ALEX CHADWICK, host:
This is DAY TO DAY from NPR News. I'm Alex Chadwick.
NOAH ADAMS, host:
And I'm Noah Adams.
Today we bring you the story of one man's struggle with tuberculosis. For 27-year-old Robert Daniels, the ordeal began two years ago with a nasty coughing spell. He contracted a dangerous strain of TB that is resistant to drug treatments.
CHADWICK: This type of tuberculosis has begun an international alarm about it and forced people to rethink some of the earliest reactions to disease, like forced quarantine. For Robert Daniels, that debate became a reality.
From member station KJZZ, Rene Gutel reports.
RENE GUTEL: For the past eight months Robert Daniels has been kept in isolation, on the lockdown ward of a Phoenix hospital.
Mr. ROBERT DANIELS (Has tuberculosis): I never thought that this could happen. I'm telling you, I'm sometimes sitting on a bed and I'm just crying because of all the quietness.
GUTEL: Daniels contracted his TB in Moscow where he used to live with his wife and their five-year-old son. He was born in Russia, but grew up in Scottsdale and has dual citizenship. He left Moscow hoping to find work and better medical care in the U.S. But his symptoms worsened not long after his arrival in Arizona.
Mr. DANIELS: I felt really tired. I couldn't work a lot. I felt awful, awful.
GUTEL: He says the Maricopa County Department of Public Health put him under a voluntary quarantine. That meant he had to check in with a health care worker who made sure he was taking his medicines. He also had to wear a face mask in public. TB is infectious and spreads through the air.
Public Health officials wouldn't talk about Daniels' case, citing privacy laws. But according to court documents obtained by the Arizona Republic and now under seal, Daniels has a type of TB that's resistant to antibiotics and he was quarantined against his will because he went out without the face mask.
He was handed over to the county sheriff, who now has him under lock and key.
Mr. DANIELS: They're telling me that I'm an inmate. They gave me a booking number, you know. Which is for what? For having TB? Booking number? It's just being ridiculous.
GUTEL: He's under the supervision of Joe Arpaio, the Maricopa County Sheriff renowned for his tough and controversial jailing policies. Lieutenant Lt. Paul Chagolla is a spokesman for the sheriff.
Lt. PAUL CHAGOLLA (Spokesman, Maricopa County Sheriff): He wasn't convicted of a crime, but he is in a facility, in a jail facility. I don't think anybody writes the book on this type of thing.
GUTEL: Chagolla says while Daniels is under the sheriff's charge, there's no distinction made between him and other inmates. He doesn't have access to a radio or a television, a shower or regular hot water. He's under 24 hour video surveillance and the light in his room never goes off, not even at night.
Mr. DANIELS: I'm not being isolated. I'm being incarcerated.
GUTEL: Daniels says his only contact with the outside world is a pay phone. He's allowed to make collect calls after four o'clock. Even just getting a hold of Daniels was a struggle. I called the sheriff's office to see if I could talk to him. They told me I had to go through Daniels' court-appointed lawyer.
So I called the lawyer, Robert Blecker(ph). Blecker wouldn't let me talk to Daniels either. He said Daniels didn't have permission to talk to me. Blecker also wouldn't talk to me. Eventually, I found someone who could slip Daniels my phone number. Then I waited for him to call.
Unidentified Woman: This is a Qwest collect call from…
Mr. DANIELS: Robert.
Unidentified Woman: …at the Maricopa County Hospital.
GUTEL: When he finally did call, he was cut off after 10 minutes.
Mr. DANIELS: I don't have anybody to talk to. I have - my mental health is going down. I'm just slowing dying…
(Soundbite of busy signal)
GUTEL: He was able to call back. Sheriff's spokesman Paul Chagolla says Daniels' only has himself to blame.
Lt. CHAGOLLA: You have the situation where you have an individual who because of his poor decisions wound up inside this hospital facility behind bars because his actions were posing a danger to the community. That's your family. That's my family. That's everybody else's family that's out there at risk.
GUTEL: Daniels' case is rare, but not unheard of. There've been a small number of forced quarantines around the nation. Internationally, public health officials are growing increasingly alarmed about new types of drug resistant TB, identified on six continents.
