TB Involuntary Detention: A Case Study

Around the world, tuberculosis (TB) remains the second leading killer of adults, responsible for more than 2 million TB-related deaths each year. In the United States, however, TB rates are at their lowest. This is largely due to the CDC TB surveillance program started in 1953 in cooperation with state and local health departments. In 2010 11,181 TB cases were reported for a rate of 3.6 per 100,000. Racial and ethnic minorities and foreign-born individuals account for the majority of the cases.

Confirmed cases of tuberculosis are a nationally notifiable condition and can pose a public health threat if clients do not follow established protocols for isolation when still infectious. In a small number of cases per year, public health officials may need to involuntarily isolate cases of pulmonary TB if they are infectious and refuse to voluntarily isolate. This case study describes the steps taken by a local health department to obtain an emergency detention order to involuntarily restrict an infectious TB client. Lessons learned include the importance of good documentation in legal proceedings, the need for culturally sensitive patient education, and the need for collaboration with different components of the public health system including outreach workers, public safety, and local and State law enforcement to achieve a safe outcome for both the client and the greater public.