10 ms·

TB patient has violated health orders for a year – could jail be next?

100 points by sohkamyung 4y ago

dotnet00 4y ago
I'm just surprised she's even physically able to go around living life if her lungs are that bad. I only caught a bad cold last week and that alone was enough to make me unable to stick to my commitments even without the safety of others coming into play.
rdxm 4y ago
[dead]
vr46 4y ago
Some people just do not give a single, solitary fuck about how their behaviour affects others. I don't think jail is the answer, some mental health support might be.
- dqpb 4y ago
  Some people even enjoy harming others.
- diob 4y ago
  That and I wonder if this person has a support system that allows them to self isolate? They still need to pay rent, etc.
  - lostlogin 4y ago
    On a related note, are they getting solitary confinement?
    - classichasclass 4y ago
      Yes, and usually negative pressure. Most jails above a certain size will have at least one or two negative pressure rooms for inmates who may have such illnesses.
  - MrLeap 4y ago
    I wondered this too. There's rock-and-a-hard place economic scenarios I'd feel a lot of compassion for. Is it one of those, or is she just woefully capricious/willfully defiant? The coverage makes it hard for me to draw conclusions.
  - KennyBlanken 4y ago
    > "We assess that balance between restricting somebody’s liberty and protecting the health of the community. We also want to make sure that we have time for the person to comply and try lots of different options that are short of requiring somebody to be detained," he added. "Incarceration detention is the very, very last option that we want to take and we don’t do that lightly. But occasionally that becomes necessary if there is a risk to the public." Also, as noted in the article: she went to the ER complaining of chest pain, knew she was TB positive, and did not tell anyone. She was a passenger in a car while sick with both TB and COVID. She's not disobeying because she doesn't have a support system. She's disobeying because she's a selfish asshole. Why after a year of her clearly being a plague rat the court is only just getting to threatening her with electronic monitoring or confinement is beyond me. She should have been given a court order, and then upon failing to follow it, involuntarily confined until she submitted to treatment. I am completely exhausted by our government's nearly endless toleration of people spreading highly contagious diseases.
    - vuln 4y ago
      I'll at least play devils advocate. Due to lack of information about the individual I wonder if language is a barrier. If their reasoning behind not seeking treatment is due to historical systemic racism within the medical community. Perhaps is a financial decision like others have stated. From the documents we can see she is ordered to confine to "her residence" but according to the documents that location changed many times. Which leads me to believe this person may be without a home. The government can deem a shelter as her residence. Should she quarantine there or with family members or friends? I believe there is a lot of nuance to these situations which may be why the state government has treaded lightly.
    - dTal 4y ago
      >She's not disobeying because she doesn't have a support system. She's disobeying because she's a selfish asshole. That might be satisfying to say, but it doesn't really solve anything on a systemic level. I think it's worth exploring how people become selfish assholes. I strongly suspect that a lack of trust in society, stemming from being repeatedly fucked over, is a primary cause. You can't expect people to show loyalty to a society that makes no secret of the fact it doesn't care about them. I'm not implying anything in particular about this case. I'm just encouraging you, in the most general terms, not to let your thoughts terminate there, and to keep pulling on that "root cause" string.
  - classichasclass 4y ago
    In California, and I'm sure many places in Washington state are the same, we have financial assistance for exactly this reason. We'll help with the rent, groceries, bills, etc. while they're on respiratory isolation (this doesn't usually last more than a couple weeks, but that can still be a lot of lost work time), and get them to and from clinic visits and handle their directly observed therapy. We don't want these people untreated and it's as big a financial burden to them as you say it is. Source: public health TB physician for 15+ years
    - bdcravens 4y ago
      > this doesn't usually last more than a couple weeks, but that can still be a lot of lost work time Are there protections against them losing their job?
      - classichasclass 4y ago
        (IANAL) California is an at-will state generally, so the answer is usually no. It is illegal in California for someone to be terminated for using their accrued sick leave, and firing someone solely on their medical condition is also illegal. But these are folks who can't afford a prolonged employment discrimination lawsuit, and I've had patients lose their jobs for "other reasons," which an employer can easily come up with if they want someone gone.
      - plandis 4y ago
        Presumably FMLA would protect their job.
- lovich 4y ago
  Mental health support is probably the answer to people waving knives around in public too. We don't let them keep the knife however, to protect their liberty. This person needs to be locked up because at minimum, if we accept that its a mental health issue and not maliciousness, they are incapable of not endangering others around themselves. Not getting her treatable fatal disease cured also implies she is incapable of not endangering herself either, but that's less troubling than what she does to others.
- jojobas 4y ago
  Mental support doesn't want when the recipient doesn't want it or doesn't care.
- anenefan 4y ago
  I don't think mental health support encompasses issues due to personality types. The vast number I've seen that do this don't seem to have anything out of the ordinary, they probably score slightly higher on narcissistic and socipathic traits. Sadly a lot of the people who ended up as my close acquaintances and including some family are like that, people I call Travellers since they don't stay at home when they're sick and like to go visiting. It took me a while to realise that the unexpected drop in, no that's no just hay fever ... I'm unlucky in that I seem to be very susceptible to respiratory illnesses. I really can't see any treatment for people who literally go visiting ten minutes after thinking they're done with a dose of the squirts.
  - hgsgm 4y ago
    Travelers means something different. Maybe call these people Spreaders.
    - anenefan 4y ago
      Spreaders would take in people who have to go to work when they're really sick and or have no idea of good hygiene, for example, visit and use the toilet and simply neglect to wonder why there's a wash basin and or soap and walk back without using them. I can't be too annoyed at those who go to work with the flu, some businesses are run by idiots who don't really care if one worker has the flu and insist they turn up or else.
- nitwit005 4y ago
  Probably would refuse the mental health support too. If she violated court orders multiple times, electronic home monitoring seems appropriate.
- themitigating 4y ago
