Wisconsin TB patient jailed for failing to take medication

Posted by Jennifer Miller, Bioethicist
July 26, 2007

The Wisconsin Supreme Court upheld the jailing of a tuberculosis (TB) patient who failed to comply with her treatment regimen. Ruby Washington had been diagnosed with noninfectious TB in 2005 by the staff of a TB control clinic. When she failed to appear to receive medication, the City of Milwaukee Health Department issued a directly-observed therapy (DOT) order and an isolation order, and Washington was confined to a medical center. Upon release, conditioned on continued DOT at the TB clinic, Washington again failed to appear for treatment, and she was subsequently confined to the Criminal Justice Facility (CJF), pursuant to Section 252.07(9)(a) of the Wisconsin Code. TB clinic staff believed that while Washington ’s TB was not infectious, it could easily become so. A circuit court judge found Washington in violation of the treatment order, and concluded that confinement at CJF was appropriate given Washington ’s admission that she had not complied with the treatment regimen. Washington requested that she be confined to the medical center, but the City argued that the cost to taxpayers for police guards if she were confined at the medical center was unfair, and the court ruled for the City. Washington appealed to the court of appeals, which affirmed the circuit court opinion. Washington then appealed to the state Supreme Court, which held that the statute “authorizes confinement to a jail … provided the jail is a place where proper care and treatment will be provided and the spread of disease will be prevented, and that no less restrictive alternative exists to jail confinement.” The Court also held that it was appropriate for the lower court to consider cost when determining the place of confinement.