Woman with untreated TB finally in custody – held in “negative pressure” room
arstechnica.com
arstechnica.com
This saga has been going on for a long, long time. At one point she was even caught going to a casino to gamble: https://arstechnica.com/science/2023/04/woman-with-untreated...
She also had a hospital visit because she was a passenger in a car (therefore not isolating) and she avoided disclosing her active Tuberculosis infection to the staff. They had to take chest X-rays as part of her accident-related treatment and the infection was so bad that they initially thought it was severe lung cancer. (Described in the linked HN article)
Given the public health risk and her continued flaunting of the isolation/treatment requirement, I'm surprised this went on for so long. We'll never know how many other people were exposed, from casinos to other hospital patients and everyone else she passed along the way without exercising even basic precautions. Wild.
I feel like this is the punchline to a great doctor joke but just needs a setup
I say this as someone who only speaks English.
I am glad she is caught, but wondering why this happened at all.
From another article[1] it sounds like psychological issues:
> [The woman's attorney's] filing stated, "She has not acknowledged the existence of her own medical condition. Because counsel is bound to represent the respondent's stated interest, a guardian ad litem would be able to provide representation of her best interests, which are not currently clear."
> [ . . . ]
> The filing added that when "the respondent has joined proceedings, she has spoken out of turn with rapid, disorganized speech."
> It noted, "She has primarily focused on how she dislikes papers coming to her home, and not the import of the process in which she finds herself. She has repeatedly threatened suicide in relationship to papers being served upon her home."
[1] https://www.thenewstribune.com/news/local/article272657405.h...
This creates a catch-22 where people that have previously-undiagnosed mental health conditions are denied access to basic healthcare. Worse, even if you were previously certified insane (e.g., for paranoid schizophrenia or manic depression) and have temporarily recovered, it's extremely difficult (impossible?) to sign away your future self's ability to decline medical care, even knowing that you would only do that because of a mental health relapse that makes you unable to care for yourself.
A large percentage of the crazy homeless people you see when walking outside in bay area cities fell into that legal trap (according to workers at our local emergency mental health facilities).
I guess the above now applies to regular health care, since they've decided that imprisoning this woman indefinitely for being sick and unable to care for herself is more compassionate than putting her through a round of antibiotics.
second, in California, a person can be involuntarily held if they are deemed a risk to themselves or others. This is typically done in a mental health facility.
third, you can't really force treatment on anything in the united states, if someone refuses care, the hospital can't just keep you there against your will. Are you advocating for the return of institutionalization?
edited to add: to be super clear: you don't want to make it easy for people to abuse the elderly, which is why the bar has to be high, but there must be a way to compassionately help someone who actually needs help. And there basically isn't.
This is very literally not the case. In California, hospitals 51-50 people all the time. It's an involuntary 72 hour hold and the criteria for meeting it is not high at all. A professional just has to deem you are a danger to yourself or others. That's the bar, and it's easily met for healthcare providers.
Maybe she's a worthless drunk shitbag, maybe she's just not all there and doesn't believe or really understand the problem.
I don't think it matters too much except when I want to use it as ammo. If she was religious, and I am not, awesome vindicating example for my side I can pull out the next time I want one.
Well I don't like how much I would like that, so I don't think it's very valid, and maybe it's correct that they don't go all "let's lift up this rock and gawp at the ugly bugs all crawling around in there".
Maybe they have no choice. Maybe the police and hospitals carefully don't disclose anything like that for exactly that reason.
It also matters for judging how the system treats someone.
I don't think that's a Tacoma thing. That's just a person in a bad way that's difficult to help.
What I keep wondering is if the authorities can find her family or anyone that could assume legal guardianship for her and get her treatment. She's going to die of TB because she doesn't understand she's that sick. She clearly had acquaintances that were willing to drive her around. Is this a case that no one is willing to come forward for her?
Update: Her son is at least trying to follow up:
> On May 1, a person who identified himself as the woman’s son called the Health Department, according to court filings, and asked if his mother had missed her hearing and when the next hearing would be held. The next hearing is scheduled for June 23.
https://www.nytimes.com/2023/05/23/us/washington-tuberculosi...
Like other Rust Belt cities, Gary's once thriving steel industry has been significantly affected by the disappearance of local manufacturing jobs since the 1970s. As a result of this economic shift, the city's population has decreased drastically, having lost 61% of its population since 1960.