  Why isn't jail the answer here? If by mental health support you don't mean being institutionalized then won't she continue to put people in danger. Most think jail is about protecting others, not a punishment, isn't this a case where it would actually be used for its intended purpose?
  - classichasclass 4y ago
    Sometimes it is. I've had a few TB patients who ended up receiving the entirety of their treatment in custody because they wouldn't stick to it, though this depends greatly on the judge. No one likes putting these folks in jail and it should always be a last resort, but it does happen.
- lazide 4y ago
  If someone is showing such casual indifference to the well being of others, turning around and putting them in jail seems like a pretty good service to the public to me. And why should anyone care about how this might offend them, if they cared so little about anyone else either?
  - agr33d 4y ago
    I love how we demean one person in a society that, on the whole, refuses to provide cheap, accessible, healthcare with high quality outcomes (US healthcare outcomes lag developing nations). Surely, surely, it’s just this one person failing society. We do not say “it is us failing each other” but this person failing us; the temerity of them!
    - lazide 4y ago
      Yeah, fuck you.
- ericmcer 4y ago
  Is your first instinct that jail is too harsh and we should find them a qualified therapist? I have several elderly relatives (including my 70+ year old parents) and if a person infected them with TB or Covid through gross negligence I would not wonder how we can help that person. I don't know if I am a bad person or what, but I struggle not to fall into tribalistic patterns mentally and view dangerous outsiders as people who should be shunned instead of people who need help. I guess I was just curious if your first instinct is so generous.
  - luckylion 4y ago
    Do you consider people with an acute neurosis the same way? Would you shun your sister if she had a sudden mental breakdown and believed to hear voices?
    - xoa 4y ago
      >Do you consider people with an acute neurosis the same way? Would you shun your sister if she had a sudden mental breakdown and believed to hear voices? This doesn't seem like an honest analogy. The legal/social concern here isn't about the individual, it's about their effect on others, and the extent to which it is willful negligence of something treatable. If someone has a known, treatable mental disorder and, repeatedly, refuses to follow the treatment and then engages in wilful behavior endangering others then yes that can absolutely be an issue. A better example would be epilepsy: in much of the world people with it cannot drive (or are restricted in license type/conditions, no Class C for example), because the accident rate for drivers with epilepsy is over double the baseline. They're not bad people obviously. And my understanding is that just in the last few years some very promising new medications have had studies showing significant improvements without side effects. So perhaps under those treatments it'd be fine for them to drive. But if someone with epilepsy knew they did, refused treatment, lied about it, got a commercial license and then started side swiping people with a semi, then yes they'd be "shunned" (dealt with). It's the "dangerous" qualifier in OP's post that is the big issue.
      - luckylion 4y ago
- xen2xen1 4y ago
  Have you read about Typhoid Mary? She went from rich house to rich house killing the inhabitants over and over, even after being shown it was her doing it, with government threats. She didn't keep doing it because she was mentally ill, she kept doing it because her livelihood has cooking for rich people. She would have to give up her lifestyle if she admitted she was killing people. Her motives were largely economic, not mental illness. There are MANY reasons people do dumb crap.
  - elif 4y ago
    USD acquisition hyper-primacy is just another form of mental illness.. it is just a socially accepted and ubiquitous one.
    - ranger_danger 4y ago
      what?
  - crazygringo 4y ago
    There are historians who disagree with you. The idea of an asymtopmatic carrier was not well understood at the time, and she had tests done that came back negative for typhoid. There's a good argument to be made that she genuinely believed she'd been singled out as some kind of anti-Irish conspiracy, that the authorities pinning the infections on her were scapegoating her based on totally hypothetical science. (That today we know the science was sound, but at the time her distrust of it may not have been unreasonable.) So the idea that Typhoid Mary knew exactly what she was doing and did it anyways, makes for a great movie villain, but not necessarily real life. For more details: [1] https://allthatsinteresting.com/typhoid-mary https://allthatsinteresting.com/typhoid-mary
    - dTal 4y ago
      Both things can be true. Mary's receptiveness to the idea that she could possibly be an asymptomatic carrier could hardly have been separated from the fact that this would be deeply inconvenient to her. Given the choice between two unlikely explanations (asymptomatic carrier of typhoid, grand "anti-Irish" conspiracy targeting her and her alone for unknown reasons), she chose to believe the one that disrupted her life less. "It is difficult to get a man [sic] to understand something, when his salary depends upon his not understanding it!" --Upton Sinclair
- aaron695 4y ago
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- squokko 4y ago
  What's wrong with jail for someone like that? There are some people who just cannot accept that some other people are unfit for civilization, and must be permanently excluded. They search for explanations like "mental illness" when mental illness is a completely different thing than being a complete fucking asshole.
  - hotpotamus 4y ago
    What if she was just forced to wear a mask? Would that be an acceptable compromise?
    - squokko 4y ago
      If effective, sure. What mechanism could the state use to enforce this in a cost effective manner?
- deleted 4y ago
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- hilbert42 4y ago
  We used to have well established practices to deal with TB and leprosy and that was enforced isolation. Leprosy cases were isolated in special locations by law. Such quarantining practices were commonplace in many countries. As we've seen with COVID that system no longer works. I can only guess why long-standing laws to protect the community are no longer applied. Even as recently as 50 years ago she would have felt the full force of the law—the moment she failed to comply she would have been put in enforced quarantine. If anyone can tell me why the law no longer work/is enforced then I'd love to know.
- jimt1234 4y ago
  I tested positive for TB back in my early-20s. I was fine, but I still tested positive, and so the county health officials were on me like flies on shit. I had to take a pill every day for a year. They'd give me a monthly supply of pills, and if I didn't pick up new meds at the end of the month, they would call me immediately (and constantly!), pressuring me to pick up my pills. I even moved and changed phone number at one point, yet they somehow found my new number and called me there. These people were intense. I was annoyed back then, but I totally get it now - you know, now that I'm older and give a shit about anyone other than myself. LOL
  - JumpCrisscross 4y ago