There're two types, one worse than the other. But keeping both from spreading is vital, according to Dr. Kenneth Castro. He's the director of TB prevention at the Centers for Disease Control.
Dr. KENNETH CASTRO (Centers for Disease Control): With garden variety TB, the person can be cured within a six month interval of taking multiple drugs. Once you have either multi-drug resistant tuberculosis or extensively drug-resistant TB, you are now using drugs that are much more toxic, less effective, and the sentence, so to speak, is increased to a couple of years of treatment to achieve the cure.
GUTEL: Dr. Castro says approaches to quarantine vary from state to state. Robert Daniels says doctors in Russia didn't wear masks when they treated him and that he didn't understand how contagious he really is. He does now.
Mr. DANIELS: (Unintelligible) if they want me to be isolated that's fine with me. But, you know, they don't have the right to isolate you from the other world, especially my family, especially from, you know, the media, the news, the everything. I mean, I'm all alone here. I don't even know what the hell's going on in the world.
GUTEL: The ACLU of Arizona says Daniels' constitutional rights are clearly being violated. They're watching the situation and may be stepping in. For now Daniels' future is unclear. Treatment for a drug-resistant TB can take years and may or may not be successful. For NPR News, I'm Rene Gutel in Phoenix.
NOAH ADAMS, host:
These two types of tuberculosis known as MDR and XDR are so dangerous that some doctors and scientists say the only way to keep them from spreading is isolation. Dr. Ross Upshur co-wrote a paper advocating that idea. He runs the University of Toronto's Joint Centre for Bioethics. Welcome to our program, sir.
Dr. ROSS UPSHUR (Head, Joint Centre for Bioethics, University of Toronto): Thank you.
ADAMS: I said MDR and XDR sounds like car models or television models, but this is pretty serious deadly tuberculosis.
Dr. UPSHUR: Yeah, it's an unfortunate development. MDR and XDR are two forms of tuberculosis that have developed progressive resistance to standard antibiotic treatments. And what distinguishes them is that they are resistant to the two cheapest and most effective first-line agents, rifampicin and isoniozid, and what distinguishes CDR TB is that it's more extensively resistant to second-line treatments and, as has been shown recently in South Africa, in conjunction with HIV infection is a highly deadly mix.
ADAMS: What does XDR stand for?
Dr. UPSHUR: It stands for extensively drug-resistant tuberculosis, and it's really just a movement forward from MDR, which is multiple-drug-resistant.
ADAMS: And of this, in general terms, the result of the over-use of antibiotics in past decades?
Dr. UPSHUR: It's a fairly complex story, but in general, yes. It's inappropriate treatment of tuberculosis in the first place that fosters resistance. And what's tragic about this, and I think all of us as global citizens and as humanity bears some of the blame, tuberculosis is a curable illness, and if we go beyond extensive drug resistance to what some people have now called the post-antibiotic era, we will be essentially back in the 19th century - that is, having no effect of chemotherapy.
It's going to take at least 10 years to get new drugs, and no new drugs for TB have come out in 40 years.
ADAMS: And in the meantime, we have Robert Daniels there in Arizona. He is apparently, effectively, a prisoner.
Dr. UPSHUR: Well, in an ideal world, what we would call voluntary measures or, in ethical terms, the least-restrictive means, would be satisfied. That is, he would willingly and voluntarily behave as prescribed so as not to put others at danger. However, when a patient or an individual gives evidence that they're unwilling and unable to comply with those, then you need to take the next step, which is to use isolative or restrictive measures.
We have argued that these are legitimate, but we also argue that there's a strong duty of reciprocity on those who are holding him. That is, he must be kept in humane circumstances. He must have as normalized a life as possible because it's not a crime to be infected with tuberculosis. Nobody would willingly wish to be infected with an extensively drug-resistant form of tuberculosis.
ADAMS: Dr. Ross Upshur runs the University of Toronto's Joint Center for Bioethics. Thank you for your time, Dr. Upshur.
Dr. UPSHUR: Thank you very much, appreciate it.
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