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).
In Sweden healthcare is already so cheap (due to state control) that Americans would consider it free, but there's a list of special diseases that are a unique danger to public health,[0] which includes TB, and in those cases you are not charged at all for treatment.[1] It seems reckless from a “not-having-epidemics” standpoint that a wealthy place like the US wouldn't do the same. Hell, it shouldn't be a problem for health industry profits, they could be paid by the state if necessary.
It's gonna take some pretty wealthy people getting pretty awful sick for that to ever happen.
I don't like the typical cynical circle jerks about capitalism etc, but that's just how it is here. The US citizens don't have the power over their healthcare system that the wealthy do. Everyone knows it, everyone readily and openly discusses it, but no one affected is in any position to change anything. Politicians are paid off, votes never go through, bills die off, nothing is allowed to happen. Politicians are voted against, money is speech, they win anyway, the cycle continues.
The cycle also ends, going by historical precedent. We humans have a long-standing tradition of painting ourselves into a sociological corner and then having no option but revolution. It always seems unthinkable before it happens, and then, once it does happen, it seems to have been inevitable.
What the second American revolution will look like, and when and where and how it will happen, I can’t say — but it will. That much is a certainty.
The other option is conquest by a power that isn’t yet in its decadent days - but that remains unlikely in the case of the US - their rivals would do better to simply wait for them to fall on their own sword, rather than expend the energy or political capital on an active invasion. The situation is not dissimilar to Russia in the early 20th century.
The window-dressing is certainly correct at the moment, with a lot of technical development and new communication methodologies available, and growing and accelerating wealth disparity.
A key difference though is that in modern America people are still nominally comfortable. People don't revolt because of expensive Healthcare, they revolt when they cannot buy food. The tragedy of modern America is that even though things are bad and people do suffer, the majority are utterly complacent and uninterested in real systemic change. As long as people can go to Walmart and watch their TV shows, nothing will meaningfully change.
> Why is this treatment that can cost from $50,000-$500,000 something a person can be burdened with by court order?
The court order is that she must either take her treatment or isolate.
If she didn't/wouldn't/couldn't treat, she was not allowed to expose other people. That is the core issue. Note that she did start the treatment, but she refused to finish the course of treatment and refused to comply with necessary testing to ensure the case had been treated. I can't find any articles suggesting that she stopped because it was too expensive, though that is what most commenters are assuming.
Also, TB antibiotics don't cost $50K to $500K, at least for first-line treatment (the treatment she refused). The published treatment costs generally include multiple weeks of inpatient hospital treatment (for example: https://www.cdc.gov/tb/publications/infographic/appendix.htm ). If someone had a case that fit this description, they wouldn't be wandering around in the world infecting others.
Regardless of this particular case, ordering someone with a disease to either pay to treat it or to isolate is surely the behavior of a dystopian state.
I can't say this for every state, but this is exactly the case in California: if you can't afford TB treatment, you're still covered. Every health jurisdiction has a TB control program, some very large, and every jurisdiction with cases gets state money to ensure those cases are treated. That goes for relatively uncomplicated active TB through horrid multi-drug resistant cases. That goes for citizens and immigrants alike. Some of the best TB docs in the state work for local health departments. I've treated cases for over 15 years. We want you to succeed. We do not want you bankrupt for a disease you had the bad luck of getting, and we don't want you to give it to other people in the process, because we're the ones that have to clean up the mess.
It's precisely because we'll bend over backwards with treatment coverage, free doctor visits, rent assistance, helping apply for short-term disability or Medicaid, home directly observed therapy, you name it to break down those barriers, that when I walk into court and say this person needs to be confined until they're no longer communicable, it's not because they can't afford it. We've done everything we could do to avoid getting to this point. Now they're a danger to the public, and we can't let that go on.
> if you can't afford TB treatment, you're still covered.
Does this help in the hypothetical case OP is mentioning? Or does the government coverage kick in only after the person has been made to spend every last dollar that they have on the mandatory treatment and are now left penniless?
Again, can't speak for places other than California, but here TB treatment is not like Medi-Cal where you have to spend your assets down first. We'll see you because it's emergent, and we'll ensure your treatment is complete because it's necessary. We'll bill your coverage if we can but we'll never bill you. If you have insurance, you can see them, or you can still see us. I have Kaiser patients who would rather come in because it's easier to get an appointment and we handle everything for them.
