Legal Power and Legal Rights — Isolation and Quarantine in the Case of Drug-Resistant Tuberculosis

Wendy E. Parmet, J.D.
The recent case of Atlanta attorney Andrew Speaker has focused attention on the role of compulsory isolation and quarantine in tuberculosis control. In May, after being diagnosed with a drug-resistant form of tuberculosis, Speaker flew to Europe for his wedding and honeymoon. While he was there, laboratory tests at the Centers for Disease Control and Prevention (CDC) indicated that Speaker's infection was extensively drug-resistant (XDR). Although accounts of what followed vary, it is known that the CDC contacted Speaker and asked him to stay in Italy while they tried to determine what to do. Fearing isolation in an Italian hospital, Speaker flew to Prague and then Montreal, bypassing his inclusion on the federal no-fly list, which doesn't apply to flights outside the United States. In Montreal, Speaker rented a car; then he drove into the United States, thanks to the help of a border agent who disregarded a detention order. Speaker then went to a New York hospital, where he was met with a CDC order restricting his movement and requiring him to cooperate with health officials — reportedly the first such federal order issued in more than 40 years

Weeks later, while Speaker was being treated at the National Jewish Medical and Research Center in Denver, laboratory tests revealed that he did not have XDR tuberculosis but instead had multidrug-resistant (MDR) tuberculosis. MDR tuberculosis is resistant to the first-line drugs isoniazid and rifampin. XDR tuberculosis is also resistant to a quinolone and to an injectable second-line drug.

Speaker's case provoked a flurry of media attention and public outrage. During hearings, Representative Bennie Thompson (D-MS), chair of the House Homeland Security Committee, exclaimed, "We've dodged a bullet. When are we going to stop dodging bullets and start protecting Americans?"¹ The implication was clear: tuberculosis carriers threaten the nation. Like terrorists, they must be thwarted by enhanced security measures, including the vigorous application of isolation and quarantine. Lost in the debate was the recognition of legal checks on the use of compulsory isolation and quarantine as well as the importance of such checks to protect the public health.
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