The Tacoma-Pierce County Health Department in Washington has obtained multiple court orders requiring a Tacoma resident to get treatment for her active tuberculosis, officials told NBC News on Friday.
The woman has thus far refused to isolate or take the necessary medications, according to Nigel Turner, the department's division director of Communicable Disease Control.
"The court order is in place ordering isolation and quarantine," Turner said. "We’re working with her on assessing the compliance with that."
The News Tribune, a local news outlet, reported on Friday that over the past year, the health department has repeatedly sought and been granted court orders compelling the woman to isolate and get treated for tuberculosis. According to the Tribune, legal petitions from the department said the patient had not abided by previous orders, and had at one point started but discontinued medication. The health department confirmed the Tribune's reporting to NBC News.
A judge issued the latest order on Jan. 20, granting the department the authority to test, treat and detain the woman, starting next week.
The department announced Monday that it was monitoring the case and said at the time that it was working with the woman’s family to persuade her to accept treatment.
The department declined to offer information about why the woman has refused treatment.
Under Washington state law, public health officials have the legal authority to seek a court order when a person’s refusal to take medication poses a threat to the public.
Tuberculosis can rise to that level because it can be deadly if left untreated, and infectious people risk spreading the disease further. The bacteria that causes tuberculosis can spread through the air when a person with an active case coughs, sneezes or speaks.
The treatment process can take three to nine months, according to the Centers for Disease Control and Prevention. People who discontinue medications before treatment is complete can also develop antibiotic resistance.
When it comes to taking legal action, Turner said, "it’s very reluctantly that we do that because obviously we’re balancing people’s civil liberties against protecting the health of the public."
In the past 20 years, the department said, it has had to enlist the help of law enforcement to detain three people who refused tuberculosis treatment until they were no longer infectious. Turner said the department typically exhausts other measures before seeking a court order, such as enlisting family members, medical providers or infectious disease experts to reason with a patient.
Treatment for tuberculosis generally consists of antibiotics taken daily or weekly for a period of months. People with infectious tuberculosis must be isolated during that time, until they’re no longer capable of spreading the disease to others. The vast majority of cases can be cured with medication, according to the World Health Organization.
Turner said the length of treatment or possibility of side effects from the antibiotics may deter some people from accepting medication. People who don’t have reliable access to food or housing may also be reluctant to follow isolation guidelines, he said, so the health department may provide them with those resources.
In regards to the current patient, he said, the department is "really looking for every opportunity for them to comply with and work with us to resolve this as soon as we can."
The Tribune reported that a January legal filing from the health department said the woman had previously gone to the emergency room following a car crash but had not disclosed her tuberculosis diagnosis to staff. Chest X-rays taken during the visit showed the disease's progression, the petition said, according to the Tribune. The Tacoma health department confirmed the report to NBC News.
Symptoms of active tuberculosis include a bad cough that lasts three weeks or longer, chest pain or coughing up blood or phlegm, according to the CDC.
Nationally, the number of tuberculosis cases has declined steadily since 1992, according to the CDC. The U.S. recorded around 7,900 active cases in 2021. Tuberculosis vaccines are not widely administered in the U.S. because the disease is not prevalent and the shots are not highly effective in adults.
Pierce County sees about 20 cases of active tuberculosis per year, the health department said.
But some people live with latent tuberculosis infections, meaning the bacteria is inactive and the host isn’t contagious and doesn’t have symptoms. The CDC estimates this affects up to 13 million people in the U.S. Around 5% to 10% of those latent cases, if left untreated, will develop into active disease at some point in people's lives.