thewayne | The continuing saga of the Tacoma woman with untreated TB running around in public

For a YEAR, the woman has refused to self-isolate and treat the tuberculosis. The Washington health department ordered her to do so, and she doesn't. She was in a car accident as a passenger, proving she wasn't self-isolating. Then a couple of days after the accident, she goes to the emergency room for chest pain, they x-ray her and think she has cancer because of the massive amount of TB in her lungs. And she put the driver of the car, emergency responders to the accident, and EVERYONE in the emergency room - staff and patients - at risk of exposure. She's also tested positive for Covid, another marker that she was violating the self-isolation order.

Well, a judge has finally said 'Enough is too much' and ordered her arrest, isolation, and treatment. This only took SEVENTEEN court hearings.

From the second link, her attorney suggested "...that the woman’s lack of acknowledging and understanding what was happening was a significant factor in her refusal to voluntarily seek treatment. Tofflemire’s filing stated, “She has not acknowledged the existence of her own medical condition. Because counsel is bound to represent the respondent’s stated interest, a guardian ad litem would be able to provide representation of her best interests, which are not currently clear.”

The second article goes on "The filing added that when “the respondent has joined proceedings, she has spoken out of turn with rapid, disorganized speech.” It noted, “She has primarily focused on how she dislikes papers coming to her home, and not the import of the process in which she finds herself. She has repeatedly threatened suicide in relationship to papers being served upon her home.”

The article also notes that apparently English is not her native language. The Court provided a real-time translator during proceedings and bi-lingual paperwork whenever it was sent to her.

I wonder if the Tacoma area is going to experience an uptick in TB because of this.

https://arstechnica.com/science/2023/03/us-woman-headed-to-jail-for-refusing-tb-treatment-for-over-a-year/

https://www.thenewstribune.com/news/local/article272657405.html

Flat | Top-Level Comments Only

From:

acelightning73

I guess there's no such thing as quarantining a person for the sake of public safety.

From:

dewline

There should still be such processes.

From:

thewayne

They tried. She would never do it even though she was ordered to. Now they're going to lock her up and treat her against her will. Sounds to me like there's some mental issues involved here, which is a whole other can of worms. Nasty case: individual autonomy vs public health, though I'm solidly in favor of the latter, especially now that I'm permanently immune compromised/deficient.

From:

dewline

Wow. This is just horrifying. I also wonder if finding out where she came from will at least partly explain her antipathy to the legal and medical processes. Or maybe she's just a narcissist?

From:

armiphlage

Or broke. Extensively drug-resistant TB cost an average of $ 567,708 in 2020 US dollars per case to treat. Getting arrested might be the only way the patient can get treatment.

https://www.cdc.gov/tb/publications/infographic/appendix.htm

From:

dewline

Also possible, yes.

Damnation upon those who actively believe such a state of affairs is right and proper.

Edited Date: 2023-03-06 03:53 am (UTC)

From:

thewayne

Recurring theme: the USA being one of the wealthiest countries in the world and doesn't provide adequate health care for its people. Who knows when our politicians will finally tell the health care industry - not service - to screw themselves and start a decent public health plan.

From:

thewayne

I'm wondering if some mental health issues might also be part of the problem.

From:

kathmandu

Neither article seems to say whether the state offered any support for isolating at home.

While I can't condone refusing treatment, or discontinuing treatment, one of the major barriers to isolating at home is when the government just expects people to live on $0 for weeks, let alone months.

From:

armiphlage

Very good point.

From:

armiphlage

Also since this is in the US, the required treatment would be expensive for the patient. They might not have the money to pay for it, or might be reluctant to sell the family's possessions and/or go bankrupt.

From:

thewayne

As I recall, one of the articles said the judge stated 'at the cost to the State'. In lots of cases where you have a highly-communicable disease like this, insurance coverage isn't much of a problem as it's recognized as a serious public health risk. Better for the state or insurance company to pay a high price to cure a small number of people than for it to become an epidemic.

From:

thewayne

There's definitely lots of issues here.

From:

conuly

Yes, once she's in jail she certainly won't be in the sort of crowded, squalid conditions where disease is most likely to spread to other vulnerable people.

From:

thewayne

There was specific mention that she'll be held in such a way to not threaten the health of other inmates or workers.

From:

conuly

I'm just thinking that even Typhoid Mary got an island.

From:

acelightning73

Have you ever heard of Rikers Island? (A famously horrible prison on an island in New York 's East River. Disease, violence, drug abuse, and other obscenities are common there. Local politicians want to close it down and build new prisons in other parts of the city.)

From:

conuly

Yes. as a New Yorker with an interest in criminal justice reform, I have in fact heard of Rikers.

I'm not quite seeing the relevance. Typhoid Mary was housed on North Brother Island. (And actually, she was allowed to leave to do her shopping and visit people, so long as she didn't cook.)

From:

acelightning73

Because of the various epidemics throughout history, various islands in the waters of NYC have been used for quarantine isolation. There was once a TB hospital on Roosevelt Island. But isolation and confinement for the sake of disease prevention is not the same as isolation and confinement for the sake of judicial procedure or else as a punishment.

From:

conuly

I feel like I should also point out that Rikers isn't a prison, it's a jail.

In casual speech we tend to use the two terms interchangeably, but there is a legal difference. People are held in jail pre-trial or for very short sentences.

https://www.prisonfellowship.org/resources/training-resources/in-prison/faq-jail-prison/

The fact that jails aren't prisons means that jails get a lot less of the attention when it comes to prison reform, even though conditions are often just as bad or, in cases like Rikers, notoriously inhumane.

From:

acelightning73

Yes, but "short time" is defined differently at Rikers. Some of those guys have been there for years.

