Robert Daniels is being held in a detention ward at an Arizona hospital because he is infected with a deadly strain of tuberculosis. Daniels refused to comply with voluntary quarantine rules.This report is a good starting point. Notice, for one thing, how quickly the sheriff blames Mr. Daniels for how the Sheriff's Dept. is treating him. One note from this report I haven't found elsewhere: the court documents related to Mr. Daniels are sealed, meaning no one can see them without court permission. Hmmm....
Rene Gutel of member station KJZZ reports, and Dr. Ross Upshur, head of the University of Toronto Joint Centre for Bioethics, argues that isolation is the only way to contain dangerous types of TB.
CNN, MSNBC, and the Tuscon Citizen have the same AP report (which tells you something about local news coverage of this story), which is:
Robert Daniels has been locked up indefinitely in Maricopa County, perhaps for the rest of his life, since last July. But he has not been charged with a crime. Instead, he suffers from an extensively drug-resistant strain of tuberculosis, or XDR-TB. It is considered virtually untreatable.And here is Dr. Upshur again:
County health authorities obtained a court order to lock him up as a danger to the public because he failed to take precautions to avoid infecting others. Specifically, he said he did not heed doctors' instructions to wear a mask in public.
Dr. Ross Upshur, director of the Joint Centre for Bioethics at the University of Toronto, said authorities should detain people with drug-resistant tuberculosis if they are uncooperative.Indeed, in light of the work of Michel Foucault, this is an intersting sidenote:
"We're on the verge of taking what was a curable disease, one of the best known diseases in human endeavors, and making it incurable," Upshur said.
But a paper Upshur co-wrote on the issue in a medical journal earlier this year has been strongly criticized.
"Involuntary detention should really be your last resort," Harrington said. "There's a danger that we'll end up blaming the victim."
University of Pennsylvania medical ethicist Art Caplan said Maricopa County health officials were confronted with the same ethical dilemma that communities wrestled with generations ago when dealing with leprosy and smallpox.The medical risk here is obviously the question. But how great is the risk? That's something these articles assume, but do not answer. Notice in that NPR story that Dr. Upshur never addresses the issue of contagion. He leaves assumed that TB is very contagious, so isolation is the only remedy for TB that is "XDR." As bloggers know, however, one must beware of "conventional wisdom:"
GEORGE ANNAS: Well, it disturbs me more than it surprises me. It's not surprising that when we get the public basically totally ignorant of infectious, contagious diseases, then they're told there's a new disease here that could kill you and it's not treatable, what do you expect? How do you expect people to react, especially people in law enforcement? They're going to react, to use the tools they have. And the tools they have are jails and punishment. And Professor Gostin is right: that's wrong. We shouldn't be doing that.This, by the way, is a point the AP article tacitly makes:
We do not want this disease in the United States, although it's clearly here. And we do want to take reasonable measures to make sure that it's not spread in the community. But it does not require locking anybody up in a jail. TB is not that easy to get. I mean, if you hang around in homeless shelters, in prisons or in places where a lot of people are immuno-compromised, like have HIV disease, then it's certainly going to be spread. But just someone walking around, at least if he doesn't go right up next to you and breathe in your mouth for a couple of hours, you're not going to get TB that way. So we have to learn something about tuberculosis, as well as something about the inappropriateness and, I think, unconstitutionality of locking people up with the disease.
