A woman with tuberculosis flees authorities after refusing to self-isolate. Here is a timeline of events, from his first treatment to his escape from arrest.

• A woman with untreated tuberculosis refused 16 court orders for home isolation.

• She was last seen boarding a bus to a casino in Tacoma, Washington.

• Tuberculosis can be treated with antibiotics, but it can be contagious if left alone.

A Washington state woman known to be contagious with tuberculosis was recently spotted boarding a bus to a local casino, in defiance of multiple court orders for home isolation and a warrant for her arrest against her, NBC News reported on April 12.

The woman, whose name has not been released but is referred to as “VN” in court documents, has refused multiple orders from the Tacoma-Pierce County Health Department (TPCHD) to isolate and resume treatment for the tuberculosis since she stopped taking her prescribed medication over a year ago.

Tuberculosis infections were once extremely deadly, but can now be treated with the antibiotic isoniazid – although it must be taken daily for six to 12 months depending on the severity of the disease. Failure to complete this treatment can make the disease more difficult to fight in the future, according to the American Lung Association.

Untreated TB can spread from person to person, but not as easily as the virus that causes COVID-19. Catching TB usually requires spending time with an infectious person in an enclosed space, local health officials said in a news release. Due to the low rates of tuberculosis in the United States, most people in the United States are not vaccinated against the disease.

For a disease as dangerous as tuberculosis, refusing treatment and ignoring isolation orders can have legal consequences. Here’s a timeline of the Washington woman’s treatment history and how she ended up on the run.

Patient started TB treatment but failed to complete it

The health department requested an involuntary isolation order for the infected woman on Jan. 18, 2022, the Tacoma News Tribune reported. According to court documents obtained by the local newspaper, the woman started treatment for tuberculosis, but did not complete full treatment.

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Since the woman refused to follow her prescribed treatment, health officials sought the help of Pierce County Superior Court to ensure she was not putting others at risk.

According to the News Tribune, the court issued an order stating that the patient must self-isolate at home for a specified period and cooperate with testing and treatment.

“It is less restrictive than a detention center; however, if such measures are not effective, more stringent measures may be sought,” the court order reads, according to the News Tribune.

As the patient flouted court orders, health officials doubled down

Through regular visits to the patient’s home and communication with the physicians responsible for her treatment, it was determined that she “(did) not remain at her home as per the court order, nor ( had she) been treated or tested to determine the status of her tuberculosis infection,” according to court documents obtained by the News Tribune.

This resulted in two more court orders for involuntary isolation being issued on February 24 and March 24, the local media reported.

In the request to renew those prescriptions, health officials warned that a patient’s actions could pose a threat to the health of the community. Failure to adhere to TB treatment can fuel the development of antibiotic-resistant strains, which are much harder to treat and more dangerous for those infected.

In March, the court also ordered an attorney to represent the woman, according to the News Tribune.

Court orders continued throughout 2022

On April 15, 2022, the health department filed another motion alleging that the patient failed to stay at her home “in accordance with the court order.”

The court renewed its order to continue involuntary solitary confinement on April 19, then again on May 17, June 28, July 27, August 25, September 27, October 21, November 18 and December 16, according to the News Tribune.

“Most of the people we contact are happy to get the treatment they need,” Nigel Turner, director of communicable disease control at the Tacoma-Pierce County Health Department, said in a news release. January 2023. “Sometimes people refuse treatment and isolation. When this happens, we take action to help keep the community safe.”

The patient had a car accident in January 2023

On January 11, 2023, health officials reported to the court that the patient had been involved in a car accident. She went to the emergency room complaining of chest pain the next day, the News Tribune reported.

“She reported that she was a passenger in a vehicle driven by another. This admission means she was not in isolation,” the health department petition said according to the News Tribune. While the isolation order would allow her to leave her home for medical treatment, the petition alleged that the patient failed to tell ER staff that she had active TB, and therefore put them at risk.

X-rays taken during her visit to the emergency room revealed that the woman’s tuberculosis had progressed, which would suggest that she was non-compliant with treatment, according to the health department. Additionally, she has also tested positive for COVID-19, further stating that she is not self-isolating at home.

A judge issued a warrant for her arrest in March 2023

After two more orders on Jan. 20 and Feb. 24, Pierce County Superior Court Judge Philip Sorensen issued a warrant for the arrest of the woman who had refused tuberculosis treatment for more than a year, reported the News Tribune. This means that the police have the ability to arrest and detain her and bring her to a facility where she will be treated for TB against her will.

The judge also upheld his previous orders, which required that the woman be confined to the county jail or another treatment and isolation facility until it is deemed safe to be released.

The woman’s attorney, Sarah Tofflemire, suggested her client might need a legal guardian to help her figure out what’s going on, according to the News Tribune. Court records show that the woman had a foreign language interpreter present for all proceedings, but she still did not acknowledge the existence of her own medical condition.

“She mainly focused on how she doesn’t like the paperwork coming to her house, not how important the process she is in,” Tofflemire said, according to the News Tribune. “She repeatedly threatened to kill herself in connection with papers served at her home,” and also spoke erratically and out of turn during court proceedings.

Last week she disappeared after getting on the bus to a local casino

In April, an officer following the woman saw her board a bus to a local casino, according to a court filing obtained by NBC News. For unknown reasons, the agent let her go.

Now the woman has been found in contempt of court and ordered to be treated against her will. But as of April 12, authorities had not located her since she was seen boarding the bus, NBC reported.

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