For what is believed to be only the eighth time in more than a decade, Public Health – Seattle & King County has taken the rare step of seeking a court order to detain a potentially contagious patient who resisted treatment for tuberculosis.
On October 23, King County Superior Court issued an order for electronic home detention. The patient is currently complying with the court order and receiving treatment.
Dr. Masa Narita, Public Health’s TB control officer, said such action is always a last resort but was necessary in this case to protect the health of the community. “Tuberculosis can be infectious without treatment, so to prevent others from being exposed to TB in the community and to prevent development of drug resistant TB, a person with active TB needs to be treated with antibiotics consistently for several months. This person did not comply with treatment on numerous occasions, which puts the patient at risk for a prolonged illness or dying and puts others at risk as well.”
Treating TB
TB is readily treatable with antibiotics that are commonly available. To become cured, a patient must complete the entire treatment, even after they are no longer infectious. If the treatment is interrupted before the bacteria are completely eliminated, the TB could come back, possibly as a multi-drug-resistant strain. Multi-drug-resistant TB is even more dangerous because patients can be contagious for a longer time, the disease is more difficult to cure, and it requires a longer treatment course with drugs that cause more frequent side effects. Learn more about TB drug resistance here.
Details of patient’s history
The patient was diagnosed with active TB in King County and started treatment on January 27, 2015. At that time, the patient agreed to isolate (stay away) from others until no longer infectious, and to complete Directly Observed Therapy (DOT). In DOT, a health care worker watches the patient take every dose of the prescribed drugs. Making arrangements to meet up every day with a public health worker can be onerous for both patients and health workers because therapy can last for six to nine months. But, if someone with TB is not compliant with full treatment, it increases the potential threat of infecting others and increases the risk to the person’s own health. The TB program works with each client on an individualized treatment plan that helps make compliance easier.
On March 31, 2015, the patient was considered non-infectious and cleared from isolation. Unfortunately, over the ensuing months, the patient missed DOT more and more frequently despite repeated effort to encourage the patient to cooperate.
“Our goal is always to work with clients to help them successfully complete treatment which also protects the community from the spread of disease, said Dr. Narita. “We would always prefer to engage the patient and gain cooperation, and our program is typically very successful in these efforts. Occasionally, as in this situation, we need to take additional steps to assure the patient is treated and the community protected.”
Court action
On Friday, October 23, King County Superior Court ordered the patient to be available at home each day for directly observed TB treatment. The patient will be monitored by electronic home detention. If the patient takes the medication consistently, treatment will be completed in approximately four months.
About Tuberculosis
Tuberculosis (TB) is a disease caused by TB bacteria that are spread from person to person through the air. TB usually affects the lungs, but can affect lymph nodes, bones, joints, and other parts of the body. A person with active TB in the lungs can spread the disease by coughing or sneezing. To learn more about signs, symptoms, and transmission of TB, visit the Centers for Disease Control and Prevention’s TB website.
About Public Health’s Tuberculosis Control Program:
Public Health – Seattle & King County’s TB Control program ensures that people with active tuberculosis are diagnosed and cured, and that others in contact with them who are at highest risk of infection are screened, so that infections do not spread. The work improves the community’s health and saves money by controlling the spread of TB, preventing outbreaks, and preventing the development of multi-drug resistant TB that can be very expensive to treat. In King County, 100 new cases of TB were reported in 2014. On average, more than two cases of active tuberculosis are diagnosed in King County each week. Another 100,000 residents are infected with TB, but the microbe lies dormant.
Note (10.30.15): This post has been updated to correct the number of petitions to the court over the past decade.
Nice article James. It reminded me of my time in the People’s Republic of Benin in the mid-80’s. I returned home to the capital Cotonou after a few weeks in the north of the country only to find that the night watchman for the neighborhood had been taken to the hospital. I considered Romeo a friend so I visited him at the hospital the next day. Turned out he was in the TB section and was being told to stay whilst he completed his course of treatment. No electronic home detention in those days ‘tho Directly Observed Therapy was in place. I asked Romeo if he needed anything and to my surprise, he answered ” a big bag of yams”. Patients were required to cook their own meals or have a family member deliver food. Pounded yam is a favorite dish in Benin.