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Wednesday 26th October 2016

Police arrest non-compliant TB patient

21st May 2012

Authorities in California have arrested and charged a tuberculosis patient who refused to comply with his treatment plan.


Police in Stockton arrested Armando Rodriguez after he was asked several times to continue taking his tuberculosis medicine.

Rodriguez had reportedly told his case officer he had stopped the treatment out of concern for his liver because of his high intake of alcohol and methamphetamines.

He was charged with refusing to comply with a tuberculosis order to be at home at certain times and make appointments to take his medication. His lack of compliance could mean other people are infected with the disease, which affects around 12,000 people annually in the United States.

However, public health experts said the move was a controversial one.

According to Lawrence Gostin, a Georgetown University public health law professor who drafted a model law adopted by several states struggling with the issue, the criminal justice system is not an appropriate forum to deal with people who violate public health policy.

Gostin said the intention of public health is to protect the population from disease, not to apportion blame and punish individuals.

The 34-year-old Rodriguez has a form of the disease known as active pulmonary tuberculosis. Patients with this stage of TB can cough up blood or mucus and spread the bacteria to others through the air.

The warrant for Rodriguez's arrest was requested by Ginger Wick, nursing director for San Joaquin County, after Rodriguez failed to give himself the drugs, as specified by his treatment plan, which included supervised drug-taking sessions during the week.

Wick quoted Rodriguez as saying that he had gone on an alcohol binge and taken methamphetamine and wanted to protect his liver.

Rodriguez will probably be given a publicly appointed lawyer.

Many people with TB have a latent form of the disease, and the active form is usually only seen in patients with compromised immune systems, including drug users.

The issue of mandatory treatment and criminal charges for those who do not comply have sparked considerable public debate, dividing experts.

Even those who support rare cases of prosecution in order to protect public health are still against non-compliant patients being sent to prison.

Gostin said that mandatory treatment should only be implemented as a last resort, and that it was unhelpful to prosecute someone for disobeying a public health order.

If protecting public health is the intent, then prosecute patients sends the wrong message. Instead, Gostin suggests assisting patients with transport to and from clinics, where they can take medication under qualified supervision.

The United States has had TB laws on its statute books for more than 100 years, although they vary from state to state.

Healthcare professionals have struggled to contain the spread of TB in recent years, in the face of newly emerging, drug-resistant strains of the disease.

However, California's TB cases reached their lowest levels ever last year, with just 2,317 cases confirmed.

Officials say prosecutions of non-compliant TB patients is still extremely rare, but Joaquin County, where Rodriguez lives, runs one of the more aggressive public health policies to combat TB, prosecuting more than 30 patients since 1984.

According to state prosecutor Stephen Taylor such prosecutions often target drug users who are harder to treat and manage because the TB medicines conflict with street drugs.

According to Taylor, such people should be thrown in jail and treated as in-patients because of their lack of cooperation as out-patients.

The county also transports patients to clinics to help them comply with their treatment plans, according to Karen Furst, San Joaquin County public health officer.

She said it was important to take some steps to stop non-compliant patients from spreading the disease.

According to officials, Rodriguez was discharged in March from San Joaquin General Hospital with four medications for active tuberculosis.

He had reportedly agreed to take the drugs under observation by a county health official on weekdays and on his own on weekends. He now faces a maximum penalty of one year's imprisonment, and still needs nine months of TB treatment.

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