State TB law makeover in works for Colorado

MDR patients must finish treatment

At press time, Colorado was a breath away from getting a new TB statute, one that would allow TB controllers to confine non-adherent patients with multidrug-resistant (MDR) TB until they have finished their course of treatment.

The old statute, which was last updated in 1960, specifies that recalcitrant patients can be confined only until they’re rendered "noninfectious." The new law would extend the reach of the statute in the most logical of ways, its supporters say, as well as take aim at patients with the most dangerous kind of disease.

The trouble with the wording of the original law, crafted back when what it meant to be "infectious" wasn’t as clearly understood, is that lawyers often interpret it to mean "no longer actively infectious," notes John Sbarbaro, MD, professor of medicine at the University of Colorado Health Sciences Center in Denver. "But even if you no longer have a [sputum-smear] positive culture, you can still reactivate," he adds. "If you’re going to protect the community, you’ve got to do it based on the reality of pathogenesis."

Hedging bets by not asking too much

It would have been useful to extend the state’s power to hold all non-adherent patients, drug-sensitive ones included, until they had finished treatment, says Ned Calonge, MD, the TB program’s medical director. "But we worried that that would jeopardize passage of the new statute, and we wouldn’t get what we wanted the most, which was the ability to hold those with MDR-TB." The new statute also codifies the state’s ability to conduct contact investigations, he adds.

All signs pointed to the new statute being approved and enacted. By last month, the bill had cleared three readings in the legislature and awaited only a signature from the governor.