Confinement for TB: Personal Rights vs. Public Health At a hospital on Roosevelt Island, New York, 15 people are being held against their will in an effort to control another outbreak of Tuberculosis. They are confined not because they are contagious but because they have repeatedly failed to take their medicines. The confinement is the result of strict new regulations that allow city health officials to detain TB patients for months, or even years, until a cure is completed. Although some detainees are past the contagious stage, health officials say detention is necessary because patients who repeatedly stop their treatment often develop deadly, drug-resistant strains of TB. When the medication is stopped too soon, the illness can recur, making patients contagious again. New York reported 3,811 cases of TB--highest in the nation. The city has attempted to balance public health concerns against civil liberties by providing due process protections to patients, including the right to a hearing and a lawyer paid for by the city. The hospital is not like a jail: patients have color TV with cable, can make telephone calls, can receive visitors, and have activities planned from 9 am to 8:30 pm. But they cannot leave until health officials determine that they are cured or that they will take their medicines under less restrictive conditions. Of the 15 people at the hospital, 11 have a history of drug use, 6 have tested positive for HIV, and some are homeless. All have developed resistance to the drugs commonly used to treat TB. All have been treated in regular city hospitals for tuberculosis. One patient refused to stay in his isolation room at the city hospital, walking around to visit other patients, so he was sent to Roosevelt Island. Patients can get drug treatment, psychiatric counseling, and other health services, as well as educational tutoring and applications for government benefits. The hospital gets $450 per day per patient from Medicaid, but pays $300,000 per year in salaries for TB workers and public health advisors.

Now is your chance to practice the steps of policy analysis. Utilize the 6 steps of policy analysis, determine should your home state adopt a similar program? Why or why not?

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