/ 2 May 2007

Govt ‘has no policy’ to detain TB patients

No policy has been adopted to detain multi-drug or extensively drug-resistant tuberculosis (XDR-TB) patients, acting health minister Jeff Radebe said on Wednesday.

He was replying to a written question from Democratic Alliance health spokesperson Gareth Morgan.

“The department has sought advice on the detention of patients with drug-resistant TB from legal experts and the Medical Research Council (MRC),” the acting minister said.

The advice was that the department is required to operate within the context of the Bill of Rights, which is enshrined in the Constitution of the country, he noted.

“The Bill of Rights affords individual rights to every person and these have to be promoted, respected and protected. Detaining patients infected with XDR-TB will violate several human rights,” he said.

On the other hand, this form of TB is a public health issue and it is the department’s responsibility to uphold the constitutional rights of South Africans to an environment “that is not harmful to their health”.

“Taking all this into consideration, the current approach is to isolate patients with infectious XDR-TB until they are non-infectious after which they are discharged back to the community provided the continuum of care is guaranteed.”

This is done “following education and counselling of the patient and the immediate family about the disease”.

The treatment is provided after written consent is obtained, “which makes this a voluntary process”.

“It is only with patients who refuse voluntary hospitalisation where legal recourse is sought to enforce hospitalisation.”

He noted that this does not guarantee that the patient will take their medication and “we cannot enforce treatment considering the toxicity of the drugs used and the uncertainty around treatment success, as it would severely violate the individual’s right to freedom and security as well as the right to bodily integrity”.

“The dilemma lies with patients who have failed treatment and still remain infectious, as there are no third-line drugs for use as an option. This group of patients would have to be hospitalised indefinitely or until they die.”

He acknowledged that this would violate several constitutional rights, including freedom and security of the person from enforced detention and treatment. It also involves the right of those not infected to be protected from infection.

The department is in the process of developing the policy on isolation of patients with drug-resistant TB, “which will then take all these medico-legal issues into consideration”. — I-Net Bridge