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TB: Public Health versus Personal Liberty


Public health officials are growing increasingly concerned about drug resistant forms of tuberculosis. Last year, in the KwaZulu-Natal province of South Africa, an outbreak of extensively drug-resistant TB killed 52 of 53 people infected. TB is highly contagious, and to keep drug-resistant types from spreading, some health experts are considering mandatory quarantines.

For Robert Daniels, the debate is not theoretical. He learned he has TB two years ago, when the coughing spells started. He's been quarantined in an Arizona hospital for the past nine months, in isolation in a lockdown ward. "I never thought this could happen. I'm telling you, sometimes I'm sitting on the bed and just crying because of all the quietness."

His incarceration has ignited a debate over the civil liberties of patients with dangerous illnesses.

Daniels contracted tuberculosis in Moscow, where he used to live with his wife and their five-year-old son. He was born in Russia, but grew up in Arizona and has dual citizenship. He left Moscow hoping to find work and better medical care in the U.S. But his symptoms worsened not long after his arrival in Arizona. "I was feeling very tired... and weak... just awful, awful," he recalls.

He says the local County Department of Public Health put him under a voluntary quarantine. That meant he had to check in with a health care worker, who made sure he was taking his medicines. He also had to wear a facemask in public; TB is highly infectious and spreads through the air.

Public health officials wouldn't talk about Daniels' case, citing privacy laws. But according to court documents obtained by the Arizona Republic newspaper, Daniels has a type of TB that's resistant to antibiotics and he was quarantined against his will because he went out without the facemask.

He was handed over to the County Sheriff, who now has him under lock and key. "They're telling me I'm an inmate and that I have a booking number," he complains. "Which is for what? Having TB? A booking number? It's just all being ridiculous."

He's under the supervision of Joe Arpaio, the Maricopa County Sheriff renowned for his tough and controversial jailing policies. Lieutenant Paul Chagolla, a spokesman for the sheriff, admits that although Daniels was not convicted of a crime, "he's in a facility... in a jail facility. I don't think anybody writes the book on this type of thing." Chagolla says while Daniels is under the sheriff's charge, there's no distinction made between him and other inmates. He's under 24-hour video surveillance, and the light in his room never goes off, not even at night.

Daniels says doctors in Russia didn't wear masks when they treated him, and he didn't understand how contagious he really is. He does now. And he understands why he needs to be isolated. But he says he's being incarcerated. "They don't have the right to isolate me from the world, especially my family, and from the media, the news, everything. I'm all alone here. I don't even know what the hell is going on in the world."

For the past seven months, Daniels' only contact with the outside world was a payphone. He was allowed to make collect calls after 4:00 p.m. After extensive news coverage of his situation, Sheriff Arpaio met with Daniels and gave him back his TV and cellphone.

Sheriff spokesman Paul Chagolla says Daniels only has himself to blame. "You have a situation where you have an individual who because of his poor decisions, wound up inside this hospital facility behind bars. It was because his actions were posing a danger to the community. That's your family, that's my family, that's everybody else's family that's out there, at risk."

Daniels' case is rare but not unheard of. There have been a small number of forced quarantines around the nation. Internationally, public health officials are growing increasingly alarmed about new strains of drug resistant TB identified on six continents. There are two types, one worse than the other. But Dr. Kenneth Castro, director of TB Prevention at the Centers for Disease Control, says keeping both from spreading is vital.

"With garden variety TB," he explains, "the person can be cured within a six-month interval of taking multiple drugs. Once you have either multi-drug resistant TB or extensively drug resistant TB, you're now using drugs that are much more toxic, less effective, and the sentence, so to speak, increases to a couple of years of treatment."

Dr. Castro says approaches to quarantine vary from state to state. The American Civil Liberties Union says Arizona's approach clearly violates Daniels' constitutional rights. The civil rights group is watching the situation, and may be stepping in. A court hearing on Daniels' quarantine is scheduled for later this month.

For now, Robert Daniels' future is unclear. As Dr. Castro noted, treatment for drug-resistant TB can take years and may or may not be successful.