Catching patients: Tuberculosis and detention in the 1990s

The resurgence of tuberculosis (TB) in the early 1990s, including multidrug -resistant strains, led health officials to recommend the use of involuntar y detention for persistently nonadherent patients, Using a series of recent ly published articles on the subject, this paper offers some opinions on ho w detention programs have balanced protection of the public's health with p atients' civil liberties. Detained persons are more likely than other TB patients to come from social ly, disadvantaged groups. Health departments have generally used coercion a ppropriately, detaining patients as a last resort and providing them with d ue process. Tet health officials still retain great authority to bypass "le ast restrictive alternatives" in certain cases and to detain noninfectious patients for months or years, Misbehavior within institutions may inappropr iately be used as a marker of future nonadherence with medications. As rates of TB and attention to the disease again decline, forcible confine ment of sick patients should be reserved for those persons who truly threat en the public's health.