Woman Jailed 10 Months for Refusing TB Medicine

Hongkham Souvannarath thought she had seen all the cruelties life had to offer in her native Southeast Asia: war, exile, the hand-to-mouth existence of a refugee camp.

But it wasn’t until she came to America that she saw the inside of a jail cell, and for a misdeed she still does not understand.

Souvannarath, the mother of seven, was sent to Fresno County jail for 10 months for refusing to take her tuberculosis medication. She never had a court hearing, never saw a lawyer and no charges were ever filed.

Last week, after public interest lawyers took up her cause, the 51-year-old Laotian refugee was released from jail by a county judge who ruled that she was the victim of “an inadvertent but illegal detention.”

“For the first two days, I had to sleep on a concrete floor in the basement of the jail so I wouldn’t [infect] the others,” she said through a translator. “Then they took me into a [cell] and stuck a medicine line in my arm. I was crying all day and night and praying.

“I thought if I got sick in America, they would put me in hospital but instead they put me in jail. I don’t understand.”

Jailing TB patients who refuse to take medication is not unheard of in California. In the mid-1990s, for instance, San Joaquin County got national attention when it began hunting down recalcitrant TB patients, putting their mug shots on the evening news and incarcerating them in a special unit of the county jail.

But even San Joaquin County’s tough approach to an old scourge came only after prosecutors filed court orders and held hearings in which TB patients were cited for a criminal violation of the state’s health and safety code. In the Souvannarath case, her attorneys say, Fresno County violated her constitutional rights by jailing her on the administrative orders of a health officer.

County lawyers and health officials declined to comment on the case. But in court papers filed last week, the county counsel and county health officer both conceded that at least seven months of Souvannarath’s detention was illegal. “Due to inadvertence, no court order continuing the detention has been issued,” the county’s court filing stated.

As for the general practice of jailing TB patients who refuse treatment, county officials say they have no choice. The county recently sold its one community hospital and lacks any other facility to house TB patients who refuse treatment.

“Generally when we detain them, it has not been for a long time,” said David Hadden, Fresno County coroner and health officer. “They are in for a month or two and then decide they will take the medication on their own.” In Souvannarath’s case, health officials said they had to be particularly vigilant because her on-and-off treatment had created a “super bug” form of the disease, one that resists the usual medicines and poses a serious health risk to the community.

“What she has is a little scary from the public health perspective and you can’t mess around,” Hadden said. “How do you protect the public? You can’t put a sign around her neck telling everyone to steer clear of this woman because if she sneezes she could be spewing out a deadly disease.”

Fresno County had 114 cases of TB last year, the vast majority of them in impoverished Latino and Southeast Asian communities. Despite several outreach programs to bridge language and cultural gaps, seven cases of drug-resistant TB were identified last year, all of the patients either Hmong or Laotian.

Because the disease is spread by coughing and many newcomers have large families living in close quarters, they are easy targets for the illness. Treatment for the milder form of TB can take up to nine months and cost $60,000, health officials said. For the drug-resistant form, treatment can last up to 36 months, cost more than $200,000 and cause nausea and other side effects .

Catherine Campbell, one of Souvannarath’s attorneys, said the fact that her client and six other Southeast Asians suffer a deadly form of TB underscores the need for Fresno County to find a treatment facility other than jail.

Campbell criticized the county counsel for failing to file a petition for a court hearing and failing to advise Souvannarath of her right to a lawyer. She also took issue with the Fresno County Sheriff’s Department for continuing to jail her without criminal charges or a court order.

“The law provides that they have to secure a court order and give her notice that she can be released in 72 hours and she can have legal counsel. None of this was done,” Campbell said. “They put her in jail and metaphorically threw away the key.”

Chris Schneider, a lawyer at Central California Legal Services, which was first alerted to Souvannarath’s plight, said the case also showed a lack of cultural understanding on the part of county officials. After more than two decades of dealing with Southeast Asian refugees, he said, the county still fails to grasp their fears and misunderstandings of Western medicine.

Last July, after Souvannarath stopped reporting to the health department and disappeared, health workers confronted the angry woman at her home. Souvannarath, whose children range from 16 to 33, was wielding a screwdriver and refusing to take her medication. Instead of sending a Laotian worker, county officials had sent a Hmong and then a Thai health worker to talk to her, according to records and interviews with family members.

“They also used an interpreter who was fluent in Hmong and knew only some Laotian,” Schneider said.

Souvannarath is back home under house arrest, awaiting a July 15 court appearance, where she must show that she is following the treatment regimen. Her family said she is continuing to take the medication even though she paces the halls all night, itching.

“She drove me crazy last night,” said her eldest daughter, 24-year-old Oudomphone. “She has a rash all over and she is scratching, scratching. . . . But no, she will not stop taking it.”