Risk to Public Health

Case Study: Risk to Public Health

Ann Singer was first diagnosed with tuberculosis (TB) in February and immediately began treatment. In June of that year she was diagnosed with multidrug-resistant tuberculosis (MDR-TB), a strain of TB that is resistant to treatment using “first-line” drugs that are usually effective against TB. She was advised by county public health officials not to fly via commercial airlines because she would be putting others at risk. She was scheduled to be married in June, and then take an extended honeymoon throughout Europe. Despite the public health risk, she decided to go through with her plans. When she was in Paris, France, she was contacted by a representative from the United States Centers for Disease Control and Prevention (CDC), who advised her that it was discovered that she had extremely drug-resistant tuberculosis (XDR-TB). XDR-TB is very contagious and is extremely difficult to treat. Mrs. Singer was told that she was put on a no-fly list, and the only way she could fly back to the United States would be to charter a private plane. Mrs. Singer then booked a commercial flight that left earlier than the one she originally booked, flew to Denmark, and then to Canada, where she and her husband rented a car and drove to the United States. Despite an alert attached to her passport, she was not detained at the Canadian border. Mrs. Singer then voluntarily checked into a Denver hospital for treatment.

All passengers on all flights with Mrs. Singer were identified, contacted, and required to undergo TB testing. French public health officials asserted that the United States did not contact them in a timely fashion. The case made national and international news. Mrs. Singer considered suing the CDC for revealing her name and breaching her privacy.

Discussion Questions

1. How were the interests of Mrs. Singer and population health involved in this case?
2. There was no evidence of team-based care in this case. How do you think team-based care could have affected this case?
3. How could cooperation among healthcare professionals involved in this case (nationally and internationally) have been improved?
4. Do you think Mrs. Singer had a trusting relationship with the public health representatives? Explain why or why not and how this may have affected the outcome.
5. Is there an ethical dilemma present in this case? How would you manage the dilemma?
6. Did the various people involved in this case act with honesty and integrity in their relationships? Explain.

1. The interests of Mrs. Singer and population health were both involved in this case. Mrs. Singer’s interest was primarily focused on her personal well-being, including her desire to get married and travel to Europe. On the other hand, population health was at risk due to the highly contagious nature of XDR-TB. Mrs. Singer’s decision to travel despite being advised against it posed a significant public health risk, potentially exposing fellow travelers and people in multiple countries to a dangerous and difficult-to-treat disease.
2. Team-based care could have played a crucial role in this case. A multidisciplinary team consisting of healthcare professionals, public health officials, legal experts, and infectious disease specialists could have coordinated efforts more effectively. Such a team might have been able to provide better guidance to Mrs. Singer, address her concerns, and ensure she received appropriate treatment while minimizing the risk to public health.
3. Cooperation among healthcare professionals involved in this case, both nationally and internationally, could have been improved through better communication and collaboration. This could have included timely sharing of information about Mrs. Singer’s condition, travel plans, and potential contacts with health authorities in different countries. International cooperation and information sharing are vital when dealing with contagious diseases to prevent the spread of infections across borders.
4. Mrs. Singer’s trust in the public health representatives might have been compromised due to the revelation of her name and the breach of her privacy by the CDC. This breach could have negatively affected her trust in public health authorities, potentially making her less willing to cooperate and follow their guidance. Trust is essential in public health interventions, and maintaining trust should be a priority to ensure patients’ compliance with recommendations.
5. There is an ethical dilemma present in this case regarding the balance between individual rights and public health. Mrs. Singer’s decision to travel against medical advice raised questions about her right to make choices about her own life versus the duty of public health authorities to protect the broader population from the risk of infection. Managing this dilemma involves respecting individual autonomy while taking measures to mitigate public health risks. In this case, public health officials had to weigh these competing ethical considerations.
6. The actions of various people involved in this case may be subject to ethical evaluation. While public health officials and the CDC acted in the interest of protecting public health by notifying passengers and taking precautions, the breach of Mrs. Singer’s privacy raises concerns about how her personal information was handled. Whether these actions were conducted with honesty and integrity would depend on the intentions and motivations behind them, which may need to be further investigated and assessed in a legal and ethical context.