Expanded AIDS Patient Detention Ordered

In an effort to reduce the risk of AIDS patients knowingly infecting others with the disease, the Los Angeles County Board of Supervisors on Tuesday ordered health officers to expand the use of involuntary detention of patients perceived to pose a public health threat.

Without discussion, the supervisors unanimously ordered county Health Director Robert Gates to review with doctors at county hospitals the laws governing detention for public health reasons of people with communicable diseases. Currently, such “holds,” as they are known, are rarely imposed because it must first be shown that the patient poses a threat, health officials said.

The board’s action was prompted by an incident in June in which an AIDS patient, Joseph Edward Markowski, 28, allegedly attempted to sell blood to a private blood bank. He had been released from a county mental health ward just one day earlier.

Markowski had been sent to the ward after he entered a bank and pleaded with a guard to kill him because he had the disease, according to police reports.

At the recommendation of police, county psychiatrists placed Markowski on a 72-hour hold, the maximum permitted without a court hearing, but he was nonetheless released the next day.

Charged with attempted murder, Markowski faces a preliminary hearing Aug. 31.

“It is the legal right and moral duty of health officials to detain patients who pose a threat to society,” said Supervisor Mike Antonovich, who introduced the motion calling for expanded use of health detention.

Dr. Martin Finn, medical director of the county’s AIDS program, said a patient with a communicable disease may be detained by public health officers against his will only if, after being told he has a communicable disease and shown how to avoid infecting others, the patient refuses to modify the behavior that places others at risk of catching the disease.

Finn said that with most infectious venereal diseases, such as syphilis or gonorrhea, recalcitrant patients detained for refusing to cooperate can be rendered noninfectious within a 24-hour period by penicillin injections. A recalcitrant tuberculosis patient, might need to be isolated for several months, he added.

But with acquired immune deficiency syndrome, Finn said, because there is no known cure, a patient refusing to cooperate could presumably be detained indefinitely. He added that his office has had several referrals for possible detention, but all of the patients have agreed to modify their behavior.

Finn said that the board’s action will probably not result in more involuntary detentions, but rather will lead to new policies for dealing with AIDS patients who are unwilling to cooperate with health officials.