I see Gary also had paper plants, but I think it also had a ton of other industrial activity.
Seems like quite the challenge, compliance wise.
I have more than one family member who could totally do this, and not all of them are religious anti vaxxers or are diagnosed as mentally ill or anything. In fact, I am a little surprised so many HNers see this behavior as unusual.
EDIT: https://www.thenewstribune.com/news/local/article272657405.h...
"Tofflemire’s filing stated, “She has not acknowledged the existence of her own medical condition. Because counsel is bound to represent the respondent’s stated interest, a guardian ad litem would be able to provide representation of her best interests, which are not currently clear.
A guardian ad litem is defined by Washington courts as “an individual appointed by the court to represent the best interests of a child or incapacitated person involved in a case in Superior Court."
The filing added that when “the respondent has joined proceedings, she has spoken out of turn with rapid, disorganized speech.”
It noted, “She has primarily focused on how she dislikes papers coming to her home, and not the import of the process in which she finds herself. She has repeatedly threatened suicide in relationship to papers being served upon her home.”
(Emphasis mine)
Bad past behavior. Their comment wasn't flag-killed, it was dead on arrival but can be vouched for (presumably you did). When comments show up [dead] (no [flagged]) it's usually some moderation (auto or manual) action that caused it. [flagged][dead] is the result of user flagging.
They can reach out to dang and appeal it (looking briefly through their comments since then I didn't see anything quite like that one that caused the initial ban, but it was a cursory check).
A reminder of the oft overlooked social component of health issues.
This women seems to have full on TB.
Not so much an issue about Mary as it was her treatment. That treatment could not end well. But back then there was very little money to deal with such cases.
You are making excuses. There isn't any. Our government is just bad at a lot of what it does. Lazy and laggardly execution or processing of orders doesn't increase due process.
Doesnt seem like the relevant factor for this person in particular.
I've only heard of it as tuberculosis in the local media, not sure if health practitioners would call it TB though.
I'd guess familiarity with that abbreviation depends on age. In the 70s TB (and the abbr.) was still fairly common. I grew up in a town with a press. Apparently the paper dust increases the risk for the workers to catch TB. I remember mobile screening units parked in front of that company periodically.
In the 90s my roommate's girlfriend was thought to have caught it (her roommate had a bad cough, probably TB then, but I don't know the details), which earned us both an "invitation" by the ministry of health for a screening. We were ok, she recovered during a stay in a sanatorium over summer (afair, it turned out not to be TB but some kind of embolism), don't know about her roommate.
Korean https://storage.googleapis.com/healthinfotranslations-pdfdoc...
Chinese https://www.sfcdcp.org/wp-content/uploads/2018/01/Active-ch-...
Hindi https://www.mass.gov/doc/tb-medicine-instructions-hindi/down...
An active TB infection is basically less dangerous to the general public than a person with active COVID-19. In both cases, elderly and immunocompromised people are the most at risk, and there are vaccines for both, though we stopped giving kids the TB vaccine in the west. But a person with active TB will usually infect only about 10-15 people in their lifetime, whereas COVID-19 is much more infectious.
One untreatable TB infection causes 15 new ones and those 15 new ones cause 15 new ones each?
In a pandemic population size macro sense that's huge and exponential.
In 2021, there were 10.6 million people infected, and 1.6 million died from it.[2]
[1]: https://www.worldlifeexpectancy.com/cause-of-death/tuberculo...
[2]: https://www.who.int/news-room/fact-sheets/detail/tuberculosi...
Just in way of an example, what evidence do we have that she committed a crime (outside of avoiding treatment, and then avoiding imo illegal detention)?
As far as I see it’s been 2-3 years she’s been out in public, likely longer with TB. Do we have any evidence it spread to others?
I’m highly skeptical of the science around TB because of cases like this.
We have laws that let people commit suicide, we sell alcohol (a known toxin), and why do we care if someone’s sick and doesn’t want treatment?
To put another way, I like to the think of the government as “we the people”. Would I be willing to restrain someone at gun point for being sick? Nah, that’s crazy.
This is a legal / law-enforcement story. How does is possibly affect your views on the science.
> We have laws that let people commit suicide, we sell alcohol (a known toxin), and why do we care if someone’s sick and doesn’t want treatment?
