Public-health agency takes rare step of detaining TB patient

A recalcitrant patient with an active case of tuberculosis — and a drinking-and-drug problem — was detained Wednesday by public-health officials intent on treating the patient and protecting others from the contagious disease

It's only the second time since 1986 that Public Health — Seattle & King County has sought a court order to detain a patient who resisted treatment. By law, the agency is allowed to do that, although Dr. Masa Narita, TB control director, said such action is always a last resort.

"We have to do this in a very rare situation," Narita said. "We try our best so we can cure all TB patients in King County while we are protecting the public's health."

Last year, there were 130 cases of tuberculosis diagnosed in King County, a number that's stayed relatively stable for the past decade.

In this case, Public Health tried to get the patient to stay put and take the required medication for more than a month, using a regimen where a public-health worker watches the patient take the medication.

The agency paid for a motel room, even groceries, for the patient. "We provide everything," Narita said. "You don't want to see this person in the grocery store."

But the patient began leaving the motel despite scheduled treatment appointments, refused to come to the TB clinic and delayed drug treatment — which the patient had earlier agreed to begin — because of illness from bingeing on alcohol or various drugs, including heroin.

Eventually, the patient skipped so many treatments there was danger of the TB resurfacing, possibly with a drug-resistant strain, Narita said.

"Of course, the detention is the last thing I want to do," he said. "But after many discussions, I really thought this would be the most appropriate option."

Public Health officials cannot disclose details about the case because of federal privacy laws and because the court has sealed some of the case, including the patient's name, age and gender, as well as information about the location of the detention.

The saga began July 21 at Swedish Medical Center, when the patient was diagnosed with a suspected case of TB. The diagnosis was later confirmed.

Public Health's efforts to treat the patient continued until early this week, when Narita sought an order in King County Superior Court for a 72-hour detention. Because of the holiday weekend, that will expire Tuesday, when Public Health could ask for an additional 45-day hold.

An entire course of treatment could last from six to nine months, although most people with active TB are only infectious to others for the first two to eight weeks of treatment.

To be completely cured, a patient must complete the entire treatment. If treatment is interrupted, TB could re-emerge as a multi-drug-resistant strain. That's even more dangerous to the patient, who can become infectious for a longer period of time and require an even lengthier period of treatment.

Carol M. Ostrom: 206-464-2249 or costrom@seattletimes.com