Thursday, April 05, 2007
Imprisoned for illness
Here's an interesting dilemma: A young man in Arizona has recently been placed in solitary confinement. He has been there for eight months and there is a good chance he will be there for the rest of his life. It is a punishment usually reserved for the very worst criminals. But Robert Daniels has not been charged with any crime. However, some say what he did was criminally negligent.

Robert has what is known as XDR TB - extremely drug resistant tuberculosis. Both the first line and second line of treatments simply don't work for him. The organism causing his infection has become too smart, easily dodging attacks from antibiotics. Add to that another problem: XDR TB is very, very contagious and Robert Daniels ignored doctor's warnings to wear a mask. And, that is where his crime may lie. Not wearing a mask, walking into public places and possibly putting many others at risk. You see, TB is spread through the air when someone who has the disease sneezes, coughs or even talks.

XDR TB is extremely rare - there have been only around 50 cases in the last 15 years here in the United States. It is more common in Africa and Asia and often accompanies HIV and other immune-compromised states.

So, how should Robert Daniels be treated? Should he be locked away for the rest of his probably-shortened life for not wearing a mask? Or, is there some sort of compromise? Also, this is just one man, but what does this say about how our country could deal with an outbreak with millions of people contracting a contagious disease such as SARS or smallpox?
I found this story very interesting because I just moved from Arizona. I feel that what he did was irresponsible, yes, possibly even criminal. It brings to mind many other diseases that people can pass on to others, and I believe there have been criminal cases on those. It does make your question, though, the "locked away" part, weigh on my mind. I feel that the man could kill people, yes, and therefore it's almost like homicide. But there should be some sort of compromise. Do I have an idea for a good compromise? No.

I do wonder about how our country could deal with an outbreak of great magnitude. Is it right to drag the sick people away and stuff them somewhere till they get better or die, if it's to save other people? Or is it a violation of their rights as people to continue living right where they're at? It's a very fine line to cross, I think. The needs of the many outweighing the needs of the few? Perhaps.
I believs that he should stay in solitary confinement if he is a threat to the public.its that simple he was given many chances to wear the mask the doctors gave him and he neglacted to wear it and sop in turn put the publics saftey at risk
This is an outrage! How can we, in a society based on the basics of freedoms, keep a man incarcerated for being ill? Now I realize he puts the public a risk with this disease and some precautions should be taken, but to not give his man access to the simple pleasures of life, such as television, radio, the internet and such is inhumane and should be illegal. I believe that the judicial system should at the very least step in and give this man the basics of human decency. Solitary confinement because he's sick, that's sick if you ask me. I am becoming increasingly ashamed to be an American, with each passing of stories such as this one. Wake up America, we might be in a "War of Terror" and the government may want to suspend our civil rights, but we seem to be just going along like good sheep. We need to step up and SHOUT, let this man have his humanity and dignity!
It's obvious he refused to follow his healthcare provider's recommendations. But sending him to solitary confinement and treating him like a prisoner is unacceptable. He is a man who is physcially sick not a raving lunatic. And what about the rest of us? What if he has infected more people? Will they be locked up as well? Maybe then this poor man will have some compaionship!
I believe what he did was neglegant. Instead to treating him like a criminal, he should be seen as a case study and given some form of comfort if he's going to live with this condition for the rest of his life. If there is no cure, then he might as well be treated like a lab rat so we can find prevention through him. I'm sure lab animals get better treatment than him.
He should go back to his own country - Russia - and let them decide what to do with him.
