Is Phoenix Taking Quarantine Too Far?
In a modern day Typhoid Mary case, Arizona has opted to quarantine a man infected with extreme drug resistant tuberculosis (XDR-TB) - in the local county hospital's Ward 41, the section set aside for sick criminals. Robert Daniels has been locked up there since last summer, and is going to be there...indefinitely. He says that he's being denied showers, has to clean with wet wipes, and has had his television, radio, personal phone and computer, etc, removed. He is effectively in solitary confinement, visited only by the medical personal who make sure he takes his medication. And I have to wonder - this really the least restrictive method of protecting the public? While I can understand having to remove someone who's a serious threat to the community during treatment, is (effectively) a jail cell the appropriate place? Why do the Phoenix hospitals not have isolation rooms outside their criminal ward? What are they planning on doing during a major outbreak of any massively contagious disease - toss out the inmates and take over the cells? And why is he being denied a television, radio, personal phone and computer, and etc? It's not like XDR-TB is going to attach itself to an email and infect the world...
There is an interesting discussion of a ruling by the European Court on Human Rights in this article by Jerome Amir Singh that suggests how to determine if forced quarantine and isolation are reasonable and justified measures (a topic Matthew Wynia wrote on in the January issue of AJOB). The courts ruled with the applicant in a Swedish case where the public health officials wanted to lock up a man who'd spread HIV after being told (basically) to knock it off, saying that "any such detention must be in compliance with both the principle of proportionality and the requirement that there be an “absence of arbitrariness” such that other less severe measures have been considered and found to be insufficient to safeguard the individual and the public."
The Arizona XDR-TB case is clearly flunking some of the most basic requirements of confinement for a public health matter. Singh (et al) say that
The use of legally sanctioned restrictive measures for the control of XDR-TB should not obscure the fact that being infected is not a crime. A strong reciprocal obligation is borne by authorities so wishing to invoke these measures. Those who are isolated require humane and decent living conditions. In fact the restriction of their liberties is more for a collective good than for their own. Thus every effort must be made to ensure conditions of living that preserve dignity.I'm pretty sure being locked up in a cell, no human contact, no mirror, no shower, no forms of entertainment, etc, for an indefinite period of time, is about the furthest you can possibly get from preserving dignity.
-Kelly Hills
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It would be interesting to hear about the terms of his incarceration from someone else. Is he really deprived of TV, etc.? And if so, why? Was he, for instance, willfully endangering the sheriff's deputies when they came to his cell? Taking away privileges is about the most benign way they have of getting prisoners to alter their behavior.
- by Laura(southernxyl) on Apr 5, 2007 at 11:21 AM | link
No, no, Laura, that's the point, he's NOT a prisoner, he's a regular patient, but they put him in solitary as a means of isolation!
- by Sarcasticus Bioethicus on Apr 5, 2007 at 5:09 PM | link
From the article: "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."
I didn't mean "prisoner" as in "convict" but as in "a person locked up in a prison." Quarantine in a hospital would be more appropriate for him IF he would comply with orders not to infect other people, which it's been shown that he won't. It's not really the function of regular hosptials to police people like that. I'm not sure he would be that much better off in hospital quarantine anyway. It's a bad situation, and I'm glad it doesn't happen more often.
- by Laura(southernxyl) on Apr 5, 2007 at 11:30 PM | link
Most hospital quarantine units I've been in have a method of lockdown to prevent delusional (from fever/meds) patients from wandering out. If Phoenix doesn't have that capability in any of their city hospitals, then I fear for them come some massive outbreak of something nasty, contagious, and scary.
It's also worth noting that he is in the prison unit of the local hospital, but is at a hospital, where he's supposed to be treated as a patient. He is not a prisoner - never been arrested, etc. That means he has rights, and they are currently being violated (and it doesn't matter how difficult he was being).
The article also states that he was never told he had to wear a face-mask, and that the area of the world (it was Russia, wasn't it?) that he comes from rarely has doctors/nurses wearing masks to prevent infection. It's not unheard of that there are many places in the world that don't have our concept of barrier medicine.
Right now, the article looks like another play by play example of how not to handle quarantine issues - and frankly, given the concerns and threats of bioterrorism and outbreaks, we should be taking every chance of quarantine that comes up as an opportunity to learn to get it right, not keep getting it wrong.
- by Kelly on Apr 6, 2007 at 6:59 AM | link
"Specifically, he said he did not heed doctors instructions to wear a mask in public."
I think the article needs to be fleshed out quite a bit before we can say we have a view of what's happening here. Since the county people won't talk, that probably can't be helped.
- by Laura(southernxyl) on Apr 6, 2007 at 8:39 PM | link
I think that this man was treated like an animal and not a human. His rights were very violated and he should be taken out from the prison population at once. He should be placed in a facility that has appropriate accomodations for him. He deserves every convenience offered every other patient. I know for a fact that all the little nicities can be provided in an isolation room. They just have to be sterilized or thrown out when the patient leaves.
- by R.Phipps on Apr 7, 2007 at 7:49 AM | link
I can't believe what I am reading. This patient is being treated worse than a prisioner would be. At least they would have tv and radio or some type of entertainment. Why couldn't they set up an intercom so that his family and friends could visit without being in the room. With technology today there has to be a better way. I think this man should look into legal issues with this.
- by Mary Beth on Apr 7, 2007 at 1:09 PM | link