Tuberculosis patient jailed after refusing treatment

Could become a serious threat to the health of the
public
by DAWN PILLSBURY, Staff Writer
In the second arrest of its kind in 10 years, Windsor resident
Miguel Alfonso, 22, is isolated in Sonoma County jail for refusing
treatment for tuberculosis.
“We average 15 cases (of tuberculosis) a year,” explained Mary
Maddux-Gonzalez, Sonoma County health officer and tuberculosis
controller. “Pursuing detention is a rare event.”
Windsor police arrested Alfonso at his Raintree Street home on
Dec. 18 after he failed, 40 times, to show up for treatment of his
multi-drug resistant tuberculosis.
Alfonso is set for jury trial at 9:30 a.m. on Jan. 20 at the
county courthouse, courtroom M9 before Superior Court Judge
Stephany Joy.
While Maddux-Gonzalez said she does not think Alfonso is
infectious – that is, able to spread the disease to others – he was
jailed, according to court records because he refused
treatment.
Alfonso’s doctor, Daniel Toub, said in Alfonso’s legal summary
of care that he diagnosed the patient with active pulmonary (lung)
multi-drug resistant tuberculosis on July 23, 2002.
“He was informed that his treatment is likely to succeed if he
further complies (with treatment) but that any lapse in his
treatment could lead to the development of further multi-drug
resistant tuberculosis, a potentially incurable infectious
condition.”
Toub wrote that Alfonso refused to keep his medication and
treatment appointments despite being informed of the dangers, and
also being given free treatment and financial help with food,
housing and transportation and a Spanish-speaking doctor and case
manager.
Alfonso had been hospitalized for three months in 2002 for his
condition, which Maddux-Gonzalez described as inadequately treated
in a memo to the Sheriff’s Department on Dec. 4. He was jailed for
refusing treatment from Dec. 31, 2002 to Feb. 3, 2003.
“The nature of Mr. Alfonso’s disease puts him at very high risk
for developing reactivation of multi-drug resistant tuberculosis,
and this has been explained to him extensively,” she wrote. “In his
presently inadequately treated state, Mr. Alfonso could become a
serious threat to the health of the public.”
Tuberculosis, caused by the bacteria Mycobacterium Tuberculosis
that spreads through the air, usually attacks the lungs, according
to the Centers for Disease Control (CDC). The disease started to
diminish in the U.S. after effective drugs were developed in the
1940s. After tuberculosis programs ceased, the disease re-emerged
in the ’80s, with 16,000 known cases in the U.S. It continues to be
common in developing countries.
“One-third of individuals worldwide are infected,” said
Maddux-Gonzalez. “But only 5 to 10 percent of those individuals
ever develop the disease.”
When an infected person does not develop the disease, they
cannot spread it, according to the CDC.
Because the bacteria become resistant to drugs if not killed off
completely, there are many strains of the disease that are
multi-drug resistant, such as is the case with Alfonso. Failing to
complete treatment contributes to increased drug resistance.
In such cases, according to the CDC, if patients stop treatment
with drugs that do work on their strain of the bacteria, further
treatment may become impossible.
The Sonoma County Department of Health Services offers
tuberculosis vaccination and treatment. For more information call
565-4762 or go online to www.sonoma-county. org/health. For more on
the disease, visit www.cdc.gov.