    > tested positive for TB back in my early-20s Note that if you were inoculated with BCG, you'll show false positive for TB [1]. I had to go on six months of Zithromax as a kid because of this, despite everything from X-rays to blood tests coming back negative. [1] https://www.cdc.gov/tb/topic/testing/testingbcgvaccinated.htm https://www.cdc.gov/tb/topic/testing/testingbcgvaccinated.ht...
    - jamiek88 4y ago
      Only the skim test. I’m British, had the BCG and for my green card had that happen. Blood test proved negative. Now they just go straight to blood test for BCG countries.
mensetmanusman 4y ago
Interesting how different cultures try to deal with those that spread sickness. Places like California have recently decriminalized spreading STI/Ds, but I wonder if they would deal with respiratory infections differently due to politicization of health.
- lostlogin 4y ago
  > I wonder if they would deal with respiratory infections differently After the covid situation, starting this conversation will take someone bold.
  - mathwords 4y ago
    [dead]
- classichasclass 4y ago
  We had several such non-adherent communicable cases in the California jurisdiction I used to work for and I was in court to handle them. However, how the case is approached varies greatly on the judge. One spent the entire duration of his treatment in custody and I reviewed the records and made recommendations. Others were released, one with an ankle monitor, and I reported back on their progress. There are specific laws about TB in California, just as there are in Washington, and we run free TB clinics and free directly observed therapy so that there is no financial reason they can't finish their treatment. No one wants them in jail and no one wants to stigmatize them for having an illness they didn't do anything to deserve, but they can't walk around untreated either. TB is unpredictably contagious and can be very difficult to treat in the multi-drug resistant form. When it gets to the point of criminal prosecution, I guarantee virtually every opportunity has been given to them to get it taken care of.
- favorited 4y ago
  > Places like California have recently decriminalized spreading STI/Ds If you're referring to SB 239, which passed in 2017, it did not decriminalize spreading STIs. It converted knowingly transmitting HIV to a misdemeanor, with the penalty changing from 3 years in prison to 6 months. Effectively, it removed the special-cased extra penalties for HIV, and brought it in line hepatitis, syphilis, etc.
notch898a 4y ago
Can they just like send her to one of the uninhabited island territories with a like a huge stash of food and water? It seems cruel to imprison someone for living with a disease. They used to send lepers to Molokai (Hawaii).
- suprjami 4y ago
  Did you even read the first paragraph? > A woman in Washington state is facing electronic home monitoring and possible jail time after spending the past year willfully violating multiple court orders to have her active, contagious case of tuberculosis treated and to stay in isolation while doing so. This isn't some unfortunate incurable disease. This is someone wilfully endangering others for no good reason and disobeying a reasonable legal order not to do that.
  - notch898a 4y ago
    I don't think dictating other people's health care is reasonable. At least give the option of exile so she can live her life in the outdoors with the disease if she likes.
    - themitigating 4y ago
      By not dictating her health care you are potentially dictating other's health. Insert quote about freedom and noses
    - maxerickson 4y ago
      Exile to where exactly? And what do you do when they violate the terms of the exile (which seems likely enough in this case)?
      - notch898a 4y ago
        Something like swain's island or baker island. I guess worst case you could go back to the other options if they escaped. Swain's is technically outside of the immigration controls of most of the US so you'd be committing another crime to re-enter without presenting to immigration anyway.
deleted 4y ago
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throwawaaarrgh 4y ago
It's the new Typhoid Mary!
deleted 4y ago
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auctoritas 4y ago
In an age of proliferating antibiotic-resistant bacteria, how do we justify 5 days back in the office?
AlbertCory 4y ago
[1] is a book about the amazing Dr. Paul Farmer, who treated drug-resistant TB cases in Haiti and elsewhere for decades. Usually those people die without treatment. [1] https://www.amazon.com/Mountains-Beyond-Quest-Farmer-Would-ebook/dp/B000FBJAW8/ref=sr_1_1 https://www.amazon.com/Mountains-Beyond-Quest-Farmer-Would-e...
- washadjeffmad 4y ago
  Who brought TB to Haiti? And cholera, for that matter?
gerdesj 4y ago
Put yourself in the position of that person. How is she feeling? TB is a nasty killer - my Dad's birth mother died of it in 1952 when he was six. So I know it is nasty. This has the look of a witch-hunt. "she did this ... TB that ...". Who exactly has taken responsibility for the woman concerned and who has taken responsibility for everyone else. I will contend that all interested agencies in the US have completely failed this lady in particular and the population at large.
- goodSteveramos 4y ago
  They have absolutely not failed this person. They have done far more than they should have to avoid embarrassing her and instead have chosen to put thousands of innocent people in danger. At the first sign of non-compliance she should have been detained. This attitude of “we have failed the criminal” is absolute malice masquerading as total malarky.
- elif 4y ago
  Confused. Very very confused and likely misled by a grifter.
- cultofmetatron 4y ago
  yea I'm curious how she was paying her bills. (correct me if I'm wrong here) its not like the US government to my knowledge, gives you free housing and food while you self isolate.
terminatornet 4y ago
> According to the World Health Organization, tuberculosis is one of the top infectious disease killers in the world, causing 1.6 million deaths in 2021. from https://covid19.who.int https://covid19.who.int, cumulative deaths for covid are at 6,825,461 worldwide, so I'm guessing it was at least equal if not higher to the number of tb deaths in 2021. I understand 2 things can be bad at once, but it does seem really strange that we removed pretty much all covid mitigations in the US but we're also mad at this one person for spreading tuberculosis when people are constantly going out in public and spreading covid.
- kevingadd 4y ago
  That's because she can go back to being a Productive Part Of The Economy once she gets treated for tuberculosis, but there's no straightforward COVID cure to give to people (the treatments we do have are very expensive and not guaranteed) so we collectively just pretend it doesn't exist and tell people to get back to work
- wkat4242 4y ago
  Covid is no longer dangerous, much less so than TB. If it weren't the hospitals would have been overflowing with the massive spread it's seeing. And avoidance is untenable as China has shown: even their dictatorship couldn't keep up the heavy-handed measures. All they've accomplished is delaying their path to recovery for more than a year. It's time to let our immune systems do the work they're supposed to again.
  - acdha 4y ago