This is not necessarily true of other diseases. But TB's legal complications plus its serious nature make it essential to handle it this way. It's cheaper for the local health department, too: think of what has to go into evaluating and testing all the people who ended up with a preventable exposure. I remember a case in which we tested over 5500 people because it was a nurse and they weren't detected for six months.
> If you have insurance, you can see them, or you can still see us.
Outside of an HMO, what does this mean? You cannot “see” or be treated by most insurers in the United States. You “see” a licensed provider, then some time later find out what, if any, of the charges billed by those provider(s) are covered by your insurance plan.
If the woman was uninsured, would she be able to purchase insurance outside of the annual open enrolment period or would she need to pay out of pocket until November?
> Insurance does not cover all health expenses, there are maximums and deductibles. Sometimes a treatment isn't covered.
Lifetime and annual insurance limits aren't legal any more. It's incorrect to say that insurance has maximums.
Tuberculosis treatment for an active, diagnosed TB infection would be considered an Essential item and therefore would be covered. It's also incorrect to suggest that insurance might just choose not to cover it.
Insurance companies can and will reject treatments recommended by a doctor on a regular basis. It's not hard to find examples of this. You can insist that The Rules say TB is exempt from this but laws aren't real unless the people responsible for enforcing the rules believe in them. Do you think some faceless health insurance administrator - whose name you don't even know - is going to go to prison for rejecting your TB treatment? Have fun with months of appeals and maybe having to retain a lawyer to get your treatment.
I've personally dealt with this post-ACA (though not for TB).
Sigh. Lifetime limits on covered procedures aren’t allowed. That isn’t to say the treatment your doctor recommends will be deemed medically necessary and be covered.
> Tuberculosis treatment for an active, diagnosed TB infection would be considered an Essential item and therefore would be covered.
As a non American who doesn't know much about the American healthcare system beyond what the internet and news tell me I so want to believe what you're saying but something tells me that there's at least one person out there right now in the US walking around with untreated TB because treatment wasn't classified as essential by some uncaring bureaucrat.
> As a non American who doesn't know much about the American healthcare system beyond what the internet and news tell me I so want to believe what you're saying
> but something tells me that there's at least one person out there right now in the US walking around with untreated TB because treatment wasn't classified as essential by some uncaring bureaucrat.
No, TB is treated as a significant public health threat. No insurance company would dare deny treatment for TB because the ensuing liability would be massive. They'd be on the receiving end of gigantic lawsuits from everyone who was possibly exposed to the person, not to mention on the receiving end of legal inquiries from the government to punish them for very clearly violating the very clear federal laws on the matter.
The US has a lot of room to improve, but it's not like the cartoonishly evil version you read about online.
This woman lives in Washington State, where eligibility for Medicaid is income dependent. There is no means test, which means that as long as her income is under $1,563/month she would be eligible. So assuming she's unemployed or marginally employed I would expect this to be free for her.
What? It is insane for a person to have to pay for TB treatment. We have a huge TB burden here in South Africa. Treatment is free because we don't want it to spread. Unfortunately, because of the massive urbanization movement after Apartheid, the shanty towns makes the spread quite easy.
It's insane for you. For them, it's good business sense, because they can protect themselves from respiratory disease. Even better if you can sell orphan drugs for huge markups because TB requires specialty antibiotics. Follow the money, as they say...
> 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).
universal health care. the same logic doesn't stop with TB, the contagiousness just makes the public health benefit obvious.
> When they performed X-rays of her chest and saw the state of her lungs, they initially suspected she had cancer. But in fact, the X-rays revealed that her tuberculosis case was worsening.
> Moreover, she also tested positive for COVID-19, "which also strongly suggests that she is not isolating as per this court’s order," the health department's court filing said.
What's the point of going after her at this point, it seems to me like she's circling the drain. Covid is bad enough without also having TB, the only people who stand to profit are lawyers. She def, should be made to get treatment one way or another, ideally it should be free.
The CDC should cover all but 5% of the person's income worth, so instead of 150k treatment taking all of a person's 401k, maybe it takes 8k. That's much more reasonable IMHO.
