Quarantine Powers, Biodefense, and Andrew Speaker

In January 2007, “Andrew Speaker (“Speaker”) underwent a chest X-ray and CT scan, which revealed an abnormality in his lungs.” However, tests results indicated that he did not have tuberculosis (“TB”). In March 2007, Fulton County officials informed Andrew Speaker that he was diagnosed with a form of non-infectious form of tuberculosis. He was prescribed a regimen of “first-line anti-TB drugs.” Fulton County officials confirmed the positive TB result, and further tests were ordered. These tests indicated that Speaker had MDR-TB. Fulton County officials told Speaker not to travel abroad for his upcoming wedding in Europe; however, he ignored them. Unbeknownst to any health official, Speaker departed Atlanta for Europe on May 12, 2007. Two weeks later, the Center for Disease Control (“CDC”) informed him that his diagnosis had changed and that he had a drug-resistant form of tuberculosis named XDR-TB. Speaker was in Rome at the time. CDC officials directed him to turn himself into Italian authorities for isolation and asked that he not return home on commercial airlines. Speaker was even placed on a no fly list by the CDC. Again, Speaker ignored CDC officials and returned to the United States via Canada. From Prague, Speaker flew back to Montreal on two commercial aircrafts, and on May 25, 2007, Speaker entered the United States from Canada by car. “Despite being aware of the border alert, the border guard allowed Speaker into the United States.” Once in the United States, CDC officials served Speaker with an isolation order and hospitalized him at Bellevue Hospital in New York City. CDC officials placed him in a secure part of the hospital, where he underwent a medical evaluation to determine the status of his TB. Speaker was then allowed to return to Atlanta, where he faced intense media scrutiny. He then was transferred to the National Jewish Medical Center in Denver for further treatment of his XDR-TB. Eventually, however, officials downgraded his diagnosis to MDR-TB as they had originally. Speaker had surgery to remove the lung infected with MDR-TB at the end of July, and he was declared non-contagious.Clearly, Speaker sparked significant interest in public health on both the national and international levels. Speaker’s initial disregard for United States authority created an opportunity for criticism of local, state, and federal public health laws, while Speaker’s subsequent disregard of authorities while abroad allowed for questioning of international public health law and in particular, the effectiveness of the International Health Regulations. This overview explains certain areas of national and international public health law, and Speaker’s impact on these areas.