 We open with Ms. Spittle trying to obtain information from Jane Woe about who she's been in contact with. And Jane is not talking to anyone. Jane is angry with Ms. Spittle for putting her into isolation. She thinks Ms. Spittle is the enemy. Since she works for those commies who arrested her because she was trying to be nice to someone, and how was she to know he was an undercover cop? All she was trying to do was give him a little taste of the good life. I know you came in as a Jane Woe, but I was able to locate your chart from your last incarceration. And you gave your name as Morning Glory Farthington. Which one would you rather be called? Um, but if you gotta call me something, call me Morning Glory. Well, Morning Glory, do you understand your disease? What disease? I don't have a disease. I've been tested and tested. Up the wazoo, had my HIV test, came out clean as a whistle. You're tuberculosis. Do you understand why you're being fussed over and why you're in this isolation cell? No, I don't have no stinkin' tuberculosis. I have a smoker's cough, you know? I wish your people would just leave me alone. I'm only trying to help. I want you to understand why you need to take your medicine and how important it is for us to get a good specimen from you so we can diagnose your disease. I told you once, I told you twice, I don't have no disease. I gave you one spit, I ain't giving up no more body parts. Well, we can talk about that later. Right now, I need for you to take your medicine. I want you to swallow all these pills. And then I gotta check your mouth afterwards. You can't make me take them, I won't. I know my rights. You can't force me to take medicine. I have the right to refuse. Hey, just leave me alone. I don't want to talk to you no more. Okay, you win. But if I call Ms. Secretion over at the health department, will you talk to her then? Well... Need your TB clinic, Ms. Lucretia Secretion, please? Ms. Mucosa Spittle calls the health department. She speaks with her friend Lucretia Secretion and they agree to meet with Morning Glory Farthington, a.k.a. Jane Woe. Ms. Lucretia Secretion arrives at the jail and tries to enter the jail with all of her tools. These include her scissors, a pocket knife, a pepper spray bottle attached to her key chain, and her stethoscope around her neck. Good morning. May I help you, please? Yes, I'm Lucretia Secretion from Beach County Health Department. I'm here to see Mucosa Spittle in medical. Well, you can't come in here with all that paraphernalia. You're gonna have to leave it here and I'll lock it up for you until you're ready to leave. You mean my pepper spray? That's exactly what I'm calling the listeners. My knife? Hello, Ms. Spittle. We have a Lucretia Secretion from the Beach County Health Department here. I'll bring her up to see you. Everything? Is that everything? Yeah, that's it. Follow me, please. Okay. In the medical clinic, Ms. Spittle and Ms. Secretion talk about Jane's incarceration. Ms. Secretion reviews the medical record and Ms. Spittle explains how long Jane Woe, a.k.a. Morning Glory Farthington, has been in jail. Jane, or should I say Morning Glory Farthington, is being difficult. She won't take her medication and I can't get her to understand her diagnosis, much less how she got it and who she's been in contact with. Well, it certainly sounds like you have a problem on your hands. But first, let me look at the cell she's in as she's been in negative pressure the whole time. Absolutely. I've checked them every day with the readout from those maintenance people and they check out perfectly. But I did notice that I got a blast of air coming from under the cell door a few days ago and I'm not sure what that was. That could be a problem. Let's take this tissue and check it quickly. First, we need to put a mask on. Do you have some? I've got these right here. Are these particulate respirator masks? Well, these are the ones the jail let me by. Do you have any masks that say N95 on them? These look like surgical masks. Oh, yeah. I have that one box that the representative from the company gave me. Some place in here in this drawer. I got lots of stuff in this drawer. It's okay. There's that slinky that it gave me. Extra heart just in case. Liver. Never can be too careful. Oh, wait. What is this? My extra set of lungs just in case. N95. That's it. That's what we need. That's what we need. That's the ones that you make exterior staff wears whenever they go in the cell with a TV patient or talk to a TV patient. This will help protect them from getting tuberculosis. These surgical masks just don't do it. This is what you need the inmate to wear whenever they go out of the room. Let's go ahead and put these on and take the tissue and go check out that room. You have positive pressure here. That means that all this bad air is going into the corridor and circulating