The point is to get her to stop endangering innocent people. Note how that includes things like going to the ER and not telling them that you have a nasty disease until you have had plenty of time to infect others.
And, yes, treatment should be free: if she’s poor, Medicare will cover it and if she’s over that the ACA will cover it until something like $50k annual income.
> The CDC should cover all but 5% of the person's income worth, so instead of 150k treatment taking all of a person's 401k, maybe it takes 8k. That's much more reasonable IMHO.
What's the point of putting 5% on the person here? Why not just cover 100%?
Those inflated prices are for tb that has become resistance to basic treatment which is the path she’s going on. because she had already started treatment and stopped increasing the likelihood of resistance. Also the treatment was offered to her by the county it’s basically free.
Meaning that if you can afford insurance, or your employer pays for it, you might be ok.
If your situation is already precarious and you cannot afford insurance then you’re doubly f*ed.
In cases like this, it is a benefit to society that people get treatment before they think (rightly or wrongly) that they can’t afford it and infect others.
Against specifically bankruptcy? Yes. As marcus0x62 already noted they are not covered by ERISA which is what deals with 401(k) plans.
However, they are covered under the Bankruptcy Abuse Prevention and Consumer Protection Act (BAPCPA) of 2005. This covers up to $1 million dollars. (I've seen something that suggests if the IRS is a rollover IRA rolled over from an ERISA-qualified plan there might be no limit, but haven't looked to see if that is right).
Note that this just covers bankruptcy, whereas ERISA also covers seizure by creditors, so the 401(k) is better in this regard since you would actually have to declare bankruptcy in the case of an IRA. States usually provide protection against creditors. See the link in marcus0x62's comment.
Also if you do something stupid like use your IRA as security for a loan the BAPCPA protections will not apply. I've also seen something that said if you borrow money from your IRA it can reduce your BAPCPA protection.
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.
> Why is this treatment that can cost from $50,000-$500,000 something a person can be burdened with by court order?
Though the US talks a good game about rights and freedoms, LEO and courts do not respect the Bill of Rights, nor is there ever any consequences for them for illegal searches, illegal interrogations nor coerced confessions. In this case, the 8th Amendment should protect her from this burden quite obviously as "excessive fines," but these rights really don't exist, nor is it possible for any court in the US to find a defendant, "innocent."
Most state law, at least, once accused, it simply is not possible to be acquitted, making nearly all trials a sham. The prosecutor, not any judge, as Robert Jackson said, "has more control over life, liberty, and reputation, than any other person in America." They don't care about justice, they only care about their conviction record. They will never agree to consider exculpatory evidence. It is only a matter of whether they think they can win, such that they will happily and readily convict the innocent if they can, and will avoid prosecuting the guilty if they have any doubt they could not.
Individuals that never had the misfortune of being charged with a crime and attempted a defense in court could never understand, and they also, as a rule, have a strong bias towards accused being guilty, even prior to conviction, even if there is no evidence of crime. There is a reason most cases end before there is any ruling... they usually end as plea deals. There is no presumption of innocence in US courts. All that is needed for a conviction is an ambitious prosecutor to slander the accused with absolute bullshit fantasy.
The ability of a prosecutor to seat and manipulate a Grand Jury, even to indict a ham sandwich if that's what they wanted, is the source of their power, which is nearly absolute, and that power is the source of their corruption. There are very few with that power that have resisted its corruption and are not obsessed with their ambition to win at any cost over the platitude of justice being served. We have to assume Associate Justice Robert Jackson was one. I think probably Kenneth Star and Merrick Garland, also. I would have insisted John Roberts was also among them until he saw the opportunity to overturn Roe with an illegitimately weighted conservative Court, and despicably did so, and young women will bear the consequences with their very lives, not him.
think a bit more before you reply, please. or maybe read a bit closer and get the details before you type out a 500 word essay on why the justice system is broken.
the court order is to get treatment according to doctors instructions, OR isolate.
isolation costs nothing.
what is worrying to me is that A) you just had this entire wall of text ready to go, it seems, waiting for somewhere to put it, and B) what the hell kind of a society do we live in where the society doesn't take care of its citizens, and how the hell do we view this as normal in the US?
in this case, it doesn't matter. she's got TB and doesn't want treatment for whatever reason. so you sit your ass down and you don't leave the house until you either die, miraculously are cured, or you change your mind about treatment.