From:

conuly

I am aware that many people are forced into pre-trial detention for unConstitutionally - and, I'll add, unconsciably - long times. However, Rikers is still a jail and not a prison. Another difference between jails and prisons is who's responsible - the local jurisdiction or the state and/or feds.

From:

acelightning73

Well, it's a political hot potato. Some people hope the next big flood will wash everybody and everything off the island, so it's *NOBODY'S* problem any more. Others want to call in the Feds and/or National Guard to restore order in the place.

And if there's a strong enough flood to destroy Riker's, there won't be much left of LaGuardia airport.

From:

acelightning73

The city wants to have a Federal commission take over operation of Rikers.

The island is very close to the Astoria section of Queens (where my son and his wife live), and it's odd that not very many prisoners have ever attempted to swim or paddle a canoe to freedom. The tidal currents around that area gave Hell Gate its name, and a small boat might not survive. Last year a developmentally-impaired teenage boy decided to try to swim from Astoria Park on the shoreline to Randalls Island (which is where the JFK/Triboro bridge is located, along with stadiums, recreation facilities like ballfields and running paths) His mangled remains washed up in the Bronx a couple of weeks later. I guess even people who are stupid enough to get committed to Rikers know this.

From:

conuly

That last sentence is extremely offensive on multiple levels.

From:

acelightning73

I apologize. It's the way they talk about themselves, and I have no excuse for it.

From:

thewayne

This was one of my main points against Sherrif "Dime Bag" Joe Arpaio in Maricopa County, Arizona. He was treating jailed detainees as if they were in 1920s chain gangs. Most of these people had not been convicted of a crime, they just couldn't bail-out for whatever reason before their trial.

From:

conuly

Not that you can convince people of that, that even if it was okay to treat anybody like that you really ought to wait until they're convicted.

When it's a white man it's "Innocent until proven guilty!" but when it's a black or Hispanic person in jail it's "Well, don't do the crime, blah blah blah".

From:

thewayne

Agreed. Racial disparity in both sentencing and bail is ridiculous.

From:

acelightning73

I should know that. I used to live next to Ossining, NY, home of the infamous Sing Sing prison (and Ole Sparky, the retired electric chair).

From:

thewayne

Hopefully the TB woman can be cured! At the time, at least, there was no cure for Mary.

From:

conuly

It'd be nice if she could be cured, but TB turned out to be a total monster to deal with, even if you catch it relatively early.

That's one of the reasons we've made so little progress in eradicating it. Even with people who understand what they're being asked to do and why, and have the ability to follow the treatment plan, mostly... don't. As far as I know, the only intervention anybody has ever found that works is paying somebody to go over to a patient's house every day and watch them take their pills.

(And that's just taking the pills. I don't know what intervention can be used to make them keep quarantine for the very long period of time when they'd have to do that if they're badly contagious, short of what they're trying here.)

From:

devilc

Even with people who understand what they're being asked to do and why, and have the ability to follow the treatment plan, mostly... don't.

Because, with multi drug resistant TB, the medications prescribed have some deeply unpleasant side effects, and you can be taking them for months before you start turning the tide ... or not.

From:

conuly

Oh yeah, no, it definitely sucks all around.

From:

thewayne

That's why they used to have TB sanitariums. Lock 'em up, cure 'em, let 'em go.

From:

conuly

I'm not sure I've ever heard that sanitoriums were mandatory for TB patients. Are you perhaps thinking of leper colonies?

At any rate, they didn't cure the patients because, without antibiotics, it is very hard to treat TB. And all of those facilities closed after antibiotics came into use.

Even with antibiotics, I believe studies have generally shown that it's more expensive and less effective to require patients to reside in a facility for treatment. They may not like taking the pill every day, but they really don't want to leave their homes to do that. People will avoid going to the doctor entirely if they think they can't be treated without leaving home, same way they avoid opening the mail if they think they'll get a bill.

And, as noted elsewhere on this thread, TB isn't really a highly contagious illness. It's a pain and a half to treat, but there's a reason it's very concentrated among the poor - they're about the only ones who have the living conditions required for the disease to spread. You can't catch it from sitting next to a sick person on the train, or passing them in the supermarket. You pretty much have to live with them, and even then most people don't get sick because most immune systems, if not overstressed, can cope. Congregate living situations, like nursing homes and prisons, are where this disease spreads.

TB is a very serious illness, but it's not covid. It's not measles. It just doesn't spread like that.

Edited Date: 2023-03-09 10:19 pm (UTC)

From:

disneydream06

WOW, that's crazy.
I hope everybody is going to be okay.
And that they lock her until she's better and able to go out in public safely. :o
Hugs, Jon

From:

silveradept

We can only hope that there will be treatment and it will not be bankrupting, because it would be an extremely USian thing to have to choose between dying of a disease and dying of not being able to pay the debts for the treatment for the disease.

From:

thewayne

Sadly true. I'm caught in that paradox if medical insurance were to disenfranchise me. And my wife is changing to a more expensive drug for her cancer-like blood disorder.

From:

acelightning73

TB is not virulently contagious like COVID or the flu. Like leprosy, it usually only spreads among people who live extremely close together - if you share a bed with someone, you can catch it. And T is why spitting on the ground/floor in public places is illegal in NYC (You still see "No Spitting" signs in some subway stations. TB makes patients cough up bloody sputum, which contains bacteria.

From:

thewayne

Having been through five pneumonias in seven months when my immune system collapsed, I'm a strong proponent of avoiding lung infections.

From:

acelightning73

Most people who have lungs feel that way - I know I do (The symptom of congestive heart failure that sent me to the ER was that it hurt to breathe, but I refused to stop breathing.)