throughout the whole area. Those people who have been working in this area have been exposed. It depends on how often and how long they've been working in the area as to how much they've been exposed. We'll need to test your infirmary staff, the deputies, anyone who is in here. Then we'll need to do a follow-up retest in 12 weeks to see if anyone else has converted. You say the cell has been working in the past? Absolutely. But like I said, about four days ago I did notice that air coming from under that door. Wait, I have an idea? Deputy, can you come open this cell door for us? You're going to need to put this mask on any time you open that cell door. Do I have to wear this thing? Yes, you do. It's a special N95 mask. It'll protect you from any germs she has. Pinch the nose tight. Good. Okay, buzz us in please. Stand away from the door. Ms. Farlington, stand away from the door. Ms. Farlington, what did you put that up in advance? I think it's about five days ago. You all remember when I needed that extra blanket and I kept complaining? What am I to do? I'm freezing to death in here. Well, you're going to need to take it down. So if you would take it down, then I'll come back and check on it, please. All right. We really need to clean those vents and we're going to need to include those vent checks and the cell checks every day. Morning, Glory. Since we're here in your cell, I'd like to ask you something about your tuberculosis. I understand you've had a cough for quite some time. Is that correct? Yeah. A little while back I was at the hospital emergency room, you know, and they said something was bad wrong with my lungs. And when was that? Well, it was just around the time I got arrested. You know, I was at the bus stop. I was waiting for the bus to go to the doctor, but these stupid cocks picked me up. Can you believe that? Honest, I was on my way to the doctor to have this looked at. And when was that? Two weeks ago, four weeks ago? Oh, let's see. It was about a month ago. Okay. Okay, do you understand why we had to isolate you? Why you're in this cell by yourself? Yeah, because I'm obstructed. I might make somebody else sick, but heck, that's okay with me. Actually, you're in what they call infectious, meaning you could give your disease to others by just coughing, singing, laughing, or talking. Anyone who shares the same airspace with you could become infected with tuberculosis if they stand in confined space for any length of time with you. Well, good then. I've infected everybody so I can go, right? No, you have to be isolated from everyone until you start feeling better. Even if you get released from jail, you still need to stay away from others until you've taken your medicine for a while. And then we are able to check your sputum to be sure it no longer has any TB germs in it. Remember the sputum specimens that we've been trying to get from you in the morning that you just won't give us? That's what she's talking about. We only need three specimens in a row without those TB germs. And after you've taken your medicine for two weeks, that's when you can get out of here. Well, that's part of it. But we need to be sure you're feeling better also. We need to see that you are coughing less, your appetite is improving, and that you're feeling better before we can take you out of isolation. And it's really important for you to take all your medicine every day. Make sure that you get better. You will need to take your medication for about six months to be sure that we get all of the TB disease. Whoa, this is way too much for me. You know, I know my rights. These pills, they make me sick to my stomach. They want to have them on an empty stomach. Hey, I got to have food with this. Well, if I get you some milk or some food, would you take your medicine then? That's not a good idea. The medicines need to be taken on an empty stomach, or maybe with something light like applesauce, jello. Something like that might work, but nothing heavy, no heavy foods. It cuts down on the absorption of the medications from the stomach, and it's almost like she's only taking half the dose. Well, that's good. We can double up on her medication and then give her the milk or the boost. No, I'm afraid that won't work either. You're going to have to trust me on that. The medication just does not work that way. You need to have her take something light like applesauce or jello. Hey, applesauce, jello, strawberry jello. What about that? That would work. Will you take it with that? Well, we can't promise anything, but I will see what we can arrange with the kitchen. I just can't guarantee anything. Right now, I want you to take all of your pills, and we can give you something for the nausea if you continue to have any. I don't think so. You know, I'm going to refuse right now, but I don't know, maybe later. Well, of course you have the right to