Maybe you want to rethink your argument as something better than a string of ad hominem attacks. I'll give you a massive hint: any time you focus on the person, you are committing a fallacy and your reasoning is invalid and unsound. All that matters is what was said, not who was saying what. You're welcome to disagree with me, but you can only rationally argue such by speaking to the argument, not the man.
The 8th Amendment reads,
Excessive bail shall not be required, nor excessive fines imposed, nor cruel and unusual punishments inflicted.
The issue here is that defense is expensive, which means it necessarily discriminates against anyone that can not afford $50K in attorneys fees, just for starters, so to protect one's 8th Amendment rights against excessive fines often costs more than the excessive fine itself.
there's no fine! all she has to do is stay home and wait to die.
why would she even want to be around other people, when she knows she has an extremely serious and contagious disease?
she is a literal menace to society and that all but voids her individual rights to freedom from fines, punishment, or excessive bail. she had her chance to play according to the rules. she chose not to. now she must pay the penalties. if she infected anyone and they die from it, she must be treated, against her will or not, and then put in prison for an appropriate amount of time.
you can't go around infecting others with tuberculosis and expect to keep your rights, no matter what "excessive" means to you. court opinion is valid and one does not get to say that legal precedent on interpretation of the bill of rights is invalid because you personally disagree with it.
how's that? please think more. not everything is an attack against you.
What’s a solution to (or, I guess, outcome of) someone refusing to get treatment or isolate with a highly infectious disease that conforms to your ideology?
> She noted that the cost of treating drug-resistant TB can run $100,000 or more.
My ideology is to not violate the patient's 5th and 8th Amendment rights. The government can pay for the treatment in the interests of public health rather than discriminate against her because she can't afford it. Though you wouldn't know it, being poor isn't a crime.
Sorry, I assumed from your other responses that you were not okay with enforced treatment. Given how focused you were on the government not infringing rights, and how you were explicitly against enforcing isolation, I guess I assumed that carried over to not allowing the government to enforce medical treatment (even if it was free).
I’m still unclear what you think should be done in this concrete case. I see a few options here:
- Don’t enforce anything, allow the person to spread TB unrestricted.
- Enforce isolation until death or recovery.
- Enforce treatment until death or recovery (note though that if you were not to enforce isolation during treatment you’re allowing TB to spread during this time!)
- Something else?
Forgetting for a moment about payment, It sounds like you would be in favor of the third option?
We can also discuss who should pay for the latter two (and I know the answer to that is not an isolated question - they go together). I would agree it should be the government - though I’m also for government-provided, taxpayer funded healthcare generally, which I suspect you are not - and would possibly consider its imposition as unconstitutional?
> Seems to me that indeterminate isolation is a much steeper cost than mere money.
I think you are correct, and that GP's solution violates the suspect's right of due process under the 5th Amendment, which is the source of an individual's right to freely travel within the borders of the US. Commonly known as the "travel right," it entails privacy and free domestic movement without governmental abridgment.
you do not get to travel free while carrying tuberculosis, and while turning down treatment.
her rights do not extend to the point where she has the right to infect others with tuberculosis. common cold, sure, fine, it isn't especially dangerous. tuberculosis IS especially dangerous.
her rights extend to the point where she impedes the rights of others, and no further. this means she can't walk around and spread tuberculosis because of "travel right". travel right is not applicable in certain situations and her situation is one of them.
people do not have unabridgable rights. if you kill someone, and you are found guilty, you lose a lot of rights, including travel right. are you arguing that the 5th amendment applies to everyone, no matter what? that the 2nd amendment applies to everyone, no matter what? you violate the freedoms of others, you get your rights taken away. that's what judicial punishments are.
if you are saying that you can go into a school and kill everyone then walk out and continue to exist freely with your 2nd and 5th amendment rights intact, you may be a sociopath. if you are not saying that, then state what you are saying more clearly, because it sounds like you want complete freedom for people who have tuberculosis and refuse treatment.
spreading tuberculosis is potentially no different than shooting a bunch of people. it's just as lethal, but over a longer period. so if you're saying that she should be allowed to spread tuberculosis wherever she wants, and never be confined because of that, then it sounds like you think you're free to do anything you want to others without any changes to your own freedoms.