None of those are communicable, as you know.
> To put another way, I like to the think of the government as “we the people”. Would I be willing to restrain someone at gun point for being sick? Nah, that’s crazy.
It really sounds like you're questioning the communicability of tuberculosis...
No evidence of spread was presented. Meaning, although there’s claims this spreads easily, no one appears to have caught it in years? Unless there’s something weird going on, you’d think they’d be pointing out all the people she got sick
This is why we have laws against drunk driving, rather than waiting until after a drunk driver hits someone. For exactly the same reason, courts do have the right to order people confined when they present a serious risk of contagion, rather than first demanding proof of contagion.
Edit: And to your point about "no crime," reckless endangerment is a crime. Defying court orders is a crime.
But to be around other people, knowing or should knowing that she is causing a high probability of harm to others IS a crime.
There’s a reason TB isn’t an issue any more… we have dramatically improved health, smoke dramatically less AND have effective antibiotics. TB kills how many people in the US? Oh right… less than strep, do we lock up people with strep? Of course not.
13 million people today in the US have latent TB. Effectively, their body fought it odd and isolated the bacteria. We don’t lock them up. What evidence do we have that this person has an active case AFTER 2-3 years?
https://www.statista.com/statistics/661344/tuberculosis-deat...
https://www.mayoclinic.org/diseases-conditions/tuberculosis/...
https://www.cdc.gov/tb/publications/factsheets/general/tb.ht...
And, yet, an article from 3 days ago calls it a global health threat and notes that a million people die from it annually.
https://chicago.suntimes.com/2023/5/30/23738607/tuberculosis...
It's best if people don't get infected with it to begin with
Antibiotic resistant TB is exponentially scarier to me than COVID.
However, piecing together more of the case over time, it appears just as you said - very much not a case of individual liberty but one of genuine health concern.
By all accounts, it appears law enforcement has tried to allow this person her personal sovereignty in many ways while still keeping track of her to ensure she doesn’t endanger others.
That it got to the point it has, is not due to some authoritarian overreach, but rather due to a series of flagrantly contemptuous actions that were defying law enforcement and putting others at risk unnecessarily.
That's not what the article says. It says this:
The woman's legal saga dates back to January
2022, when the health department resorted to
court orders to try to get her to treat her
deadly infection—or at least prevent her from
readily spreading it in the community. "The
Local Health Officer ordered [the woman] to
self-isolate and treat; which she declined to
do. [The woman] has not complied with such
efforts, has discontinued treatment and is
unwilling to resume treatment or voluntarily
self-isolate," court documents from January
2022 read.Detention, isolation, quarantine, and treatment are all subject to due process and overseen by the courts.
In fact both are sections of https://app.leg.wa.gov/RCW/default.aspx?cite=70.28 titled "CONTROL OF TUBERCULOSIS".
TB is extremely dangerous, airborne, and if it's the antibiotic resistant type...completely incurable.
The worst thing about the overreaction to COVID is it made people lose trust in health authorities and right fully so.
But trust me AB resistant TB is scary shit.
yeah and HIV positive people having sex are next!
Another person linked to the WA law that makes it possible to jail a person for being sick. I'm surprised laws like that are on the books.
If you are under a treatment regime, and have an undetectable viral load it is basically impossible to spread HIV. https://en.m.wikipedia.org/wiki/Undetectable_%3D_Untransmitt...
People who have consciously had sex while not undetectable, and without disclosing their HIV status to their partners have been prosecuted for it. And rightly so in my opinion.
You see the problem?
Indefinitely detaining people without proving they hurt someone is not really something that’s supposed to be done.
In this case; there was no evidence presented that they spread TB. There are 13 million people with TB in the US and the vast vast majority aren’t undergoing treatment nor are they detained. It’s often in a dormant form, but even when it isn’t many many people go untreated.
This is why this case is a bit … much? I do get she had a trial, so there was due process, but im criticizing the judge here because the facts don’t back the judgement
How many people do you want her to have the opportunity to infect while we wait for definitive proof that she was the source of infecting at least one of them?
> im criticizing the judge here because the facts don’t back the judgement
BS. Your false belief that TB isn't infectious and deadly is distorting your view of the judge and his ruling. You're wrong; the judge and the epidemiologists are right.