In times past it was common to quarentine people who were extremly contagious, and nobody raised the question of civil libeties. Modern medicine has for the most part eliminated that need; however, there are times when even the most moden society must revert to archaic practices. This is, in my opinion, one of those times. Mr. Daniels has shown a callous disregard for the public through his refusal to wear a mask. The rest of us should not have to risk exposure in order to protect his or anyone else's civil libetties, due to their repeated refusal to co-operate with health care officials. It may sound a little harsh, but the same thing should be done to those with AIDS who refuse to use protection and are found to be unwilling to reveal their status to thier partners.
It has been said, "Your rights end, where mine begin". Although I believe the incarceration and solitary confinement is a bit harsh, he has already shown that he cannot comply with the laws of the country and simple human decency (not exposing others to a disease), so, yes he should be confined. I wouldn't want my family to be exposed to a strain of TB that cannot be cured or even controlled. It would be like an assault. If you assaulted someone, you should be prepared for the consequences. In this case, jail. He was warned. It�s not as if it happened out of the blue. The health care providers informed him of the consequences of his actions. He has no right to expose others to this disease. We need to make more people accountable for their actions.
This man made his own decision not to wear protective equiptment so that he did not spread an incurable, contagous disease. This was his choice. Now he whines because he has to live with the consequences...breaks my heart. Should he have access to TV? Why not. Should he be allowed another chance. NO! And as far as the ACLU representative, if he wants to take the guy home, into his house with his children then let him stand up and sue for that right, but do not ask me to sacrifice the health of my child or family so that this man can walk around spreading his disease.
Mr. Daniels is not in solitary confinement in a prison. He is in a locked hospital room equipped with negative ventilation systems for people with TB. He cannot have visitors except hospital staff because of the ventilation system and the dangerous virus he carries. He is in a locked room, instead of a standard TB room, because he had to be admitted involuntarily on account of him failing to follow doctor's orders to wear a mask. If he cooperated and submitted to voluntary quarantine, he could be moved to a regular TB room with more luxuries like a television, phone, etc. That is the compromise before him. If he does have to stay there for years because no other solution can be found, then his stay should be made as comfortable as possible. It's not his fault he contracted XDR TB.
Putting this man in prison in solitary confinement is insane. If they want to isolate him, put him in a hospital or institution where he would be treated with more dignity than in solitary confinement in prison. Doctors and nurses could wear protective gear and he could still enjoy a reasonable quality of life. This should be treated like a medical issue, not a criminal one.
Hi Dr. Gupta,
You said XDR Tb is extremely rare, 50 cases in the last 15 years. Do we want this man to make those 50 cases rise to 5 million! No. I feel for him, but he obviously doesn't feel for the rest of his fellow man...Or he'd be wearing his mask! Take Care
So, why did they remove his TV and other amenities? While some of you (above) seem to feel his incarceration is justified, you cannot possibly feel that removing mirrors, TV, Radio, etc. from his confinement is rational or helpful to the public safety. The compromise you are all searching for is the isolated sanatoriums used in the past for this very problem.
Martin K...why are you assuming he doesn't have TV, internet, telephone, etc.? I'm sure he does. I'm sure he's not locked in a 5 X 10 concrete cell with nothing but a cot and a terlit!
And SH...where in the world did you get the idea he's from Russia?
In my opinion, it is a testament to our growing, and sometimes misplaced, humanity that he was ever even given the option of being allowed in public at all, albeit with a mask. Further, he knew the consequences of not wearing the mask, and he made his choice.
If anyone feels that it is wrong to isolate him...well, they should go visit the guy and tell him face to face how they feel. Take your kids with. Sure it makes us feel bad, but, because of his actions, there doesn't seem to be any other alternative. Not one that I can think of...put him on a deserted island, maybe? Oh no..he wouldn't have internet access there.
I agree with the majority of posters. This man was given advice that he refused to follow. If it is feasible to protect the majority of the public by placing one person in solitary confinement, then so be it. If I were the ill person, I would have it no other way( I would have worn the mask).

