Quarantine breach leaves TB patient locked in isolation

Man may serve life in hospital

Dennis Wagner

The Arizona Republic

Mar. 1, 2007 12:00 AM

A young man sits in a locked room, windows covered, in the detention ward at Maricopa Medical Center, under sheriff's guard.

He is not allowed a TV, a radio, a cellphone, a shower or visitors. A video camera catches his every move.

His floormates are criminals, including a suspect in the killing of a police officer.

He has been isolated here for eight months and is expected to remain much longer, perhaps until he dies.

But Robert Daniels is not charged with any crime. He has tuberculosis. And he is under court-ordered confinement because he violated the rules of voluntary quarantine, exposing others to a potentially deadly illness.

Daniels is afflicted with a TB strain so dangerous that he has never met his appointed lawyer, Robert Blecher, who describes the situation as "extremely unusual."

"Mr. Daniels' problems occurred - and he understands this - because of his own actions," Blecher said. "It does come down to a health issue for the entire community. He did go out in the public. He was exposing people."

Blecher acknowledged that his client's living conditions are unusual: Daniels is housed in Station 41, a room where air flows only in, not out. He is on a hospital floor supervised by the Sheriff's Office. There is no other facility in the Valley for medical lockdown.

Jack McIntyre, a sheriff's spokesman, said sympathetic nurses gave Daniels a computer, a phone and other items for a time, but those were confiscated for security reasons. "While he's there, we treat him as an incarcerated individual," McIntyre said. "It's a jail ward."

Daniels contracted TB while living in Russia, according to Superior Court filings. In July 2006, he was admitted to Scottsdale Healthcare Osborn hospital for respiratory illness. Lab tests revealed that he suffered from "extreme multi-drug-resistant tuberculosis," records show.

The disease is spread by airborne contact: If a patient coughs in public, others are endangered.

Robert England, Maricopa County tuberculosis control officer, said in court filings that Daniels was transferred from the hospital in July to Monroe House, an outpatient facility for indigent TB patients near downtown Phoenix. He was instructed to continue treatment and wear a mask whenever going out in public. England alleged that Daniels stopped taking his medication and went unprotected to a Jack in the Box, a Circle K and other stores. Daniels understood the rules, England said in his affidavit, but "merely refuses to follow them."

Based on that, the Maricopa County Department of Public Health obtained a court order for "compulsory detention," a legal tool used only about once a year in Arizona and usually only for a short time.

Daniels is a Russian-born 27-year-old with dual U.S. citizenship. During a hurried and rare phone conversation Tuesday, he admitted making a mistake eight months ago but said he did not understand the gravity of his disease at the time.

"I don't want to confuse people if I wear a mask," Daniels said, describing his thoughts. "What if they think I'm a robber? What if I get shot?

"Nobody talked to me about this thing. Nobody lectured me."

Daniels said face covers are not worn by tuberculosis patients in his homeland, which ranks 12th on the World Health Organization's list of most infected nations.

"In Moscow," he said, "when I went to clinics, even the doctors did not wear masks."

Russia, with 26,000 TB deaths annually, has more than 80 cases per 100,000 population, compared with five per 100,000 in Arizona.

Daniels said he has become depressed to the point of weeping.

"They're making a criminal out of me," he added. "I've been crying almost every day. . . . I'm all alone. No showers. No sunlight. It's the silence that's pushing down on me. . . . It's the worst you can get, even if you murdered somebody."

Daniels, who has an American father and lived in the United States during the 1990s, was diagnosed with TB two years ago in Moscow. He was told drugs were difficult to obtain and too expensive for a poor laborer. Daniels said he came to Arizona in January 2006 looking for work and hoping to get treatment.

His wife, Alla, who is in Russia with their 5-year-old son, said in a phone interview that the imprisonment seems inhumane.

"I know he has a very dangerous form of the disease," she said. "But he was not arrested. His rights are being violated."

Daniels said hospital workers became so upset with his plight recently that a series of county Superior Court hearings were conducted. Last week, Commissioner Randy Ellexson ordered that the patient be moved to new quarters. He then reversed that decision during an emergency session, which Daniels said he was not allowed to monitor by phone.

Daniels said he has been a model patient at Station 41 and would not violate quarantine again. He claimed recent tests of sputum from his lungs were negative for TB.

But prospects for freedom remain unclear. A medical assessment submitted to the court in August indicated the disease was still mutating in Daniels and may require treatment for years.

"There is certainly a high likelihood that the patient has developed additional drug resistant (sic) that may make cure impossible," the assessment said. "If this is the case, the patient must be detained in isolation until death or patient's own immune system contains it (50% chance of either possibility)."

A Feb. 20 entry in the file added that Daniels needs eight weeks of clear tests before he can be deemed non-infectious. Court records do not contain an updated prognosis, and medical authorities declined to comment.

Reach the reporter at dennis.wagner@arizonarepublic.com.