    COVID is still dangerous, and the death figures are still undercounted[1]. There’s a certain romantic appeal to leaving it up to our immune systems but that means millions of premature deaths and millions more disabled people. The best way to make it actually less dangerous is to train your immune system with vaccines but we haven’t been doing very well with that because it undercuts the “everything’s over, start spending more!” message the downtown business associations so badly desire. 1. https://theconversation.com/covid-19-deaths-in-the-us-continue-to-be-undercounted-research-shows-despite-claims-of-overcounts-198266 https://theconversation.com/covid-19-deaths-in-the-us-contin...
6gvONxR4sf7o 4y ago
It's absurd that you can be jailed for not getting treatment in a country where healthcare tends to be so expensive.
- Fezzik 4y ago
  TB treatment appears to be relatively inexpensive, even including physician visits: https://www.cdc.gov/tb/publications/infographic/ltbi-treatment-costs.htm https://www.cdc.gov/tb/publications/infographic/ltbi-treatme...
- King-Aaron 4y ago
  https://i.kym-cdn.com/entries/icons/original/000/028/596/dsmGaKWMeHXe9QuJtq_ys30PNfTGnMsRuHuo_MUzGCg.jpg https://i.kym-cdn.com/entries/icons/original/000/028/596/dsm...
- smt88 4y ago
  It would be absurd if this were common or if they did it for, say, Covid. But this is an extreme case where the woman spent years defying court orders to either get treatment or to isolate. No one was forcing her to get treatment, and there are many income-adjusted means of getting health care in this country (including free health care). It's likely her county would have paid for her treatment if she couldn't afford it, considering the court order. It would be much more absurd if this woman were allowed to continue spreading a serious illness to people who didn't know they got it and couldn't afford treatment. The harm to the guilty woman is much smaller than the harm she has caused others. She may have even killed people.
- omao 4y ago
  Did you even read the article she was offered the treatment and refused, and if you click on the supporting links you can see that in Pierce County they basically go through many steps to insure any who wants treatment can get even if you’re not insured so it basically free. Also she started the treatment and stopped which is worse because it can lead to resistance and she violated a court order for isolation and was caught after a car crash that could have easily spread the disease
- deleted 4y ago
elif 4y ago
Can a biologist please chime in here... Being that TB is bacterial and covid viral, there is no risk of this petri dish of a person mutating a combination pathogen, right? It seems odd and concerning to have level 3 containment labs with all their rules, but defacto allowing individuals to essentially roll the dice in public. I have to admit this is one of the first times my philosophy has tended toward authoritarianism...
- kylehotchkiss 4y ago
  (Not a biologist) one of the biggest fears with this particular bacteria is that if you start the treatment and then stop it before the duration completes, you will almost certainly end up with drug resistant bacteria. The treatment drug resistant takes much longer and has heavy side effects. And if you screw that treatment up, you can harbor totally drug resistant bacteria and there’s no treatment available anywhere. This bacteria is especially hard to kill - your body can’t, which is why you need treatment. And the medicine doesn’t kill especially well, it interferes with reproduction primarily and the cells end up dying on their own slow scale.
- acdha 4y ago
  The two won’t combine but several of the COVID variants are believed to have evolved in immune-compromised people where the virus had many cycles to improve thanks to the host immune system being unable to destroy it. Someone with a massive TB infection seems like they might provide a similar breeding ground, and the reverse could be true if they didn’t manage a successful treatment regimen for TB.
- classichasclass 4y ago
  No, they can't combine like that. But irregularly treated TB can become resistant to the most useful antibiotics which in turn makes the case extremely difficult to treat (sometimes years). There are individuals who have TB untreatable by currently known means, even failing surgical approaches. They are rare but they exist. The COVID co-infection may make her more subject to more significant pulmonary complications but what this means in terms of variants isn't clear. Source: public health TB physician
cybwraith 4y ago
While this person should definitely get treatment or at the least isolate per the court order... Why is this treatment that can cost from $50,000-$500,000 something a person can be burdened with by court order? The CDC and relevant laws around TB only have the government cover treatment "if you are unable to pay", so if someone had $150,000 in their 401k and got Tb with charges of $149,000 their progress towards any sort of financial stability could be brought back to effectively zero. Even if they were low income and covered by an ACA plan, those usually have pretty high coinsurance percents so this is still a very possible scenario. This is clearly a case where treating anyone with TB in this country is a public good and should never burden the individual to such an extent (or at all, really).
- ThrustVectoring 4y ago
  401k accounts are generally exempt from bankruptcy proceedings and other debt-collection activities.
  - pyuser583 4y ago
    Are IRAs exempt?
    - marcus0x62 4y ago
      Depends on the state. IRAs are not ERISA-qualified plans, it may have some state-level protection. https://www.irafinancialgroup.com/learn-more/self-directed-ira/ira-asset-and-creditor-protection/ https://www.irafinancialgroup.com/learn-more/self-directed-i...
    - compsciphd 4y ago
      Its fairly easy enough to setup a Solo 401k. While it could be difficult to send contributions to it directly, you can contribute to an IRA and then rollover into the Solo 401k. Solo 401Ks are also useful for enabling backdoor roth IRA contributions. For those with traditional 401Ks, one doesn't want to roll them over into a traditional IRA as that would remove one's ability to do backdoor roths.
Am4TIfIsER0ppos 4y ago
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- deleted 4y ago
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cm2187 4y ago
What is missing from the article is her motive to decline the treatment. No matter how dumb the motive is, if it is not mentioned I cannot help suspecting there is more to the story.
- more_corn 4y ago
  I also would like to hear her reasoning.
orbisvicis 4y ago
Given the advanced state of her tuberculosis yet active lifestyle, what symptoms is she likely suffering? Mild cough? And what are the long-term side-effects of two years of "alternative ... toxic" antibiotics? Are these the types of treatments that require daily IV therapy at an outpatient facility?
dang 4y ago
Url changed from https://arstechnica.com/science/2023/02/us-woman-has-walked-around-with-untreated-tb-for-over-a-year-now-faces-jail/ https://arstechnica.com/science/2023/02/us-woman-has-walked-..., which points to this. Submitters: "Please submit the original source. If a post reports on something found on another site, submit the latter." - https://news.ycombinator.com/newsguidelines.html https://news.ycombinator.com/newsguidelines.html
snvzz 4y ago
At some point, justice should act in the interest of public health. It shouldn't have taken so long.