Motive matters. There is a world of difference between intentionally trying to infect others and doing your best to not infect while still using the right to travel.
A distinction you have failed to acknowledge at all in your narrative. You simply assume guilt and appear to have no real conceptual understanding of justice, guilt, fault and appropriate punishments.
This individual has needs and rights that must be upheld as well.
The ends justify the means is a terrible philosophy that, if pursued, ends in sorrow. Another way to describe it is the many out weigh the few. It is the pavement of the road leading to pretty much every totalitarian government in history.
Finally, every day activities entail a certain amount of risk. Car accidents, disease, pests. You assume these risks to participate in public and they cannot be eliminated. Reasonable efforts to reduce them is fine, but there is a growing mentality that any risk you impose on others is unacceptable and this is an untenable position. You can't reasonably zero out risk.
> This is the pavement of the road to totalitarianism.
no, it isn't. telling someone that they are not allowed to freely spread a lethal disease is the exact same as telling someone that they can't freely assault anyone they choose.
> What if the doctors are just... wrong?
all of them? over time? all of whom have reached false positive diagnoses for tuberculosis, for which there are good, reliable tests?
unlikely to the point of virtual impossibility. winning the lottery while being bitten by a shark is probably more likely.
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.
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?
[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.
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.
> 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, 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.
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
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.
> A total of 1.6 million people died from TB in 2021 (including 187 000 people with HIV). Worldwide, TB is the 13th leading cause of death and the second leading infectious killer after COVID-19 (above HIV/AIDS).
it's crazy how covid became nice as soon as we got a non-sterilizing vaccine that doesn't prevent spread, just keeps people out of hospitals for the short term. Best of luck with your repeated infections.
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.
COVID is extremely contagious now, and it's spreading faster than ever before, yet the hospitals are fine.
Of course it still causes deaths as does the flu but it's not an emergency anymore. TB totally would be if it were as common as COVID is in our society because that's so deadly. It's just much easier to prevent.
And it's not just business that needs to be open. People do too, for their mental state and livelihoods. If China couldn't make it happen we certainly can't.
COVID is still killing hundreds of people per day in the United States (450/day currently), and hospitals are still running very close to capacity with extended delays for treatment in many cases. The numbers are slowly trending better but wishful thinking doesn’t mean it’s over.
> And it's not just business that needs to be open. People do too, for their mental state and livelihoods. If China couldn't make it happen we certainly can't.
There’s quite a range of options between lockdowns and doing nothing. The restaurant and bar industry favor the latter because their businesses are the highest risk and the owners didn’t want to spend money on air quality upgrades but that doesn’t mean that those are the only possible options.
450 per day is not a lot though. It's much lower than the normal number of deaths you'd expect in the US for its population and life expectancy (about 12000 per day I figure?) - after all people have to die of something eventually. Considering covid is absolutely everywhere now it's really not high numbers. It's just taking its share of the seasonal flu deaths and other common causes for the old now. After all it is the season for respiratory illnesses. I don't consider that a danger to society. A tuberculosis outbreak would really be because that has a mortality rate of over 10%, much higher than covid has ever been.
Not sure about the US but the hospital numbers here are really fine. A bit more ventilation is always good of course, and it'll be nice if that can be made in due course.
You're free to keep worrying and masking of course, but don't expect everyone to :) Personally I'm making up for lost time now, going clubbing more than ever. I really needed that. Social needs are also important.
You incorrectly stated that “COVID is no longer dangerous”. While a widespread TB outbreak would be worse, COVID is still killing people at significantly higher rates than the flu — something like 5-10x — and that rate is not dropping significantly. It makes sense to spend time on the thing which is actually killing people rather than currently hypothetical problems.
Similarly, it's important to remember that nuance is possible here: there's a wide range between doing nothing and the kind of lockdowns China had. Focusing on things which reduce lethality (vaccination) and spread (improved ventilation, mitigating the highest risk activities) saves lives and has little cost. That's especially important when you consider that the costs are unevenly distributed: for example, wearing a mask to the pharmacy or grocery store has no real cost but it helps high-risk individuals can safely use key services.
