A Tacoma, Washington, woman who has refused court-ordered tuberculosis treatment for over a year is evading arrest and has reportedly taken public transit to go to a casino while on the lam.

The Tacoma-Pierce County Health Department has been trying to get the woman to comply with treatment since at least January 2022, when she received her first court order. Since then, she has received over a dozen court orders for treatment and isolation amid monthly court hearings and order renewals. Last month, Pierce County Superior Court Judge Philip Sorensen finally found her in contempt and issued a warrant for her arrest and involuntary detention at the county jail for treatment and isolation.

"In each case like this, we are constantly balancing risk to the public and the civil liberties of the patient," the health department wrote in a blog post days before the arrest warrant was issued. "We are always hopeful a patient will choose to comply voluntarily. Seeking to enforce a court order through a civil arrest warrant is always our last resort."

But, according to a report from The News Tribune, the woman continues to buck authorities, evading apprehension and her court-appointed monitor.

In court filings from April 3, Chief of Corrections Patricia Jackson said she directed a law enforcement officer to surveil the woman to "determine her habits in order to execute the warrant in a safe manner." During that surveillance, the officer witnessed the woman "leave her residence, get onto a city bus, and arrive at a local casino."

But in days following the casino trip, the woman did not appear to be home, the surveilling officer reported. Meanwhile, the woman's relatives have also been unresponsive to authorities' attempts to contact the woman, and her court-appointed monitor said she also has not been able to meet with her. Law enforcement concluded that the woman is now "actively avoiding execution of the warrant."

Ars reached out the Tacoma-Pierce County Health Department, but a representative did not respond to questions about the risk the woman posed to the public or the woman's current whereabouts. The representative only pointed to an April 6 update on the health department's blog that reads simply:

"Law enforcement has the civil arrest warrant that authorizes them to detain the patient who is still refusing treatment."

In a meeting of the health department's board committee Wednesday, the department's director of communicable disease control, Nigel Turner, told board members that the Pierce County sheriff is arranging for her detention, though it's still unclear when that will occur. A press officer for the Pierce County Sheriff's department did not immediately respond to a comment request from Ars.

Tuberculosis is a potentially life-threatening bacterial infection caused by Mycobacterium tuberculosis. It spreads through the air when an infected person coughs, sneezes, spits, or launches bacterial cells around them. Risk of transmission is highest during prolonged contact with an infected person. But, inhaling just a few bacterial cells is enough to cause an infection, and curing it requires lengthy antibiotic courses, spanning four to up to 20 months.

Tuberculosis is one of the top infectious disease killers in the world, causing 1.6 million deaths in 2021, according to the World Health Organization. In the US, there were 7,882 tuberculosis cases in 2021 and 600 tuberculosis-related deaths in 2020, according to the Centers for Disease Control and Prevention. Washington state averages around 200 cases per year, and Pierce County averages about 20, the Tacoma-Pierce County Health Department reported.