100 points by sohkamyung 4y ago

I'm just surprised she's even physically able to go around living life if her lungs are that bad. I only caught a bad cold last week and that alone was enough to make me unable to stick to my commitments even without the safety of others coming into play.

rdxm 4y ago

[dead]

vr46 4y ago

Some people just do not give a single, solitary fuck about how their behaviour affects others. I don't think jail is the answer, some mental health support might be.

dqpb 4y ago
Some people even enjoy harming others.
diob 4y ago
That and I wonder if this person has a support system that allows them to self isolate? They still need to pay rent, etc.
- lostlogin 4y ago
  On a related note, are they getting solitary confinement?
  - classichasclass 4y ago
    Yes, and usually negative pressure. Most jails above a certain size will have at least one or two negative pressure rooms for inmates who may have such illnesses.
- MrLeap 4y ago
  I wondered this too. There's rock-and-a-hard place economic scenarios I'd feel a lot of compassion for. Is it one of those, or is she just woefully capricious/willfully defiant? The coverage makes it hard for me to draw conclusions.
- KennyBlanken 4y ago
  > "We assess that balance between restricting somebody’s liberty and protecting the health of the community. We also want to make sure that we have time for the person to comply and try lots of different options that are short of requiring somebody to be detained," he added. "Incarceration detention is the very, very last option that we want to take and we don’t do that lightly. But occasionally that becomes necessary if there is a risk to the public." Also, as noted in the article: she went to the ER complaining of chest pain, knew she was TB positive, and did not tell anyone. She was a passenger in a car while sick with both TB and COVID. She's not disobeying because she doesn't have a support system. She's disobeying because she's a selfish asshole. Why after a year of her clearly being a plague rat the court is only just getting to threatening her with electronic monitoring or confinement is beyond me. She should have been given a court order, and then upon failing to follow it, involuntarily confined until she submitted to treatment. I am completely exhausted by our government's nearly endless toleration of people spreading highly contagious diseases.
  - vuln 4y ago
    I'll at least play devils advocate. Due to lack of information about the individual I wonder if language is a barrier. If their reasoning behind not seeking treatment is due to historical systemic racism within the medical community. Perhaps is a financial decision like others have stated. From the documents we can see she is ordered to confine to "her residence" but according to the documents that location changed many times. Which leads me to believe this person may be without a home. The government can deem a shelter as her residence. Should she quarantine there or with family members or friends? I believe there is a lot of nuance to these situations which may be why the state government has treaded lightly.
  - dTal 4y ago
    >She's not disobeying because she doesn't have a support system. She's disobeying because she's a selfish asshole. That might be satisfying to say, but it doesn't really solve anything on a systemic level. I think it's worth exploring how people become selfish assholes. I strongly suspect that a lack of trust in society, stemming from being repeatedly fucked over, is a primary cause. You can't expect people to show loyalty to a society that makes no secret of the fact it doesn't care about them. I'm not implying anything in particular about this case. I'm just encouraging you, in the most general terms, not to let your thoughts terminate there, and to keep pulling on that "root cause" string.
- classichasclass 4y ago
  In California, and I'm sure many places in Washington state are the same, we have financial assistance for exactly this reason. We'll help with the rent, groceries, bills, etc. while they're on respiratory isolation (this doesn't usually last more than a couple weeks, but that can still be a lot of lost work time), and get them to and from clinic visits and handle their directly observed therapy. We don't want these people untreated and it's as big a financial burden to them as you say it is. Source: public health TB physician for 15+ years
  - bdcravens 4y ago
    > this doesn't usually last more than a couple weeks, but that can still be a lot of lost work time Are there protections against them losing their job?
    - classichasclass 4y ago
      (IANAL) California is an at-will state generally, so the answer is usually no. It is illegal in California for someone to be terminated for using their accrued sick leave, and firing someone solely on their medical condition is also illegal. But these are folks who can't afford a prolonged employment discrimination lawsuit, and I've had patients lose their jobs for "other reasons," which an employer can easily come up with if they want someone gone.
    - plandis 4y ago
      Presumably FMLA would protect their job.
lovich 4y ago
Mental health support is probably the answer to people waving knives around in public too. We don't let them keep the knife however, to protect their liberty. This person needs to be locked up because at minimum, if we accept that its a mental health issue and not maliciousness, they are incapable of not endangering others around themselves. Not getting her treatable fatal disease cured also implies she is incapable of not endangering herself either, but that's less troubling than what she does to others.
jojobas 4y ago
Mental support doesn't want when the recipient doesn't want it or doesn't care.
anenefan 4y ago
I don't think mental health support encompasses issues due to personality types. The vast number I've seen that do this don't seem to have anything out of the ordinary, they probably score slightly higher on narcissistic and socipathic traits. Sadly a lot of the people who ended up as my close acquaintances and including some family are like that, people I call Travellers since they don't stay at home when they're sick and like to go visiting. It took me a while to realise that the unexpected drop in, no that's no just hay fever ... I'm unlucky in that I seem to be very susceptible to respiratory illnesses. I really can't see any treatment for people who literally go visiting ten minutes after thinking they're done with a dose of the squirts.
- hgsgm 4y ago
  Travelers means something different. Maybe call these people Spreaders.
  - anenefan 4y ago
    Spreaders would take in people who have to go to work when they're really sick and or have no idea of good hygiene, for example, visit and use the toilet and simply neglect to wonder why there's a wash basin and or soap and walk back without using them. I can't be too annoyed at those who go to work with the flu, some businesses are run by idiots who don't really care if one worker has the flu and insist they turn up or else.
nitwit005 4y ago
Probably would refuse the mental health support too. If she violated court orders multiple times, electronic home monitoring seems appropriate.
themitigating 4y ago
Why isn't jail the answer here? If by mental health support you don't mean being institutionalized then won't she continue to put people in danger. Most think jail is about protecting others, not a punishment, isn't this a case where it would actually be used for its intended purpose?
- classichasclass 4y ago
