Australia: TB Detentions Turn Patients Into Prisoners, Doctors Say

A New South Wales (NSW) law that permits forcible detention for non-compliant infectious TB patients makes patients feel like prisoners and hospital staff like guards, a study by two infectious disease specialists concluded. The law, which can also be applied to HIV/AIDS or SARS patients, allows a panel of doctors, social workers and counselors to order a 28-day mandatory detention for patients who fail to maintain their medical regime despite counseling, education, financial support and psychiatric help. Similar laws exist in other Australian states and territories.

Dr. Sanjaya Senanayake and public health specialist professor Mark Ferson reported on two highly infectious TB patients ordered to NSW isolation wards after failing to take their drugs. One stopped eating and lost weight before escaping from the ward, and the other made six escape attempts and was abusive and aggressive toward staffers. The first patient is still missing; the second patient was found drunk and still infectious at a major railway station. While acknowledging that mandatory detention is necessary because a single patient can infect scores of people, the study authors argue that the two NSW detentions did not necessarily minimize public risk. "These patients have a medical condition ... they are not criminals to be punished," they wrote. "Ideally, a dedicated medical facility should be available."

Ten such detention orders have been issued for TB patients in Australia over the past five years, Ferson and Senanayake said. Such an order can be extended by up to six months by making an application to the Administrative Decisions Tribunal, at which point patients can bring in legal representation, they noted.

A federal health department spokesperson said mandatory detention is used as an extreme and unusual last resort. "In most circumstances they will be at home and be checked on every week to make sure they're taking their tablets," she said.

The full report, "Detention for Tuberculosis: Public Health and the Law," was published in the Medical Journal of Australia (2004;180(11):573-576).

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