TUBERCULOSIS: Patient Detention Used Sparingly
Tuberculosis cases plummeted in New York City after health officials launched a controversial program in 1993 to detain patients who repeatedly refused treatment and posed a public health threat, according to a study in today's issue of the New England Journal of Medicine. Study author and former program director Rose Gasner said that "fears from civil libertarians and AIDS activists that officials would not use detention as a last resort" were unfounded. The tactic "was used sparingly" said Gasner -- during the program's first two years, only 2% of the city's TB patients were detained. In an attempt to prevent the alarming spread of drug-resistant TB, New York City health officials "sent workers to patients' homes and workplaces, park benches, homeless shelters or crack houses to administer medication," and "offered housing to homeless patients and offered to treat the AIDS, psychiatric disorders or drug and alcohol addictions that some TB patients also suffered." Over a five-year period from 1992 to 1997, Gasner found that the number of new TB cases dropped by 55% and new drug-resistant cases declined by 87% (AP/Richmond Times-Dispatch). Dr. Barron Lerner, a professor at Columbia University and the author of "Contagion and Confinement," a book addressing TB detention, commended the city for "a terrific job," but expressed concern about the punitive approach. He said, "You still should get a little uncomfortable when certain members of society are the ones whose rights are most affected by coercive measures. One thing you really want to avoid, is to say that not taking your medicine makes you a criminal." Massachusetts and Denver have launched similar TB detention programs, and some California counties take a more aggressive approach by "arrest[ing] hard-to-treat patients so they can admit them to prison hospitals" (AP/Las Vegas Sun, 2/3). Click here for recent Kaiser Daily HIV/AIDS Report coverage of TB drug resistance in HIV patients.This is part of the California Healthline Daily Edition, a summary of health policy coverage from major news organizations. Sign up for an email subscription.