  Sometimes it is. I've had a few TB patients who ended up receiving the entirety of their treatment in custody because they wouldn't stick to it, though this depends greatly on the judge. No one likes putting these folks in jail and it should always be a last resort, but it does happen.
lazide 4y ago
If someone is showing such casual indifference to the well being of others, turning around and putting them in jail seems like a pretty good service to the public to me. And why should anyone care about how this might offend them, if they cared so little about anyone else either?
- agr33d 4y ago
  I love how we demean one person in a society that, on the whole, refuses to provide cheap, accessible, healthcare with high quality outcomes (US healthcare outcomes lag developing nations). Surely, surely, it’s just this one person failing society. We do not say “it is us failing each other” but this person failing us; the temerity of them!
  - lazide 4y ago
    Yeah, fuck you.
ericmcer 4y ago
Is your first instinct that jail is too harsh and we should find them a qualified therapist? I have several elderly relatives (including my 70+ year old parents) and if a person infected them with TB or Covid through gross negligence I would not wonder how we can help that person. I don't know if I am a bad person or what, but I struggle not to fall into tribalistic patterns mentally and view dangerous outsiders as people who should be shunned instead of people who need help. I guess I was just curious if your first instinct is so generous.
- luckylion 4y ago
  Do you consider people with an acute neurosis the same way? Would you shun your sister if she had a sudden mental breakdown and believed to hear voices?
  - xoa 4y ago
    >Do you consider people with an acute neurosis the same way? Would you shun your sister if she had a sudden mental breakdown and believed to hear voices? This doesn't seem like an honest analogy. The legal/social concern here isn't about the individual, it's about their effect on others, and the extent to which it is willful negligence of something treatable. If someone has a known, treatable mental disorder and, repeatedly, refuses to follow the treatment and then engages in wilful behavior endangering others then yes that can absolutely be an issue. A better example would be epilepsy: in much of the world people with it cannot drive (or are restricted in license type/conditions, no Class C for example), because the accident rate for drivers with epilepsy is over double the baseline. They're not bad people obviously. And my understanding is that just in the last few years some very promising new medications have had studies showing significant improvements without side effects. So perhaps under those treatments it'd be fine for them to drive. But if someone with epilepsy knew they did, refused treatment, lied about it, got a commercial license and then started side swiping people with a semi, then yes they'd be "shunned" (dealt with). It's the "dangerous" qualifier in OP's post that is the big issue.
    - luckylion 4y ago
xen2xen1 4y ago
Have you read about Typhoid Mary? She went from rich house to rich house killing the inhabitants over and over, even after being shown it was her doing it, with government threats. She didn't keep doing it because she was mentally ill, she kept doing it because her livelihood has cooking for rich people. She would have to give up her lifestyle if she admitted she was killing people. Her motives were largely economic, not mental illness. There are MANY reasons people do dumb crap.
- elif 4y ago
  USD acquisition hyper-primacy is just another form of mental illness.. it is just a socially accepted and ubiquitous one.
  - ranger_danger 4y ago
    what?
- crazygringo 4y ago
  There are historians who disagree with you. The idea of an asymtopmatic carrier was not well understood at the time, and she had tests done that came back negative for typhoid. There's a good argument to be made that she genuinely believed she'd been singled out as some kind of anti-Irish conspiracy, that the authorities pinning the infections on her were scapegoating her based on totally hypothetical science. (That today we know the science was sound, but at the time her distrust of it may not have been unreasonable.) So the idea that Typhoid Mary knew exactly what she was doing and did it anyways, makes for a great movie villain, but not necessarily real life. For more details: [1] https://allthatsinteresting.com/typhoid-mary https://allthatsinteresting.com/typhoid-mary
  - dTal 4y ago
    Both things can be true. Mary's receptiveness to the idea that she could possibly be an asymptomatic carrier could hardly have been separated from the fact that this would be deeply inconvenient to her. Given the choice between two unlikely explanations (asymptomatic carrier of typhoid, grand "anti-Irish" conspiracy targeting her and her alone for unknown reasons), she chose to believe the one that disrupted her life less. "It is difficult to get a man [sic] to understand something, when his salary depends upon his not understanding it!" --Upton Sinclair
aaron695 4y ago
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squokko 4y ago
What's wrong with jail for someone like that? There are some people who just cannot accept that some other people are unfit for civilization, and must be permanently excluded. They search for explanations like "mental illness" when mental illness is a completely different thing than being a complete fucking asshole.
- hotpotamus 4y ago
  What if she was just forced to wear a mask? Would that be an acceptable compromise?
  - squokko 4y ago
    If effective, sure. What mechanism could the state use to enforce this in a cost effective manner?
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hilbert42 4y ago
We used to have well established practices to deal with TB and leprosy and that was enforced isolation. Leprosy cases were isolated in special locations by law. Such quarantining practices were commonplace in many countries. As we've seen with COVID that system no longer works. I can only guess why long-standing laws to protect the community are no longer applied. Even as recently as 50 years ago she would have felt the full force of the law—the moment she failed to comply she would have been put in enforced quarantine. If anyone can tell me why the law no longer work/is enforced then I'd love to know.
jimt1234 4y ago
I tested positive for TB back in my early-20s. I was fine, but I still tested positive, and so the county health officials were on me like flies on shit. I had to take a pill every day for a year. They'd give me a monthly supply of pills, and if I didn't pick up new meds at the end of the month, they would call me immediately (and constantly!), pressuring me to pick up my pills. I even moved and changed phone number at one point, yet they somehow found my new number and called me there. These people were intense. I was annoyed back then, but I totally get it now - you know, now that I'm older and give a shit about anyone other than myself. LOL
- JumpCrisscross 4y ago
  > tested positive for TB back in my early-20s Note that if you were inoculated with BCG, you'll show false positive for TB [1]. I had to go on six months of Zithromax as a kid because of this, despite everything from X-rays to blood tests coming back negative. [1] https://www.cdc.gov/tb/topic/testing/testingbcgvaccinated.htm https://www.cdc.gov/tb/topic/testing/testingbcgvaccinated.ht...
  - jamiek88 4y ago
    Only the skim test. I’m British, had the BCG and for my green card had that happen. Blood test proved negative. Now they just go straight to blood test for BCG countries.

