diagnosed. He'd had it for a while, and they found it too late. He didn't live in a third world country, he was born in the US.

The guy admitted to going to public places without wearing his mask, AFTER being told to wear his mask. Yeah, this guy was quite aware of the consequences of his actions. Quite aware of them.

I feel sorry for the guy, but if he does not comply with medical advice, he is not only putting himself in danger, but the whole world.

I can honestly say that I don't feel sorry for him at all. He knew what he was doing. Folks, the guy is 26 years old!!



[edit on 4-4-2007 by SpeakerofTruth]

I do feel bad for this fellow, but this is no joke. This is the kind of thing we gasp about in movies. It is that serious. Those apocolyptic end-game scenario can be possible if this were treated in a lax manner.

If those 80 passenegers disembarked ito at least a dozen different countries, can you imagine the threat? How many people could they come into contact with just by walking through any airport, which could further transfer this stuff all over the world?!

I agree they should at least give him a TV. Does anyone know if it is possible to donate him one? I will fork up the cash for one, they only like less than a hundred dollars at Wal-Mart, and I frankly think it is a little to pay for the burden he must now suffer.

So does anyone know the exact location of where this is, so that I may call the authorities and ask if I can send him a Television set, and maybe a chess set and a deck of cards?