- PHOENIX (AP) -- Behind the
county hospital's tall cinderblock walls, a 27-year-old tuberculosis patient
sits in a jail cell equipped with a ventilation system that keeps germs
from escaping. Robert Daniels has been locked up indefinitely, perhaps
for the rest of his life, since last July. But he has not been charged
with a crime. Instead, he suffers from an extensively drug-resistant strain
of tuberculosis, or XDR-TB. It is considered virtually untreatable.
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- County health authorities obtained a court order to lock
him up as a danger to the public because he failed to take precautions
to avoid infecting others. Specifically, he said he did not heed doctors'
instructions to wear a mask in public.
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- "I'm being treated worse than an inmate," Daniels
said in a telephone interview with The Associated Press last month. "I'm
all alone. Four walls. Even the door to my room has been locked. I haven't
seen my reflection in months."
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- Though Daniels' confinement is extremely rare, health
experts say it is a situation that U.S. public health officials may have
to confront more and more because of the spread of drug-resistant TB and
the emergence of diseases such as SARS and avian flu in this increasingly
interconnected world.
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- "Even though the rate of TB in the U.S. is at the
lowest ever this last year, we live in a globalized world where, if anything
emerges anywhere, it could come to our country right away," said Mark
Harrington, executive director of the Treatment Action Group, an American
advocacy group.
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- The World Health Organization warned last year of the
emergence of extensively drug-resistant TB. The new strain, which has been
found throughout the world, including pockets of the former Soviet Union
and Asia, is resistant not only to the first line of TB drugs but to some
second-line antibiotics as well.
-
- HIV patients with weakened immune systems are especially
susceptible. In South Africa, WHO reported that 52 of 53 HIV patients died
within an average of 25 days after it was discovered they also had XDR-TB.
-
- How to deal with people infected with the new strain
is a matter of debate.
-
- Dr. Ross Upshur, director of the Joint Centre for Bioethics
at the University of Toronto, said authorities should detain people with
drug-resistant tuberculosis if they are uncooperative.
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- "We're on the verge of taking what was a curable
disease, one of the best known diseases in human endeavors, and making
it incurable," Upshur said.
-
- But a paper Upshur co-wrote on the issue in a medical
journal earlier this year has been strongly criticized.
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- "Involuntary detention should really be your last
resort," Harrington said. "There's a danger that we'll end up
blaming the victim."
-
- In the United States, which had a total of 13,767 reported
cases of tuberculosis in 2006, public health authorities only rarely have
put TB patients under lock and key.
-
- Texas has placed 17 tuberculosis patients into an involuntary
quarantine facility this year in San Antonio. Public health authorities
in California said they have no TB patients in custody this year, though
four were detained there last year.
-
- Upshur's paper noted that New York City forced TB patients
into detention following an outbreak in the 1990s, and saw a significant
dip in cases.
-
- In the Phoenix area, only one other person has been detained
in the past year, said Dr. Robert England, Maricopa County's tuberculosis
control officer.
-
- Daniels has been living alone in a four-bed cell in Ward
41, a section of the hospital reserved for sick criminals. He said sheriff's
deputies will not let him take a shower - he cleans himself with wet wipes
- and have taken away his television, radio, personal phone and computer.
His only visitors are masked medical staff members who come in to give
him his medication.
-
- The ventilation system draws out the air and filters
it to capture the bacteria-laden droplets he expels when he coughs. The
filters are periodically burned.
-
- Daniels said he is taking medication and feeling a lot
better. His lawyer would not discuss his prognosis. Daniels plans to ask
for his release at a court hearing late this month.
-
- Daniels lived in Russia for 15 years and returned to
the United States last year after he was diagnosed. He said he thought
he would get better treatment here, and hoped eventually to bring his wife
and children from Russia. He said he briefly worked in an office in Arizona
for a chemical company before he was put away.
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- He said that he lost 50 pounds and was constantly coughing
and that authorities locked him up after they discovered he had walked
into a convenience store without a mask.
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- "Where I come from, the doctors don't wear masks,"
he said. "Plus, I was 26 years old, you know. Nobody told me how TB
works and stuff."
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- County health officials and Daniels' lawyer, Robert Blecher,
would not discuss details of the case. But in general, England said the
county would not force someone into quarantine unless the patient could
not or would not follow doctor's orders.
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- "It's very uncommon that someone would both not
want to take treatment and will willingly put others at risk," England
said. "It's only those very uncommon incidents where we have to use
legal authority through the courts to isolate somebody."
-
- University of Pennsylvania medical ethicist Art Caplan
said Maricopa County health officials were confronted with the same ethical
dilemma that communities wrestled with generations ago when dealing with
leprosy and smallpox.
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- "Drug-resistant TB, or drug-resistant staph infections,
or pandemic flu will raise these questions again," Caplan said. "We
may find ourselves dipping into our history to answer them."
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- Daniels said he realizes now that he endangered the public.
But "I thought I'd come to a country where I'd finally be treated
like a person, and bam, here I am."
- _____
-
- From Alan Cantwell M.D.
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- alancantwell@sbcglobal.net
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- http://www.ariesrisingpress.com
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- FOUR WOMEN AGAINST CANCER:
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