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.

Last week, the Tacoma-Pierce County Health Department announced that it was "monitoring" a case of active tuberculosis in a county woman who had refused treatment.

"Most people we contact are happy to get the treatment they need," Nigel Turner, division director of Communicable Disease Control, said in a press announcement last week. "Occasionally people refuse treatment and isolation. When that happens, we take steps to help keep the community safe."

But reporting by The News Tribune discovered that the woman's refusal to heed public health guidance is a long-standing challenge for local officials. Documents filed in the Pierce County Superior Court and reviewed by the Tribune found that the woman's first court order for involuntary isolation dates back more than a year ago, to January 19, 2022.

Deadly threat

Tuberculosis is a bacterial infection caused by Mycobacterium tuberculosis, which mostly causes disease in the lungs, though it can invade other areas of the body. It can easily turn deadly without proper treatment. M. tuberculosis is transmitted through the air when an infected person coughs, sneezes, spits, or launches bacterial cells around them. Although transmission mostly occurs from close, prolonged contact, inhaling only a few of these microscopic germs is enough to spark an infection. According to the World Health Organization, tuberculosis is one of the top infectious disease killers in the world, causing 1.6 million deaths in 2021.

Treatment for tuberculosis is not easy—in uncomplicated cases, it takes a four-month or six-month course of four types of antibiotics to effectively rid the infection. But M. tuberculosis is becoming increasingly drug-resistant, even extensively drug-resistant (XDR-TB), both of which are considered a global public health crisis and health security threat. These drug-resistant cases can take up to 20 months of antibiotic courses to shake using alternative treatments that can be expensive and toxic. But drug resistance develops or increases if patients fail to complete or properly take their prescribed antibiotic courses—as is the case for the Washington woman.

As the January 2022 court documents noted, "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." As such, the health department was seeking an order "requiring [the woman] to isolate in her residence [and] cooperate with testing and treatment as recommended by medical providers."

The court issued an order for involuntary isolation, but it did little good. The woman continued to refuse treatment and isolation, according to an order issued on January 26, 2022. The order was renewed on February 14, 2022—and then again on February 24, and again on March 24, April 19, May 17, June 28, July 27, August 25, September 27, October 21, November 18, and December 16.

Breaking point

Last month the health department, it seems, reached a breaking point. Not only was the woman nearing the one-year mark for violating court orders, but she also got into a car accident, which appeared to underscore her negligence. According to a supplemental court document filed by the health department on January 11, the woman had been in the car accident as a passenger—meaning she had not been in isolation at home where she was meant to be and was in close contact with the driver, who would have been at risk of contracting tuberculosis during such close, confined contact.

Additionally, she went to the emergency department the day after the crash complaining of chest pain and failed to tell her treating physicians about her active tuberculosis case, putting them and other hospital staff at risk, too. When they performed X-rays of her chest and saw the state of her lungs, they initially suspected she had cancer. But in fact, the X-rays revealed that her tuberculosis case was worsening.

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.

The court renewed its order on January 20, 2023, adding that failure to comply this time "may result in a finding of contempt whereby the court orders further measures, up to and including electronic home monitoring and detention in Pierce County Jail or other lawful orders the court may issue, in accord with the applicable code."

In a statement to the Tribune, the health department's Turner said: "We assess that balance between restricting somebody’s liberty and protecting the health of the community. We also want to make sure that we have time for the person to comply and try lots of different options that are short of requiring somebody to be detained," he added. "Incarceration detention is the very, very last option that we want to take and we don’t do that lightly. But occasionally that becomes necessary if there is a risk to the public."

According to the latest data from the Centers for Disease Control and Prevention, there were 7,882 tuberculosis cases in the US in 2021 and 600 tuberculosis-related deaths in 2020. Tacoma-Pierce County Health Department reported that the state of Washington averages around 200 cases per year, and Pierce County, south of Seattle, averages about 20.