Woman with an active case of tuberculosis spotted heading to casino on public transportation

By Lisa Marie Basile | Fact-checked by Davi Sherman
Published May 11, 2023

Key Takeaways

  • A woman in Washington with active tuberculosis (TB) has been asked by local health authorities to voluntarily quarantine and seek treatment for over a year; in March, a court ordered her arrest. 

  • The woman has not been found, although an officer did spot her taking a bus to a casino last month. It is unclear why she was not taken into custody.

  • Experts say that TB is contagious and can spread in shared spaces, such as public transportation. It is important that patients with TB disease seek early diagnosis and treatment.

A Washington woman with an active case of tuberculosis (TB)—who was previously issued an arrest warrant in March after failing to comply with health officials’ requests to isolate and receive treatment—was recently spotted boarding a bus to a casino last month, although she was not taken into custody for reasons unknown. []

The woman is referred to only as V.N., according to court documents obtained by The News Tribune, which states that the person who spotted V.N. was a police officer, was directed to “surveil the respondent.”[]

A look back

On February 28, a press release issued by the Tacoma-Pierce County Health Department stated that the department had been trying “for more than a year to do everything [it could] to persuade this woman to take her medication to protect herself and [the] community.”[]

Related: Arrest warrant issued for woman with an active case of tuberculosis

After several court hearings, the Tacoma-Pierce County Health Department press release stated that the Pierce County Superior Court Presiding Judge Philip K. Sorenson found the woman in contempt of court for refusing to comply with his order that she take medicine or voluntarily isolate. Sorenson issued a warrant for civil arrest by law enforcement on or after March 3, but authorities were not able to locate the woman. 

The department said the case was “a rare instance where the patient has refused to take the life-saving medication she needs or remain in isolation” and that “this case is only the third time in the past 20 years the Health Department has had to seek a court order to detain a potentially contagious patient who refused treatment for TB.”

The Tacoma-Pierce County Health Department press release was last updated on April 6, stating, “Law enforcement has the civil arrest warrant that authorizes them to detain the patient who is still refusing treatment.” Then, news reports from April 7 say that authorities had not been able to find the woman—until she was spotted on a bus going to a casino. 

The News Tribune reports that, according to court documents, Pierce County Chief of Corrections, Patricia Jackson, said she had received a copy of the warrant and was assigned “‘to handle this matter in compliance with the Court’s Orders.’” Jackson reported in the April 3 filing that she had assigned an officer to surveil V.N. in order to determine her habits and detain her. 

The officer Jackson assigned to watch V.N. “‘observed a person they believed to be [the] respondent leave her residence, get onto a city bus, and arrive at a local casino.” The officer did not detain V.N. but said that they continued to try and find her at home in the following days. They did not succeed. It is unclear why the officer did not detain V.N. when they initially spotted her on the bus. 

When asked for a comment, Kenny Via of the Tacoma-Pierce County Health Department told MDLinx, “Our latest info about this case is in our blog. Law enforcement has the civil arrest warrant that authorizes them to detain the patient who is still refusing treatment.”[]

A look at TB by the numbers

TB, caused by the bacterium Mycobacterium tuberculosis, attacks the lungs and other parts of the body and is the 13th leading cause of death worldwide, according to the World Health Organization.[] 

Although not as deadly as heart disease or stroke, TB still poses a risk to public health; physicians need to be aware of this. Data provided by the Centers for Disease Control and Prevention (CDC) showed that TB cases grew from 7,874 in 2021 to 8,300 in 2022. However, unreported or undiagnosed cases abound. As many as 13 million Americans may have latent TB infection (LTBI). Although these individuals may not be symptomatic or contagious, 5% to 10% will go on to develop active TB disease.[] 

You should know that there are a few groups at higher risk for TB. These include children four and under, incarcerated individuals, and people with medical conditions like diabetes, cancer, or HIV. In 2022, 6,009 of 8,248 TB cases occurred in non–US-born persons, the majority being Asian or Hispanic. Of the 2,239 US-born persons with TB in 2022, nearly 30% identified as non-Hispanic Black or African American. 

Symptoms change depending on the body parts affected but may include coughing with blood, chest pain, weakness, night sweats, weight loss, and fever.[] 

Although TB is most contagious when a patient spends time with people daily, it spreads through the air from person to person. Research published in PLoS One found that people commuting on buses and mini buses in Lima, Peru, a high-incidence area, were at higher risk for contracting TB. Immunocompromised people may be at greater risk of contracting TB from an infected patient if they share public transportation, says the Journal of Infectious Diseases.[][][] 

For people with active TB, like V.N., the journal noted that infectiousness—and the duration of infectiousness—can be reduced through not only early detection but also early treatment. Erica Susky, an infection control practitioner (ICP) and instructor at Infection Prevention and Control (IPAC) Canada says there’s no way to know exactly how contagious V.N. was when she was out in public: “For example, some bus rides take hours—and buses are confined spaces. Some visits to the casino also may take hours, and it cannot be said with certainty if this is a spacious casino with higher ceilings and good ventilation. These parameters cannot be known with certainty. ”

Still, Susky says, “It remains important to treat TB, [since] the disease can still be fatal; globally, it still kills millions of people annually. The certain way to prevent TB is to prevent further exposures, and this is done by minimizing exposure to other individuals and by effectively treating the person.”

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