Should TB Patients Who Don't Take Their Medicine be Detained?

Analysis of ethical, legal, and policy issues in tuberculosis control

From 1995 to 1997, researchers at the University of California, San Francisco, School of Medicine studied the issue of detaining TB patients who are persistently non-adherent to therapies.

Although only a very small percent of patients are persistently non-adherent, they are at highest risk for spreading multiple drug resistant TB, the most dangerous kind of TB.

The project was part of the Robert Wood Johnson Foundation's (RWJF) national program Old Disease, New Challenge: Tuberculosis in the 1990s.

The project conducted a 50-state survey of laws and regulations regarding long-term detention of persistently non-adherent TB patients, comparing provisions for civil (versus criminal) detention and for procedural safeguards.

Researchers did case studies of civil and criminal detention of persistently non-adherent TB patients in California. They also made an assessment of the need for secured housing for tuberculosis patients, carried out through a questionnaire to county tuberculosis controllers in California.

Key Results

  • About 1.3 percent of adult TB patients in California need to be detained due to non-adherence. Other states that have laws allowing for involuntary detention report a similar percentage.
  • The average length of detainment was two weeks, and it takes roughly one year to complete therapy for tuberculosis.
  • The grant created an unprecedented collaboration between the University of California, San Francisco; the State of California; and the City and County of San Francisco Health Department. The institutions have developed a long-lasting relationship that has already resulted in a policy change that allows detained TB patients to be in the civil justice system instead of the criminal justice system.