That being said, I live in Arizona and have read local reports about this case. While this patient is being isolated, consideration should be taken for his environment. Local media has stated that this patient is locked up without the benefit of anything. No books, radio, tv, window, phone, etc. He is in a spartan setting with no access to the outside world. Criminals in prison have better living conditions if this is true. I don't suggest a country club setting for the patient but really, a person have the right to maintain contact with families, read a book, have a hobby or whatever to make life a little more bearable.
I am assuming "solitary confinement" is in a prison. I don't see the need for this. House arrest type of confinement in an apartment type setting with comfortable furnishings, TV, music and windows would be a more humane solution. Surely there are rooms in some nursing home which could be set up for the care of this man. If tax payer money is supporting him in prison it can just as well support him in a medical facility.

I do feel he needs to be confined though as he obviously has an uncaring disregard about spreading his deadly disease.
Diseases become drug resistent when people do not do their full regime of antibiotics. Is this the case or did he contract the already resistent TB? Is it possible to contract ADRTB> If so, please keep him in jail. As long as people pay attention to their dr.s and take medication properly, hopefully, we won't create any more Drug Resistent diseases. We have created a society where people are lazy, self centered and not very bright, or we wouldn't even be writing comments on this subject.
This disease,(TB)is largely a disease of the poor. Because of this fact drug companies are years behind on developing new drugs to fight these highly resistant strains of TB. (No Profit to be Made!) In the meantime quarantine will be more and more common in this country. As the word gets out of how people are treated with this disease as prisoners with no basic comforts, no visitors etc., will cause many to not seek medical treatment. This will cause pockets of outbreaks as a result, hampering containment of this disease. If you do some research on this subject you will find that hospital costs alone for treating someone up to two years with very expensive antibiotics runs about $500,000. How many of us in this country have insurace to cover such treatment? How many of us in this country can afford to be out of work this long and not go bankrupt?
I feel sorry that he has to spend his life in a cell, alone. However, I think you have to think broadly at all the people he could sicken. He needs to be away from people, it's too risky.
This man was given numerous chances to live a reasonably normal life-- he just refused to wear a mask in public, which endangered every life he came into contact with. If you look at history, you'll see that "Typhoid Mary" also refused to follow proper medical safety precautions and ended up killing several families. According to her story, she prepared food for families. She was not afflicted by typhoid fever, she was merely a carrier. Once doctors understood what was happening, they demanded that she be locked up. She was set free under the condition that she not prepare food for others. She blatantly disregarded the health of others and got a job for another family, preparing their meals. That family died as well.
Typhoid Mary and this gentleman have a common bond... both could have single-handedly prevented the spread of a killer disease and both blatantly refused to act responsibly. Typhoid Mary was later returned to her imprisoned state for the remainder of her life. Perhaps this gentleman should have considered the consequences of his actions before he endangered the lives of everyone he spoke to. Yes, he deserves to remain locked away. Maybe he should have some human comforts-- television, internet, etc... but his negligence is clearly criminal. I wouldn't want my family to be exposed to his sickness. Would you?
Having this disease is punishment enough. He should atleast be given a television with cable channels to keep him educated and entertained during his final days and even a pc with internet connection for receiving emails from family and friends. No one would want to spend their final days confined to four walls without some type of communication with the outside world. This seems so inhumane.
Being a leftist and a person in the medical field. If the patient is educated about his disease and he denies treatment, that is fine dandy, it is his legal right to refuse treatment. But when that said person has no regard for the populace with a very contagious disease, terminal disease and refuses to take one of the simplest forms of protection for public safety, well lock him up. As time goes on, we are going to see more and more very resistant, infectious, deadly and debilitating diseases appearing. In reference to books, tv and a phone, any sympathizers can find out where he is and donate those items because they will have to be disposed of afterwards. Now just think if you had to donate to thousands of people because of one fool.
Or better yet, let's just increase our taxes to 75% to help the health care system after this selfish person spread the disease to thousands.
In response to one person who asked how did I know he was being kept in solitary confinement without TV, radio, etc. Well, I watch CNN and it was reported that he had no contact with the outside world other than a telephone, which is being monitored. It was reported that he is being held without those basic luxuries. That's all I have to go on, but I assume that CNN did their research and got the facts right.
Sorry, but this was really bugging me. TB is caused by a bacteria, not a virus like another poster mentioned, hence why we have antibiotics that work against most strains of it.

Speaking of which, taking antibiotics for TB isn't anything like taking them for strep throat or pneumonia. You have to take 3 drugs every day for 9 MONTHS and you can't have a drop of alcohol the entire time (b/c the drugs make your liver extremely susceptible to alcohol damage). This is done to prevent the spread of TB and the evolution of drug-resistant strains. I wouldn't be surprised if XDR TB came about because of partial or incomplete antibiotic regimins (by the man in question or someone who spread it to him).

