Tuberculosis Patient Locked Up to Protect the Public

Robert Daniels may become the first person in history to receive a life sentence in prison without ever committing a crime. Daniels, 27, suffers from an extensively drug-resistant form of tuberculosis. The strain, called XDR-TB, is considered by medical professionals to be virtually untreatable. So Daniels has been locked up to protect the public.

Daniels’ jail cell is equipped with a ventilation system to keep germs from escaping, and the door remains firmly locked to keep Daniels from escaping. "I’m being treated worse than an inmate," Daniels told an Associated Press reporter last month in a telephone interview. "I’m all alone. Four walls. Even the door to my room has been locked. I haven’t seen my reflection in months."

Daniels is confined to a four-bed cell in Ward 41, a section of the Maricopa County hospital normally reserved for criminals who are ill. He told the AP that sheriff’s deputies will not allow him to take a shower and he has to clean himself with wet wipes. He said that officials have taken away his radio, television, computer, and personal telephone. The only people who come to visit him are medical technicians wearing masks, who come to administer medication. The filters in the room’s ventilation system capture the bacteria-laden droplets Daniels expels when he coughs, and the filters are burned.

County health authorities obtained a court order to confine Daniels last summer because he failed to take the necessary precautions to avoid infecting other people with the deadly strain of TB he carries. Physicians had warned him to wear a mask in public but he didn’t, so the county locked him up for being a danger to the public.

Daniels has lived in Russia for 15 years, but last year when he was diagnosed with TB he returned to the United States because he thought he would have access to better medical treatment here. He worked in the office of a chemical company in Arizona briefly, but he lost 50 pounds and was constantly coughing. When authorities discovered that he had walked into a convenience store coughing, without wearing a mask, they asked for permission to lock him up.

Dr. Robert England, Maricopa County’s tuberculosis control officer, said that only one other person has been detained for drug-resistant TB in the past year. But usually, England said, officials would not force someone into quarantine involuntarily unless the patient was unable or unwilling to follow doctors’ orders in order to protect the public from being exposed. "It’s very uncommon that someone would both not want to take treatment and will willingly put other at risk," England said. "It’s only those very uncommon incidents where we have to use legal authority through the courts to isolate somebody."

Health experts say that because of the gradual spread of drug-resistant TB and other threatening diseases such as avian flu and the SARS virus, confinement of sick patients is a situation that the public health officials must start planning for now. "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 American advocacy association Treatment Action Group. But, Harringon said, "Involuntary detention should really be your last resort. There's a danger that we'll end up blaming the victim."

Dr. Ross Upshur, director of the Joint Centre for Bioethics at the University of Toronto, said that authorities have no choice but to detain people with drug-resistant TB if they are uncooperative in protecting the public on their own. "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. There were 13,767 reported cases of tuberculosis in the United States last year.

A paper by Upshur published earlier this year notes that New York City forced several drug-resistant TB patients into detention following an outbreak there in the 1990s, and as a result, the number of cases declined significantly. Public health officials in California said that four patients were detained there last year, and Texas has 17 TB patients in involuntary quarantine in San Antonio.

Daniels says he is taking medication and feeling a lot better. He realizes now that he endangered the public by not following doctors’ orders and wearing a mask. But he says that where he comes from, the doctors don’t even wear masks. "Plus, I was 26 years old, you know. Nobody told me how TB works and stuff."