TB patient may be jailed for refusing treatment

For the first time in recent memory, public health officials in Seattle have petitioned a court to jail a patient for refusing to take tuberculosis medications.

"This was a last resort," said James Apa, spokesman for Public Health -- Seattle & King County. "Our goal is to always work with clients to achieve voluntary compliance."

Seattle has been at the epicenter of a small but persistent TB outbreak for the past few years, as disease rates here have increased compared with declining rates nationally. The region hit a record high of 158 confirmed cases in 2002, mostly among the homeless. Those with TB must take drugs for at least six months to clear the bacterial infection.

Citing medical privacy laws and a King County Superior Court seal on the records, Apa said he could not provide much information about the person or why the health department sought the court order for involuntary detention.

But Apa did say nobody at the department can remember the last time it had to seek incarceration to persuade someone with TB to get treated. As it turned out, this non-compliant "TB client" was involuntarily detained for something else.

"It just so happened that (the person with TB) was arrested on a criminal offense," Apa said. The public health department had been preparing to have the person taken in on a civil detention order for refusing to take the needed TB medication, he said, when criminal charges trumped the matter last week.

Apa would not say if the department's petition for involuntary detention was carried out or if, since the person was already under arrest, officials used the patient's being in jail to make sure the medicine was administered.

"The person is no longer in jail, but we're continuing to work with the client on a treatment plan," he said. So far as public health officials can tell, Apa said, the infected person did not spread his respiratory illness to others.

Though much of the TB problem has been among the homeless, there have been outbreaks in schools, a recent isolated case with a student at the University of Washington and among some members of the immigrant community.

"What's been happening here just reflects the global problem," said Dr. Masa Narita, director of TB control for the health department. "A third of the world's population has dormant tuberculosis infection. That's one out of every three people."

Every year, Narita said, TB kills 2 million people -- almost as many as killed by AIDS. Lack of complete drug compliance not only hurts the infected individual by allowing the disease to return, he said, but it also allows TB to spread and sometimes develop drug resistance.

About 100,000 people in King County are infected with TB, Narita said, though most likely aren't aware of it. The infection can smolder undetected for years before causing disease. Drug-resistant TB can require years of treatment, he said, involving both pills and injections.

The lengthy treatment requirements to cure TB can be difficult for the homeless, the poor or for others lacking stability, Narita said. The health department offers all the drugs and care for free, he said, sometimes even providing food and lodging to assure that an infected person completes the drug treatment.

"But sometimes, we have to be more aggressive," Narita said.

Tuberculosis, a respiratory infection, is usually spread through close contact with an infected individual.

In the early half of the past century, Seattle was notorious for its exceptionally high rates of TB among poor residents of Skid Road. TB was the leading cause of death in the city. A TB sanitarium to quarantine and treat the infected was established in North Seattle, a site that today is the Fircrest School for the developmentally disabled.

MORE INFO

Symptoms of active tuberculosis include a persistent cough with blood, fatigue, weight loss, chills, fever and night sweats.

For more information about tuberculosis, see the public health department's TB Web site at www.metrokc.gov/health/tb/ or call the TB clinic at 206-731-4579.

P-I reporter Tom Paulson can be reached at 206-448-8318 or tompaulson@seattlepi.com.

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