mensetmanusman 4y ago

Interesting how different cultures try to deal with those that spread sickness. Places like California have recently decriminalized spreading STI/Ds, but I wonder if they would deal with respiratory infections differently due to politicization of health.

lostlogin 4y ago
> I wonder if they would deal with respiratory infections differently After the covid situation, starting this conversation will take someone bold.
- mathwords 4y ago
  [dead]
classichasclass 4y ago
We had several such non-adherent communicable cases in the California jurisdiction I used to work for and I was in court to handle them. However, how the case is approached varies greatly on the judge. One spent the entire duration of his treatment in custody and I reviewed the records and made recommendations. Others were released, one with an ankle monitor, and I reported back on their progress. There are specific laws about TB in California, just as there are in Washington, and we run free TB clinics and free directly observed therapy so that there is no financial reason they can't finish their treatment. No one wants them in jail and no one wants to stigmatize them for having an illness they didn't do anything to deserve, but they can't walk around untreated either. TB is unpredictably contagious and can be very difficult to treat in the multi-drug resistant form. When it gets to the point of criminal prosecution, I guarantee virtually every opportunity has been given to them to get it taken care of.
favorited 4y ago
> Places like California have recently decriminalized spreading STI/Ds If you're referring to SB 239, which passed in 2017, it did not decriminalize spreading STIs. It converted knowingly transmitting HIV to a misdemeanor, with the penalty changing from 3 years in prison to 6 months. Effectively, it removed the special-cased extra penalties for HIV, and brought it in line hepatitis, syphilis, etc.

notch898a 4y ago

Can they just like send her to one of the uninhabited island territories with a like a huge stash of food and water? It seems cruel to imprison someone for living with a disease. They used to send lepers to Molokai (Hawaii).

suprjami 4y ago
Did you even read the first paragraph? > A woman in Washington state is facing electronic home monitoring and possible jail time after spending the past year willfully violating multiple court orders to have her active, contagious case of tuberculosis treated and to stay in isolation while doing so. This isn't some unfortunate incurable disease. This is someone wilfully endangering others for no good reason and disobeying a reasonable legal order not to do that.
- notch898a 4y ago
  I don't think dictating other people's health care is reasonable. At least give the option of exile so she can live her life in the outdoors with the disease if she likes.
  - themitigating 4y ago
    By not dictating her health care you are potentially dictating other's health. Insert quote about freedom and noses
  - maxerickson 4y ago
    Exile to where exactly? And what do you do when they violate the terms of the exile (which seems likely enough in this case)?
    - notch898a 4y ago
      Something like swain's island or baker island. I guess worst case you could go back to the other options if they escaped. Swain's is technically outside of the immigration controls of most of the US so you'd be committing another crime to re-enter without presenting to immigration anyway.

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throwawaaarrgh 4y ago

It's the new Typhoid Mary!

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auctoritas 4y ago

In an age of proliferating antibiotic-resistant bacteria, how do we justify 5 days back in the office?

AlbertCory 4y ago

[1] is a book about the amazing Dr. Paul Farmer, who treated drug-resistant TB cases in Haiti and elsewhere for decades. Usually those people die without treatment. [1] https://www.amazon.com/Mountains-Beyond-Quest-Farmer-Would-ebook/dp/B000FBJAW8/ref=sr_1_1 https://www.amazon.com/Mountains-Beyond-Quest-Farmer-Would-e...

washadjeffmad 4y ago
Who brought TB to Haiti? And cholera, for that matter?

gerdesj 4y ago

Put yourself in the position of that person. How is she feeling? TB is a nasty killer - my Dad's birth mother died of it in 1952 when he was six. So I know it is nasty. This has the look of a witch-hunt. "she did this ... TB that ...". Who exactly has taken responsibility for the woman concerned and who has taken responsibility for everyone else. I will contend that all interested agencies in the US have completely failed this lady in particular and the population at large.

goodSteveramos 4y ago
They have absolutely not failed this person. They have done far more than they should have to avoid embarrassing her and instead have chosen to put thousands of innocent people in danger. At the first sign of non-compliance she should have been detained. This attitude of “we have failed the criminal” is absolute malice masquerading as total malarky.
elif 4y ago
Confused. Very very confused and likely misled by a grifter.
cultofmetatron 4y ago
yea I'm curious how she was paying her bills. (correct me if I'm wrong here) its not like the US government to my knowledge, gives you free housing and food while you self isolate.

terminatornet 4y ago

> According to the World Health Organization, tuberculosis is one of the top infectious disease killers in the world, causing 1.6 million deaths in 2021. from https://covid19.who.int https://covid19.who.int, cumulative deaths for covid are at 6,825,461 worldwide, so I'm guessing it was at least equal if not higher to the number of tb deaths in 2021. I understand 2 things can be bad at once, but it does seem really strange that we removed pretty much all covid mitigations in the US but we're also mad at this one person for spreading tuberculosis when people are constantly going out in public and spreading covid.

kevingadd 4y ago
That's because she can go back to being a Productive Part Of The Economy once she gets treated for tuberculosis, but there's no straightforward COVID cure to give to people (the treatments we do have are very expensive and not guaranteed) so we collectively just pretend it doesn't exist and tell people to get back to work
wkat4242 4y ago
Covid is no longer dangerous, much less so than TB. If it weren't the hospitals would have been overflowing with the massive spread it's seeing. And avoidance is untenable as China has shown: even their dictatorship couldn't keep up the heavy-handed measures. All they've accomplished is delaying their path to recovery for more than a year. It's time to let our immune systems do the work they're supposed to again.
- acdha 4y ago
  COVID is still dangerous, and the death figures are still undercounted[1]. There’s a certain romantic appeal to leaving it up to our immune systems but that means millions of premature deaths and millions more disabled people. The best way to make it actually less dangerous is to train your immune system with vaccines but we haven’t been doing very well with that because it undercuts the “everything’s over, start spending more!” message the downtown business associations so badly desire. 1. https://theconversation.com/covid-19-deaths-in-the-us-continue-to-be-undercounted-research-shows-despite-claims-of-overcounts-198266 https://theconversation.com/covid-19-deaths-in-the-us-contin...

