TB patient has violated health orders for a year – could jail be next?
thenewstribune.com
thenewstribune.com
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).
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.
Treatment should be free.
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.
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.
The US healthcare system is broken but if you had insurance they could not take your whole 401k.
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.
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.
You don't need to trust me. It's really easy to Google: https://www.healthcare.gov/coverage/what-marketplace-plans-c...
> 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.
I've personally dealt with this post-ACA (though not for TB).
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.
[0] https://www.folkhalsomyndigheten.se/smittskydd-beredskap/ove...
[1] https://www.1177.se/sa-fungerar-varden/lagar-och-bestammelse...
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.
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.
> 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.
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.
What's the point of putting 5% on the person here? Why not just cover 100%?
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.
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.
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.
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.
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?
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.
Seems to me that indeterminate isolation is a much steeper cost than mere money.
> 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.
This is the pavement of the road to totalitarianism.
What if the doctors are just... wrong?
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.
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.
if I'm wrong, please explain how I'm wrong.
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.
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.
Isolation, absent treatment, for TB will cost you your life. Untreated TB will kill you.
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.
Source: public health TB physician
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?
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.
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.
universal health care. the same logic doesn't stop with TB, the contagiousness just makes the public health benefit obvious.
It shouldn't have taken so long.
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
[1] https://www.amazon.com/Mountains-Beyond-Quest-Farmer-Would-e...
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.
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.
1. https://theconversation.com/covid-19-deaths-in-the-us-contin...
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.
> 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.
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.
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.
https://www.who.int/news-room/fact-sheets/detail/tuberculosi...
> 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).
And TB isn't very common in our western world, if it would be as common as COVID it would have huge numbers. That's what makes it dangerous.
It's not as contagious but much more deadly.
I don't think jail is the answer, some mental health support might be.
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.
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.
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.
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.
Source: public health TB physician for 15+ years
Are there protections against them losing their job?
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.
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?
And why should anyone care about how this might offend them, if they cared so little about anyone else either?
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 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.
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.
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.
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.
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:
"It is difficult to get a man [sic] to understand something, when his salary depends upon his not understanding it!" --Upton Sinclair
(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".)
Why is this in any way acceptable?
Those rich people could have paid her to quarantine, but they preferred to be rich rather than alive.
Mary preferred being alive over starving.
Who was doing dumb stuff? Not Mary.
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”
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.
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.ht...
Blood test proved negative.
Now they just go straight to blood test for BCG countries.
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.
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...
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
> 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.
Insert quote about freedom and noses
And what do you do when they violate the terms of the exile (which seems likely enough in this case)?
I hear Florida is fond of bussing people to more agreeable political locations.
edit: fixed spelling error only
After the covid situation, starting this conversation will take someone bold.
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.
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.
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!
> 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.
(And stabbing someone non-lethally can also be a misdemeanor, by the sounds of it: https://www.shouselaw.com/ca/defense/penal-code/245a1/)
Enough people that a major dating platform has a profile section dedicated to it.
https://help.grindr.com/hc/en-us/articles/230077107-Undetect...
Have you never heard of PrEP?
https://www.statnews.com/2022/08/11/decriminalizing-hiv-scie...
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.