HIV patients with weakened immune systems are especially susceptible. In South Africa, WHO reported that 52 of 53 HIV patients died within an average of 25 days after it was discovered they also had XDR-TB.But in contrast to the claims of Dr. Upshur in that NPR story, according to the Director of the Center for Law & the Public's Health at Johns Hopkins and Georgetown Universities:
LAWRENCE GOSTIN: Yeah, I mean, it's -- TB is a bacterial infection. It's very prevalent throughout world. In fact, one out of every three or four people have tuberculosis infection, but don't get the disease. So only a small number of those will go on to get the disease. It's prevalent in other parts of the world. It exists in the United States. And in the 1990s in New York and a number of other cities, there was a rise of cases of what they called multidrug-resistant tuberculosis. And more recently, not in the United States particularly, but in other countries, like Russia and South Africa and other places, there's been something called extremely drug-resistant tuberculosis, which means that it really can't even be treated with second- and third-line medications. And that's what I gather we're talking about here, something that is extremely resistant to treatment. And the reason is, is that the bacteria just simply adapt to the medications and become resistant and resist them.And while the NPR report mentions it, the AP article doesn't bother to mention the bleak conditions Mr. Daniels is forced to live in:
Today, Daniels has been forced to live in a hospital cell in complete isolation. His only visitors are medical staff. Sheriff's deputies have taken away his television, his radio, his phone and his computer. He's under 24-hour surveillance. The light in his room is never turned off, even at night. His only contact with the outside world is a pay phone.Let me put this in further context. The Houston Pacifica station runs a program called "The Prison Show." Part of the program is devoted entirely to call ins, but call ins of a unique type. The callers are family and friends of prisoners in the Huntsville prison north of Houston. They call for one more opportunity to talk to their loved ones who are behind bars, one more chance to communicate with them. You can tune into the show one Friday night, if you like, and listen to the phone calls. If they don't break your heart, then you simply aren't human. And these are prisoners who are not in solitary confinement, not shut off entirely from the outside world. These are simply people who have done crimes and been locked up and are cut off from family, from friends, from whatever world they know.
Daniels recently described his ordeal in a phone interview with the Arizona radio station KJZZ.
ROBERT DANIELS: I never thought that this could happen. I’m telling you, I'm sometimes sitting on a bed, and I'm just crying because of all the quietness. I don't have, you know, a permission to take a normal shower, and I have to spit wash. It's really cold, especially at this time. I can't, you know, even -- I can’t even spit wash normally.
They 're telling me I’m an inmate. They gave me a booking number, you know, which is for what? For having TB? Booking number? It's just being all ridiculous. If they want me to be isolated, that's fine with me, but, you know, they don't have the right to isolate me from the other world, especially my family, especially from the media, the news, the everything. I mean, I’m all alone here. I don't even know what the hell is going on in the world. I’m not being isolated. I’m being incarcerated, and I have nobody to talk to. My mental health is going down. I’m just slowly dying.
AMY GOODMAN: Robert Daniels is speaking to the Arizona radio station KJZZ. On Wednesday, Democracy Now! spoke to a former worker at the Maricopa County Medical Center who has kept in touch with Daniels. She spoke to us on condition that she not be identified and that we disguise her voice.
FORMER MARICOPA COUNTY MEDICAL CENTER WORKER: He says he cries a lot, says he's very depressed. You have to understand that he is in what, for all practical purposes, is in solitary confinement. He is in a room in the hospital that, number one, has no hot water, has no privacy, has no natural lights. The windows are blocked.
He has no visitation. He can make calls, but who can afford to accept their collect calls? At 4:00, they turn the telephone on. He doesn't really have magazines. If he does, it's rare. He doesn't have TV. He does not have a radio. So all he has is the quietness of the room and then the nurses coming in when they bring him his medicine.
He cannot take a shower. There are no showers right now. There are no showers on the floor. But he has not had a shower since January. So he gets nothing for personal hygiene other than a basin of water and some, you know, washcloths. So he's unable to shampoo his hair, because the faucet in a detention unit is very small, and, of course, with no warm water in there, he can't shampoo anyway.
Now imagine how Mr. Daniels feels.
I don't mean to be snarky, or deliberately insulting: but this is the kind of fear and ignorance I am much more concerned about than the abstractions of who is dominating our "mainstream discourse" with what ideas. It's the actions of sheriffs, not national politicians, that matter to most people. As far as I'm concerned, Sam Harris and Rick Warren deserve each other. My concerns are much more pastoral, and that means real human beings, not abstract debating points (much as I do love a good rhubarb!). Of course, I can't do any more about Mr. Daniels' situation than I can do about US troops in Iraq or who's in the White House. Still, this is an indication of an erosion of civil rights that may be as worrisome as the "war on terror."
An Update: "ross upshur" defends his position in this matter in the comments. To the extent that position is misrepresented in this post, I humbly apologize.