Policing the TB Beat : San Joaquin County Jails Patients Who Refuse or Stop Treatment

Deborah Sanchez, 32, has spent half her life dodging the law as a prostitute and heroin addict, but it wasn’t until last summer that she became a wanted woman on the run in this Central Valley city.

Her mug shot flashed across TV screens, and the police, armed with a no-bail warrant, scoured back alleys in search of her. When they finally found their 86-pound quarry hiding under a mattress in a cheap motel, a judge read her the riot act and sentenced her to a year in county jail.

Her crime? She had stopped taking her tuberculosis medicine.

“We don’t mess around when it comes to TB,” said San Joaquin County Deputy Dist. Atty. Stephen Taylor. “If you don’t take your medicine here, you’ll be hunted down and jailed very quickly. We’ll bring you back in chains if we have to.”

This tough, new approach to an old scourge has gotten a lot of attention among health officials throughout the state, and not all of it positive. While other counties, including Los Angeles, lock up TB patients who refuse treatment, it is done only as a last resort.

Here, San Joaquin County health authorities do not hesitate to call in the police and courts. Already this year, nine people have been arrested for breaking their treatment regimen, a violation of state health and safety laws. Five of them, like Sanchez, have been sent to jail.

“We’re not supposed to be health Nazis,” said Mike Squires, a Los Angeles County health official critical of the approach here. “Unlike San Joaquin County, we try very hard to exhaust all avenues before we jail someone. And we don’t give out their names to the media for publication.”

Many counties are debating the best approach to fight the contagious and deadly bacterial disease--an ancient plague that is nearing epidemic proportions in California again.

Stockton--with 220,000 residents the largest city in San Joaquin County--has the third-highest TB rate in the state. Over the past decade, as the city has absorbed a new generation of refugees from Southeast Asia and immigrants from Mexico and Central America, TB incidence has doubled to more than 100 cases a year.

Because the disease is spread by coughing and many newcomers have large families living in close quarters, they are easy targets for the illness. But health officials say they are generally open to treatment.

It is the TB patients strung out on crack and heroin or those living on Skid Row who often resist help. They are too busy trying to feed their addictions and stomachs to worry about a disease that takes its time ravaging the body. Some complain that the medication--eight and nine pills at a time--makes them sick to their stomachs.

The danger, officials say, comes when patients stop taking the pills before the disease has been fully arrested. Strains of TB resistant to drugs can gain a foothold this way.

“I know the civil rights issues are delicate, but we are dealing with a killer,” said Dr. Bruce Nickols, the San Joaquin County jail physician. “Half the people with drug-resistant TB end up dying.”

The county is so committed to the take-your-medicine-or-go-directly-to-jail approach that the new 750-bed jail has been equipped with five cells for highly contagious inmates. After two weeks of heavy treatment in isolation, they are transferred to a special ward where they serve time beside other inmates with physical and mental problems. They remain behind bars until treatment is complete, which can take up to nine months.

This places an extra strain on an overcrowded jail where some nonviolent felons must be released before their sentences are complete, said San Joaquin County Sheriff’s Lt. Tom Robert DeChance. “It is conceivable that a TB person stays in and a felony convict is released because of overcrowding,” he said. “But no serious felons go out the back door because these TB people are coming in the front.”

The American Civil Liberties Union, while taking no formal stance on the issue, is concerned that the county’s approach may be forcing TB victims underground. But Carol Brie, a county health physician, said the program is having the opposite effect.

“A number of our TB inmates never realized how sick they were,” she said. “They leave jail spreading the word to other TB patients about the need for treatment.”

Sanchez has put on 25 pounds since she was sentenced in September to a year in county jail for refusing to take her medicine. She said she knew so little about TB that she thought the weight loss and night sweats were the effects of heroin and crack, a $280-a-day habit she supported through prostitution.

“I would inject the heroin and smoke the crack,” she said at the jail. “It was an all-day thing. I’d go up and come down. Up and come down. My veins are so bad that I had to shoot it right in the muscle.”

She said she doesn’t know when or how she contracted TB, although it may have had something to do with “supercharging” crack--a process by which one user gets another user high by locking lips and blowing the smoke directly into the other’s lungs.

She was diagnosed as having TB this year on her last trip to jail for prostitution. She took her medication for a few weeks after her release, but stopped. Health officials tried to entice her with McDonald’s Happy Meal certificates and free cookies and punch.

“I was too jacked up and rebellious to care,” she said. “I had no excuse. If I couldn’t make it to the health clinic, the nurses said they would bring the medicine to my motel.”

After she missed a month of treatment, health authorities contacted the district attorney’s office and a warrant was issued for her arrest. Sanchez crashed into a van trying to elude local police. The Stockton Record newspaper wrote an account of her disappearance. The story was picked up by the local TV news and newspapers throughout the state.

“They said I had TB and was wanted for contaminating the city of Stockton,” she said. “I was ashamed, because I knew my 14-year-old daughter would read it.”

She has spent the past two months reading novels and apologizing to her daughter, and is thankful for the arrest. “They probably would have found me dead out there somewhere if I hadn’t been brought in,” Sanchez said.

Other TB inmates agree. Juanita Luna, recently released from jail after completing her treatment, penned an apology to the people of Stockton titled “My Insanity.”

“My cough just got worse and worse. Almost took a ride in a big-black hearse,” she wrote. “I thought I put my illness on the shelf. Instead, I almost killed myself.”

At a recent statewide conference of health officials in Anaheim, prosecutor Taylor outlined the county’s tough approach in his blunt, no-nonsense style. Most in the room applauded, but a few shook their heads in disapproval.

“People are shocked to hear that someone is actually being arrested for this,” Taylor said. “ ‘What’s the big deal?’ they say. It doesn’t seem to register that we’re talking about a killer. And if we can help it, that killer’s not going to be walking our streets.”

Times staff writer Maria La Ganga contributed to this story.