Laws Protect Local Public Health

September 08, 2004

La Marque - Various state laws address the reporting of infectious diseases to local health departments and procedures necessary to isolate or quarantine persons infected with contagious diseases. These laws may be used when it is essential to prevent others from becoming infected. Most commonly the laws are used in cases of tuberculosis when individuals fail to follow necessary treatments needed to both cure the disease and prevent healthy individuals from being exposed and/or becoming infected.

“In the great majority of cases, individuals are fully compliant and understand the need for testing and treatment of an infectious disease. In almost all cases, involuntary quarantine is not considered” says Dr. Mark Guidry, Galveston County’s Public Health Authority. A recent tuberculosis case was quarantined after a five year lapse since the laws were last used. The recent incident involved a case of infectious tuberculosis (TB) in the lungs of a 45 year old homeless man on Galveston Island. The Health District filed suit in the District Court of Galveston County to have the man involuntarily committed to the state’s TB treatment hospital in San Antonio where he will remain for a period of between six and twelve months.

The case was reported to the Health District by a UTMB physician who admitted the patient after he sought medical attention for shortness of breath, weight loss and night sweats. The physician placed him on an appropriate treatment regimen of four drugs and the patient remained at UTMB. Although placed in an isolation room with infection control precautions, the patient was legally free to leave and did so at least once for over twelve hours.

The Health District’s state funded TB program investigated the case and discovered that the patient had been locally incarcerated over a year ago. A TB skin test was performed and was positive, but the man was ordered released before treatment could begin. He was provided with written information on the seriousness of his condition and was instructed to report to the Health District for further evaluation and treatment. Although he agreed to do so, he did not comply and was lost to follow-up until the recent hospitalization.

While hospitalized, the treating physician and the Health District’s TB nurse advised the patient that the infection required long-term, inpatient care to cure his infection and prevent spread to others. The patient refused to consider the recommended treatment regimen.

Given a history of non-compliance in the past and the fact the advanced stage of the patient’s disease was highly infectious to all who came in contact with the patient, Dr. Guidry determined that the patient would continue to endanger the public’s health.

After consultation with the Texas State Department of Health Services, which concurred with Dr. Guidry’s analysis, a suit asking for an involuntary quarantine was filed by the Health District using attorney Don Glywasky in Galveston County’s Legal Office. The District Court issued and order allowing the patient to be taken into immediate protective custody, and the patient was held at UTMB pending a hearing. On the day of the hearing, after consulting with his court appointed attorney, the patient waived all further proceedings and agreed to the Court ordered treatment. With the assistance of the Galveston County Sheriff’s Department, the patient was transported to San Antonio for treatment.

TB, or tuberculosis, is a disease caused by bacteria. The bacteria can attack any part of the body, but they usually attack the lungs. TB in the lungs can be infectious to other people who come into contact with an infected individual. The bacteria are put into the air when an infected person coughs or sneezes. People nearby may breathe in these bacteria and become infected. When a person breathes in TB bacteria, the bacteria can settle into the lungs and begin to grow. From there, they can move through the blood to other parts of the body, such as the kidney, spine, and brain. TB in these parts of the body is usually not infectious.

What makes tuberculosis unique and challenging as a communicable disease is that it is transmitted by air. Once a person becomes infected and contagious, extensive, long-term and daily medications are needed to first convert them to a non-infectious state and even longer for a complete cure and to avoid a relapse into being infectious to others.

People with TB disease are most likely to spread it to people they spend time with every day. That includes family members, friends, and coworkers. In most people who breathe in TB bacteria and become infected, the body is able to fight the bacteria to stop them from growing. The bacteria become inactive, but they remain alive in the body and can become active later. This is called latent TB infection. People with latent TB infection have no symptoms, don’t feel sick, can’t spread TB to others, but will usually have a positive skin test reaction and can develop TB disease later in life if they do not receive treatment for TB infection.

Symptoms of TB depend on where in the body the TB bacteria are growing. In the lungs, one may have a bad cough that lasts longer than two weeks, pain in the chest, coughing up blood or sputum. Other symptoms of TB disease are weakness or fatigue, weight loss, no appetite, chills, fever, and night sweats.

The Health District has staff who actively search out those who may have been infected and test them for exposure. They also assist in ensuring that any person in need of treatment receives the necessary medications to cure them of the disease.

The initial detection of the disease is done by a skin test that is administered quickly and is relatively painless. The skin is checked a few days later to determine whether there has been any reaction indicating exposure to the disease. Further testing is done as necessary.

For more information on the Galveston County Health District’s TB Program visit their web site at www.gchd.org/chn/TB.htm.