Authorities Criminally Charge Tuberculosis Patient for Not Taking Meds

SAN FRANCISCO (The Blaze/AP) -- It's a difficult legal situation. A person has an infectious disease. Taking medication is not only beneficial to them, but it can help stop the spread of said disease. When it's found the patient is not taking these medications, the authorities arrest them and institute a measure that will ensure the patient is at a certain place where administration of the medication can be monitored.

This exact situation is what has happened with Armando Rodriguez who has tuberculosis, but some public health officials think the authorities went too far.

Rodriguez was warned several times to continue taking his tuberculosis medicine. At one point, authorities said, he told his case officer he stopped the treatment out of concern for his liver while binging on alcohol and methamphetamine.

On Tuesday, authorities arresting Rodriguez and charged him with refusing to comply with a tuberculosis order to be at home at certain times and make appointments to take his medication.

It's a move that divides public health officials.

"I think it's an error to confine someone in the criminal justice system for a public health crime," said Lawrence Gostin, a Georgetown University public health law professor who drafted a model law adopted by several states struggling with the issue. "The whole intention is to protect the public's health. It's not to lay blame on someone."

Health officials say Rodriguez, 34, of Stockton has active pulmonary tuberculosis, which can include coughing up blood or phlegm and can spread through the air.

Rodriguez has been noncompliant with his treatment and could become contagious as a result, Ginger Wick, nursing director for San Joaquin County, said in a letter requesting a warrant for Rodriguez's arrest.

After failing one time to give himself the drugs, Rodriguez told a nurse he had gone on an alcohol binge and taken methamphetamine and didn't want to hurt his liver, Wick said in her letter.

Rodriguez was arrested Tuesday and is expected to be arraigned Thursday on two misdemeanor counts. Each charge against Rodriguez carries a maximum penalty of a year behind bars.

He will likely be appointed a public defender.

Tuberculosis is a bacterial infection that usually attacks the lungs. Many people have a latent form, and the active form usually only affects adults whose immune systems are compromised, which can happen from drug use.

Public health experts are divided on the issue of mandatory treatment and criminal charges for patients who don't comply with treatment orders.

Many of those who do support criminal prosecution in the rarest of cases when public health is in jeopardy oppose the jailing of patients.

Implementing mandatory treatment should be a last resort, and prosecuting someone for disobeying a public health order is unhelpful and sends the wrong message if protecting public health is the intent, Georgetown's Gostin said.

Instead, the afflicted should be given assistance such as transportation to and from treatments rather than punishment as an incentive to take their medicine, he said.

The Centers for Disease Control and Prevention said laws to control the spread of tuberculosis have been in use for more than a century, though regulations differ in each state. Here's an excerpt from the CDC's TB Policy Handbook:

In other cases, however, it may be necessary for government to significantly restrict individual liberty to protect the public’s health. Under one state’s law, for example, a TB patient may be required to undergo outpatient examination and treatment, DOT, hospitalization, or residential isolation to prevent the spread of the disease. When public health authorities seek to use powers that restrict individual freedoms, fundamental rights of due process, travel, or association may be implicated. In such cases, courts may seek to determine whether government’s action advances a compelling state interest that is narrowly tailored, and there are other less restrictive alternatives available to protect the public’s health and the individual. Generally, liberty principles allow individuals (or their legal guardians) to decide whether to treat an illness, regardless of its severity, consistent with traditional notions of informed consent. The U.S. Supreme Court has recognized a right to bodily integrity that includes a right to refuse medical treatment, except in limited cases (e.g., treatment of prisoners with infectious diseases).

As many as 12,000 new cases of tuberculosis are reported in the country each year, the CDC reported. California recorded 2,317 new cases in 2011, a low since records have been kept.

Nonetheless, officials throughout the nation continue to struggle to stop the spread of tuberculosis, with several drug-resistant strains emerging in recent years.

Federal and state officials don't keep records of the number of people prosecuted for refusing to take their medicines. But some say it's exceedingly rare to file criminal charges in such cases.

San Joaquin County has had more than 30 tuberculosis prosecutions since 1984, prosecutor Stephen Taylor said, noting the county is more aggressive than other jurisdictions in prosecuting patients to get them to take their medication.

"The criminal cases we're dealing with generally involve drug users who are harder to treat and manage because the TB medicines conflict with street drugs," he said. "We have to throw these people in jail and treat them as in-patients. They don't cooperate as out-patients."

Karen Furst, San Joaquin County public health officer, said the county arranges transportation and other services to help patients stick to their drug regimen and turns to the legal system only as a last resort.

"I have to make sure that if I'm aware that somebody is in a position that could possibly be spreading a disease to another person, that I take steps that are necessary to prevent that from happening," she said.

Rodriguez was discharged in March from San Joaquin General Hospital with four medications for active tuberculosis and agreed to take the drugs under observation by a county health official on weekdays and on his own on weekends, authorities said.

He allegedly refused to take the drugs on another day and then was not at home on three occasions and missed an appointment.

In her letter, Wick said Rodriguez would need nine months of treatment.