6gvONxR4sf7o 4y ago

It's absurd that you can be jailed for not getting treatment in a country where healthcare tends to be so expensive.

Fezzik 4y ago
TB treatment appears to be relatively inexpensive, even including physician visits: https://www.cdc.gov/tb/publications/infographic/ltbi-treatment-costs.htm https://www.cdc.gov/tb/publications/infographic/ltbi-treatme...
King-Aaron 4y ago
https://i.kym-cdn.com/entries/icons/original/000/028/596/dsmGaKWMeHXe9QuJtq_ys30PNfTGnMsRuHuo_MUzGCg.jpg https://i.kym-cdn.com/entries/icons/original/000/028/596/dsm...
smt88 4y ago
It would be absurd if this were common or if they did it for, say, Covid. But this is an extreme case where the woman spent years defying court orders to either get treatment or to isolate. No one was forcing her to get treatment, and there are many income-adjusted means of getting health care in this country (including free health care). It's likely her county would have paid for her treatment if she couldn't afford it, considering the court order. It would be much more absurd if this woman were allowed to continue spreading a serious illness to people who didn't know they got it and couldn't afford treatment. The harm to the guilty woman is much smaller than the harm she has caused others. She may have even killed people.
omao 4y ago
Did you even read the article she was offered the treatment and refused, and if you click on the supporting links you can see that in Pierce County they basically go through many steps to insure any who wants treatment can get even if you’re not insured so it basically free. Also she started the treatment and stopped which is worse because it can lead to resistance and she violated a court order for isolation and was caught after a car crash that could have easily spread the disease
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elif 4y ago

Can a biologist please chime in here... Being that TB is bacterial and covid viral, there is no risk of this petri dish of a person mutating a combination pathogen, right? It seems odd and concerning to have level 3 containment labs with all their rules, but defacto allowing individuals to essentially roll the dice in public. I have to admit this is one of the first times my philosophy has tended toward authoritarianism...

kylehotchkiss 4y ago
(Not a biologist) one of the biggest fears with this particular bacteria is that if you start the treatment and then stop it before the duration completes, you will almost certainly end up with drug resistant bacteria. The treatment drug resistant takes much longer and has heavy side effects. And if you screw that treatment up, you can harbor totally drug resistant bacteria and there’s no treatment available anywhere. This bacteria is especially hard to kill - your body can’t, which is why you need treatment. And the medicine doesn’t kill especially well, it interferes with reproduction primarily and the cells end up dying on their own slow scale.
acdha 4y ago
The two won’t combine but several of the COVID variants are believed to have evolved in immune-compromised people where the virus had many cycles to improve thanks to the host immune system being unable to destroy it. Someone with a massive TB infection seems like they might provide a similar breeding ground, and the reverse could be true if they didn’t manage a successful treatment regimen for TB.
classichasclass 4y ago
No, they can't combine like that. But irregularly treated TB can become resistant to the most useful antibiotics which in turn makes the case extremely difficult to treat (sometimes years). There are individuals who have TB untreatable by currently known means, even failing surgical approaches. They are rare but they exist. The COVID co-infection may make her more subject to more significant pulmonary complications but what this means in terms of variants isn't clear. Source: public health TB physician

cybwraith 4y ago

While this person should definitely get treatment or at the least isolate per the court order... Why is this treatment that can cost from $50,000-$500,000 something a person can be burdened with by court order? The CDC and relevant laws around TB only have the government cover treatment "if you are unable to pay", so if someone had $150,000 in their 401k and got Tb with charges of $149,000 their progress towards any sort of financial stability could be brought back to effectively zero. Even if they were low income and covered by an ACA plan, those usually have pretty high coinsurance percents so this is still a very possible scenario. This is clearly a case where treating anyone with TB in this country is a public good and should never burden the individual to such an extent (or at all, really).

ThrustVectoring 4y ago
401k accounts are generally exempt from bankruptcy proceedings and other debt-collection activities.
- pyuser583 4y ago
  Are IRAs exempt?
  - marcus0x62 4y ago
    Depends on the state. IRAs are not ERISA-qualified plans, it may have some state-level protection. https://www.irafinancialgroup.com/learn-more/self-directed-ira/ira-asset-and-creditor-protection/ https://www.irafinancialgroup.com/learn-more/self-directed-i...
  - compsciphd 4y ago
    Its fairly easy enough to setup a Solo 401k. While it could be difficult to send contributions to it directly, you can contribute to an IRA and then rollover into the Solo 401k. Solo 401Ks are also useful for enabling backdoor roth IRA contributions. For those with traditional 401Ks, one doesn't want to roll them over into a traditional IRA as that would remove one's ability to do backdoor roths.

Am4TIfIsER0ppos 4y ago

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deleted 4y ago
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cm2187 4y ago

What is missing from the article is her motive to decline the treatment. No matter how dumb the motive is, if it is not mentioned I cannot help suspecting there is more to the story.

more_corn 4y ago
I also would like to hear her reasoning.

orbisvicis 4y ago

Given the advanced state of her tuberculosis yet active lifestyle, what symptoms is she likely suffering? Mild cough? And what are the long-term side-effects of two years of "alternative ... toxic" antibiotics? Are these the types of treatments that require daily IV therapy at an outpatient facility?

dang 4y ago

Url changed from https://arstechnica.com/science/2023/02/us-woman-has-walked-around-with-untreated-tb-for-over-a-year-now-faces-jail/ https://arstechnica.com/science/2023/02/us-woman-has-walked-..., which points to this. Submitters: "Please submit the original source. If a post reports on something found on another site, submit the latter." - https://news.ycombinator.com/newsguidelines.html https://news.ycombinator.com/newsguidelines.html

snvzz 4y ago

At some point, justice should act in the interest of public health. It shouldn't have taken so long.