Fortunately, most people in this country have never had to worry too much about dying from an infectious disease. Those who would send Mr. Daniels home, even under house arrest, probably don't realize just how big of a threat this is and hopefully never will because of the public health efforts like this one.
Finally, I never said he should be allowed to go free, just that he should have basic humanistic treatent and perhaps access to a lawyer. I am really amazed at some of the statements I read here today. It saddens me that someone would actually suggest that another person take their children to see this man. What a cynical world we live in.
The novel The Plague by Nobel Prize winner Albert Camus is an investigation of civic responsibility and existential crisis during a highly contagious outbreak. It's a great read and relevant to a possible flu or other pandemic
If he won't act in the public's best interest he should be kept from it. We do it to sex offenders so the precdent is made.
It's not a far walk at all from this instance of a public health threat and internment to having 'bad' contagious thinking becoming a public mental health threat; 'a nation of warriors and fanatics, marching forward in perfect unity, all thinking the same thoughts and shouting the same slogans, perpetually working, fighting, and triumphing, persecuting- three hundred million people all with the same face.'
While I do agree that locking him up is very extreme it is a necessity to protect the greater public good. What if he came into contact with someone who is HIV positive or another immunocompromised individual and inadavertently infected them? We could have a very serious outbreak in the United States of XDR-TB which as of now there are very few drugs available to handle a crisis of that sort. Since both the 1st and 2nd line drugs do not hinder this resilient microbe it is imperative that we protect others and identify others who are infected with it. If someone is infected with a deadly pathogen they should be responsible enough to reduce transmission and obviously Robert Daniels did not do this. Are there not documented cases of individuals deliberately infecting others with HIV? And were they not prosecuted for their actions? This situation mirrors that and should be dealt with a similar manner.
I worked for a county health department doing Directly Observed Therapy for TB patients for 3 years. In that time, I twice had clients that worsened due to non-complience and one that we had to swear out a warrent and transport him under police patrol to the specialized hospital that our state still maintains because he was drug resistant and very non-compliant.
I do belive this gentleman should be isolated, however, the setting is all wrong. He should be in a hospital in a negative pressure room with at least whatever he needs to maintain contact with the outside world. I am also concerned that he is not being exposed to sunlight ( ultraviolet light can kill TB spores) and some type of fresh air. Anyone wanting to visit with him can use protective measures and spend at least a few minutes with him with little risk. Human contact can not be undersated.
While the "punishment" may seem severe, it is not what he did, but rather what he could do that is most important in this case. While extremely rare, XDR-TB has the potential of wide-spread infection and just as with Robert in this story, individuals who contract this deadly and extremely contagious infection face the same "punishment." The problem with many individuals who contract the more common form of TB is that they do not adhere to their medication treatment, which can last for a year or more. Once someone stops taking their medications before the end of the course of treament, the infection returns and the prior medications no longer work. Each time new medications are introduced and the course not completed, the same resistance can develope. This poses an extremely serious health risk for people, so while keeping someone confined to a hospital isolation room sounds ominous and severe, it is absolutely necessary. This too can happen with any bacterial or viral infection, including common infections, which is why it is so important to always complete all prescribed medications. If not, this story is just a glimpse of things to come in the near future.
I seem to recall a case called 'Typhoid Mary' many years ago in which a women with a highly contagious thyphoid problem was put away as a threat to public safety. People were also put away for having small pox when that existed as a problem. There are also some with HIV who have deliberately infected others.
I am not sure that such people should be treated as convicted criminals, but the need to isolate a clear and present danger to the public is very clear. You would certainly do that during a pandemic.
i believe if a person is a carrier of some type of illnes and there is no cure for it. then get him off the streets why so the illness would not spread to anyone by air,sex,blood and any other way it can spread. we need to think about our selfs and the safety of others. if a criminal goes to prison for a crime that he or she has done. i belive that an illness that has no cure and can kill people like aids and tb and other types of deadly illness that can be spread by air,sex,blood. then yea i believe they should be locked up off the streets for my safety and your safety and the safety of others and your children.
Of course he should be locked away. He had the opportunity to stay free by wearing a mask and chose not to do so, creating a hazard for everyone with whom he comes in contact. He had his opportunity for compromise, and he compromised the health of every man, woman, and child who came in contact with the XDR TB germs he spread.
This is a conundrum only for fools.
Robert is reaping what he has sown. He was alowed all the freedoms enjoyed by Americans on the condition that he wore a mask over his mouth and nose...refused to do so and now he is confined because of his own actions. He knows he disease is EXTREMELY contagious and completely untreatable with our current drugs...he risked infecting thousands of others in his selfish act of refusing to ware a mask. It is more then unfortunate that we had to take his freedoms in order to protect the freedoms of others.
Reminds me of the story of "Typhoid Mary". She refused to believe she was a carrier of the disease since she herself had never been ill, despite the overwhelming evidence to the contrary (entire households left dead or ill after she had worked in their kitchens). Eventually, she had to be confined to an island to prevent the deaths or serious illness of the population at large. Sometimes it is ugly but true - if someone is criminally negligent, as I believe this man was, then he should be incarcerated. His right to go around swinging his arms ends when his fist comes into contact with someone else's face. That's the cold, hard truth.
Absolutely he should wear a mask. Yes he should be obligated by law if he wants to roam free. He should learn to give up on stubborn pride. Put the mask on hang out with your loved ones whenever possible for support. Wearing the mask is the right and moral and consciencious thing to do. Not wearing would put your loved ones in danger and any other person accidently exposed to you. Please reconsider. Thanks
Hello..! The man delibertly didn't wear a mask. Solitary confinement is the same as jail time to me. He should be punished, he could of killed others if he hasn't already. Let him serve some time with medical care. Then I believe he (and others like him) do need to be kept from the public until they pass on, or find a cure. They need to be treated with dignity and respect, and that is what he deserves after he serves his time.
We have alot of resorts all over the world....why can't they live out their days there...in some comfort waiting for a cure.
I have been following this story, and no he does not have everyday living basics, even felons have access to the basics, I agree, put him in a hospital to study this disease more closely but at least let the man have the basic necessities of everyday life, what if if were you or someone you love, one never knows what God has in the future for you!! We should be careful how we treat people - what goes around does come back around.
Does anyone know WHY he doesn't have the basic conveniences such as television, computer, books, etc? Just curious.
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