TB Patient Quarantine Raises Legal Concerns

ATLANTA – The case of a jet-setting tuberculosis patient might soon shift from the hospital wards to the courts. The patient, Andrew Speaker, an Atlanta personal injury attorney, could sue the federal government for being quarantined on the basis of federal regulations that some scholars see as unconstitutional.

Or Speaker could be sued by fellow airline passengers, especially if any caught the disease from him — which some legal scholars say is much more likely.

"He may be personally liable if someone contracts TB" from being near him on his recent flights to and from Europe, said Peter Jacobson, a University of Michigan professor of public health law. "I can see a jury coming down very hard on someone like that who willfully ignored advice not to travel."

Speaker flew to Europe for his wedding and honeymoon after being advised by health officials not to make the trip because he had TB. Then, while he was in Rome, U.S. health officials told him to stay put because further tests showed he had an even more dangerous, drug-resistant type of TB than previously thought.

The 31-year-old newlywed disregarded those instructions, taking commercial jets to Prague and then Montreal in an attempt to sneak back into the United States.

In an interview earlier this week with The Atlanta Journal-Constitution, Speaker said he declined to report to Italian health officials because he believed the only lifesaving care for his condition was available in the U.S.

"I'm a very well-educated, successful, intelligent person," he told the newspaper. "This is insane to me that I have an armed guard outside my door when I've cooperated with everything other than the whole solitary-confinement-in-Italy thing."

A barrage of criticism was posted Thursday on the Web site of a Georgia newspaper that carried Speaker's engagement announcement and allows outsiders to post comments.

Under a picture of the smiling couple on the Appen Newspapers Web page, a person signed as 'Concerned Citizen' wrote: "Warned not to fly but just put your personal pleasure above the safety of other passengers. I hope you get sued by potential victims for your actions."

Lawrence Gostin, a public health law expert at Georgetown University, agreed with those who feel Speaker has exposed himself to possible litigation.

"There are a number of cases that say a person who negligently transmits an infectious disease could be held liable," he said.

Perhaps the most significant legal issues in Speaker's case concern the federal quarantine law, and the difficulty federal health officials had trying to learn the identities of those who were exposed to Speaker, Gostin said.

The quarantine order was the first issued by the federal government since a patient with smallpox was isolated in 1963, according to the Centers for Disease Control and Prevention.

CDC officials have been requesting changes in the nation's antiquated quarantine laws to gain easier access to airline and ship passenger lists, provide patients a clearer appeals process when subjected to quarantines and give health officials explicit authority to offer vaccinations and medical treatment to quarantined people.

In the past week, Speaker was quarantined in New York City and then again — under guard — at an Atlanta hospital. The quarantine order was not approved by a judge, but rather issued under the CDC's administrative powers.

There's a reason for that, Jacobson said: In certain rare instances, such action is deemed necessary to avoid legal delays in rapidly protecting the public from a disease-carrying person.

While Speaker was still in Atlanta on Wednesday, a CDC official said Speaker had the right to request an administrative hearing to appeal the quarantine order but had not. (On Thursday, Speaker was flown to a Denver hospital, where he is no longer under guard.)

The legal rights of a quarantined person, including the right to request a hearing, are not clear under current law, Gostin said. Some legal scholars said the absence of clear guidelines could lead to a legal tangle that might stall government quarantine actions during an outbreak of pandemic flu or other contagious diseases.

Speaker can challenge the constitutionality of the quarantine order, and might even be able to seek a federal payment for damages, Gostin said.

Airlines can be slow to hand over passenger information because of concerns of violating customer privacy. It was not until late Wednesday that the CDC got full information from Air France about U.S. passengers on Speaker's May 12 flight from Atlanta to Paris.

One proposed change in the law would require airlines and cruise lines to electronically submit passenger and crew lists to the CDC upon request.