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.
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:
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
“Inconvenient to her” is an interesting way of describing “destitute and homeless”.
Her only source of income was cooking and house care. The state said “you cannot do this”, but also did not provide her with any alternative. Noting of course that putting a contagious typhoid carrier into the homeless community would like exacerbate any spread of disease, the only “safe” option given all of that is suicide, which doesn’t seem particularly just.
I want to be clear: knowing she was causing death means she was clearly not in the right, but saying she kept on working because it was inconvenient is a gross misrepresentation.
(There's really no need to nitpick my choice of words here. Your observations are quite valid and strengthen the point I was making. "Inconvenient" does not imply "trivial".)
“Give up her livelihood” is a fairly gentle way to put “become homeless and destitute”.
There’s a huge chasm between “self isolate with government support so you don’t become homeless while being treated” and “you are no longer permitted to do any of the jobs you are allowed or able to do, you must isolate from everyone, I hope you’re independently wealthy”
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.
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?
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!
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.
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.
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.
(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.
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.
> "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.
>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.
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.
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.
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.
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.
It's clear that jail does not resolve the consequences of the crime. So then the question is, does the threat of jail achieve deterrance of the behavior you're referring to?
I would probably guess that anyone not thinking about the consequences of their actions on other people are also not thinking about the consequences of their actions on themselves, so jail seems like a pointless threat overall.
Not all criminals are deterred by threat of prison, and not all prisoners can be rehabilitated. For those people, jail is simply a mechanism to remove a known threat to society.
In this TB case, jail isn't a threat, it's a consequence that will improve the safety of innocent citizens.
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?
>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.
Darius McCollum [0] comes to mind. Clearly he might endanger people with his stunts, but just as clearly it's because of his mental illness.
If someone refuses treatment for a fatal illness, isn't that a clear sign of mental illness to you? To me, that's barely different from "God talked to me through my dog's poop and commanded me to poison my neighbor". Yes, clearly you don't want neither the TB-spreader nor the Poisoner running around doing their thing. But is jail the approach you'd go for?
I'd call those cases more crazy than criminal. A psych hospital would be a much better approach imho. Granted, they can look a lot like jails, but maybe that's something that could be changed instead of just using jail as a one-size-fits-all thing.
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.
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
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.
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.
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.
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
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...
(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.
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.
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.
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).
> 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.
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.
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.
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.
> 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.
To add to this, it's a perfectly justified change. HIV is significantly less harmful these days.
At one time, contacting HIV was only a matter of time until you developed AIDS, after which you could expect to have a life of increasing suffering and early death. A large part of your sex life is permanently eliminated, lest you spread the virus.
Today it is entirely possible to contract HIV and not develop AIDS. Should you develop AIDS, the prognosis is significantly less grim. It is also possible to maintain normal sexual relationships without causing viral spread.
Since HIV is no longer a death sentence it no longer makes rational sense for the legal system to treat it as one.
On an even more positive note, mRNA research is amazing and there may be an HIV vaccine as soon as this decade. The last person to die of AIDS may have already been born!
That's absurd. So what if nobody has to die from AIDS? It's still a life changing thing that means being on expensive medication permanently. Spreading it knowingly should be a crime. If I go around stabbing people in non-lethal locations, should I only be charged with a misdemeanor?
> A large part of your sex life is permanently eliminated, lest you spread the virus.
Please tell us who you think is willing to have sex with someone carrying HIV.
It's outside of my risk profile, but the common refrain today is "undetectable == untransmissible", which is assured by routine medical checkups[where they try to detect viral load] and a daily dose of drugs[which suppresses the virus]. Some people may find that to be acceptable in order to have sex with someone carrying HIV. Safer sex should be encouraged in most circumstances.
California specifically lowered the criminal penalty for knowingly spreading HIV because the data showed that the risk of felony conviction had a cooling effect on folks willing to get tested and treated. The medical community generally supports these measures as they are shown to be more effective at combating HIV. These findings have been born out in studies all around the world.
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.
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.
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.
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.
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).