Diseased inmate placed in forced isolation

Molly Ball

Tuesday, May 31, 2005 | 11:17 a.m.

A Clark County jail inmate who has tuberculosis was quarantined by a judge on Friday after he refused to take his medication, in the first-ever use of a 2003 Nevada statute that allows involuntary isolation of those with contagious diseases.

In a court hearing Friday, District Judge Jennifer Togliatti reasoned with 55-year-old inmate Juan Marin via videoconference until he agreed to take the medicines. The judge said she didn't want to forcibly medicate him except as a last resort.

"The reason I'm here in a matter of your health is it's not just about you right now," Togliatti told Marin. "Right now, you pose a risk to everybody around you."

It wasn't clear why Marin, a bespectacled man wearing a hospital mask and gown, had refused to be medicated.

He told the judge both that he believed himself to be cured and that he was angry that he hadn't received disability benefits from the federal government, and he seemed generally indignant.

"These people are manipulating my life for no reason," he said.

The case was brought by the county's chief health officer, Dr. Donald Kwalick, who is authorized under the new statute to petition the court for forced quarantine of infectious individuals.

"It's the first time that we understand that anyone has utilized this procedure," said Stephen Minagil, the Clark County Health District's attorney.

In 2003 the state Legislature passed a number of public health measures designed to combat potential bioterrorism. One such measure, NRS 441.600, sets out the process by which people with diseases can be isolated against their will.

Under the statute, free individuals could be taken from their homes if they were sick and uncooperative. In this case, the point was somewhat moot because, as an inmate of the Clark County Detention Center, Marin was already subject to forced isolation from the general population, Togliatti noted.

"While he's in custody on the probation violation, this is an intellectual exercise," the judge said. Marin is being held without bail.

Marin was on probation for drug charges when he was picked up by U.S. Marshals April 15 for an unspecified probation violation. The arrest was part of a multi-agency fugitive task force, said Supervisory Deputy U.S. Marshal Pat Sedoti, who coordinates the task force.

Marin had previously been receiving tuberculosis treatment from the Health District, but had stopped, and did not resurface again until his arrest, Kwalick said at the hearing.

An initial test for active tuberculosis came up negative, but a more detailed test -- a sputum culture to check for drug resistance -- has not yet come back from the laboratory, Kwalick said.

Under public health guidelines, Marin is still considered contagious, Kwalick said. But Marin said he had been told that his treatment would be over in six months, and it had been six months, so he didn't see why he should still have to take anything.

Tuberculosis, a respiratory illness that spreads through coughing and sneezing, kills about 2 million people each year worldwide, according to the World Health Organization. It is curable with a long and intensive course of treatment.

Clark County sees 70 to 75 new cases of active tuberculosis each year, most of them in foreign-born individuals, according to the county's public health nurse manager, Maryellen Harrell. So far in 2005, there have been 23 cases, 75 percent of them foreign-born.

These people pick up the disease in the areas of the world where it is endemic and carry it in its latent form. Later on, after they've come here, the disease becomes active.

Health officials say tuberculosis sufferers are often reluctant to take the life-saving medications for a variety of reasons, from superstition to unpleasant side effects. Because of this reluctance, health workers insist on "directly observed therapy," wherein the patient is watched as he swallows his pills. Kwalick said Marin refused to participate in such a regimen.

"He has refused my nurses at the jail from directly observed therapy," Kwalick told the judge.

Togliatti extracted a promise from Marin that he would take the pills in exchange for arranging to resolve the issue as quickly as possible. Marin gave his word.

Marin is scheduled to come back to court on June 13, when Togliatti said she will check on his medication regimen, his medical tests and the status of his criminal case.