The TB Lawyer

When I read this a couple days ago, I was incredulous. How many things went wrong? What, if anything, should be done?

Andrew Speaker would be thrown in jail if he had done these actions with AIDS

First, what is TB? Many people in the United States probably know it by name, but have little or no experience with it. TB is the common acronym for tuberculosis, the disease caused by the bacterium Mycobacterium tuberculosis.

For those unfamiliar with microbiology, think of a bacterium (singular for bacteria) as a pill. Some come in ball shapes, others in more elongated brick shapes, just like your medicine. The genus Mycobacteria is a group of bacteria characterized by a brick shape and a thick waxy coat around the bacterium--like a long gel cap.

Mycobacteria are typically the "jungle ulcers" and tropical diseases you think about when you see movies or read history books. They range from Mycobacterium ulcerans, the cause of Buruli ulcer (my personal favorite and target of research for many years), to Mycobacterium leprae, cause of Leprosy, to M. tuberculosis.



M. tuberculosis typically causes a respiratory disease. The bacteria get into the lungs of a person, and your immune system tries to "wall it off" by encasing it because it is hard to kill. When looking at x-rays, you can usually see white spots showing these hard encasings in a person that had infectious TB in the past. Someone with TB will have "chronic, productive cough, low-grade fever, night sweats, easy fatigability, and weight loss" (Medical Microbiology, 4ed, Samuel Baron, ed.). As the disease progresses, the sick person starts coughing up blood.

This month I am at a county hospital in Houston, TX and have seen a couple of tuberculosis patients. Pulmonary TB is highly infectious, and every patient suspected of having TB is put in isolation. Everyone who interacts with the patient must wear protective masks, because TB is spread by coughing.

How bad is this disease? In America there are about 5 cases per 100,000 people (CDC data, 2003). In the rest of the world, it is

the second-largest cause of death from an infectious agent worldwide—killing approximately 1.7 million people in 2003. Despite steady drops in the number of cases in some parts of the world, the number of new cases appears to be growing, with an estimated 8.8 million new cases in 2003. (Disease Control Priorities Project, Tuberculosis, fact sheet)

Approximately 1/3 of the world's population is infected with latent TB, but fortunately only about 10% progress to disease every year.

The short synopsis of Andrew Speaker's journey is thus: he was diagnosed with TB in America, and told not to go anywhere. At that time they didn't know it was the extremely drug-resistant strain he actually has (XDR-TB). He goes against medical advice and flies to Europe for his wedding. Then it is confirmed he has XDR-TB and he goes against medical advice again and against the USA "no fly" policy and flies into Canada and drives into the US. Now he's in isolation in Denver.

You can get a more detailed timeline based on Speaker's view of the events, at abcnews.go.com

In all this ruckus, people have forgotten the most important point--Speaker willingly flaunted medical advice more than once, blatantly snuck into the United States and, most importantly, exposed so many people to this disease.

Mycobacteria are typically the "jungle ulcers" and tropical diseases you think about when you see movies or read history books

He can blame his actions on ignorance, or "he said, she said" stuff, but the truth is he's a bright young man and can't seriously feel the ONLY place he could get treatment is in Denver, CO. He can't seriously believe that when doctors in Europe tell him not to leave, after already being told that in America, that he knows better than them and he should be ok to go to Canada. He can't be a good lawyer when he blatantly flaunts the law he went to school to learn and prosecute and adjudicate.

Let's change the name for a minute. Instead of TB, it's AIDS. Imagine with me. Andrew is diagnosed with AIDS. He is infectious, but doesn't look overly sick. Doctors admonish him to be celibate or practice safe sex. He flaunts their advice and sleeps around without protection and without telling his partners he's sick.

Then he moves to another area, and the doctors there tell him he has a rapidly mutating form of the virus that depletes the immune system far faster than the more prevalent form. They tell him again to be celibate/use protection and that he is required to tell his partners he has AIDS.

Speaker proceeds to again have unprotected sex with many people and not tell them he's infected. Finally, he checks into a hospital.

Andrew Speaker would be thrown in jail if he had done these actions with AIDS. In America it is a crime to knowingly infect or expose someone to HIV. But Speaker had TB, not AIDS. He had a disease that is easier to transmit, infects more people, and kills about as many people. He knowingly put other people at risk many times -- especially when flying to Canada WITHOUT wearing a mask and AGAINST both medical advice and US law.



Many people walk out of hospitals against medical advice every day. Usually they only hurt themselves. TB is a special case. If you do not follow your treatment regimen, you can be locked in isolation until you finish your medication--9 to 12 months. So, a precedent was set by making TB a special disease under the law, and another set by prosecuting special diseases in criminal court (AIDS).

Given what Andrew Speaker did, passengers on that plane have a very good basis for a civil suit, and possibly criminal charges, due to his reckless endangerment of their lives. And that opens up a whole new can of worms...