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.

Case Study: Risk to Public Health

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