refuse, dear. Actually, Morning Glory, you don't have the right to refuse. Did you know that tuberculosis is considered a public health threat? And because of that, there are special laws that say you don't have the right to refuse examination or treatment. We can actually hold you in jail or put you in a special TB hospital under court order and have the judge state that you must have directly observed therapy. That means that someone must watch you take your medications and you cannot leave until you complete treatment for your tuberculosis. And the doctor says that you are cured. If I know Morning Glory, I would say watch her swallow her medications. Never mind just directly observed. Very true. Taking them and swallowing them are two different things. So, will you take your pills? Oh, man, I guess if I have to, but I sure as heck don't have to like it. Morning Glory, we need to find out who you've been in contact with since you've started with your cough. Can you tell me who you've been talking to recently? Man, you guys just leave me alone. I'm tired. I'm not going to tell you nothing. I'm just going to lay down and I'm going to rest and just leave me alone. I understand, but I'll be back. I do need to talk to you some more, but another day will be fine. If you get released from jail before I return, you must contact me at the health department. If you don't, we will come looking for you. Let me give you one of my cards. If you get released from jail and have problems getting to the health department, call me. I can arrange transportation for you. Well, I guess that'd be all right if you came back, but please get this lady out of here. I don't want to talk to her no more. No problem. I'll come back when nobody can hear our conversation. That'd be fine with me. Morning, Glory. You know that won't happen. You are not allowed to speak with anyone alone. You have to have a deputy with you at all times. Don't you remember? Yeah, but shoot, I thought maybe they could bring me some food or maybe some clean underwear or something. Absolutely not. You know that's against the rules, but we'll talk more later. You go ahead and rest now. Back in the medical clinic area, Ms. Biddle and Ms. Secretion discuss implementing a contact investigation. What a difficult person. I don't know how I'm going to find out who she's been in contact with. She just won't talk to me at all. Well, you can start by locating who she's been in close contact with while she's been in jail. Everyone who was in the cell with her, all of them are included. Since she's been coughing the whole time she's been in jail, you will probably need to know everywhere she's been. And since the air flow has been bad in the isolation room, you probably should just test the whole jail. It certainly won't hurt. I wish reading in this here MMWR book about contact investigations and it doesn't say anything about jails. But I thought that since jails is something I know a lot about and contact investigation is something you know a lot about, we might be able to put our heads together and come up with a list that might be doable. I think that's a wonderful idea. We'll start with her close contacts, those people who have been with her for long periods of time. This is the beginning of the concentric circle contact and investigation approach. Can you identify those people and get them tested? I'll have to get with the classification people and I'm sure I'll be able to check her chart to see what healthcare workers spoke with her. Oh no, I'm going to have to get with the jail administrator and the lieutenant. Let them know and see what officers worked on her housing pod. Is that enough? It's a great start. I'll also need a list of everyone who was in contact with her who has been released to the community so I can follow up on them. I'll need addresses so I can contact them to have them come into the health department for a risk assessment and testing. That reminds me. I'm also going to need to put a list together of all the inmates who have been in her cell that have gone on to prison. Boy, this is going to be a lot of work. When did you say this needs to be done? Well, the guidelines state that it should be initiated within seven working days of identification of a suspect or an active case of TB. We can come in and help you if you need us. Oh yeah, absolutely. The hardest part's going to be getting those lists put together. Actually, the hardest part will be the 12-week read test because people aren't always where they need to be. Oh yeah, I forgot about that one. What about the ones that get released after the first skin test? Well, that's why we need to have addresses, not just names and dates of birth. It's the health department's responsibility to follow up on those people who are no longer in jail and are living in the community. Okay, I'll start cracking them right away. Boy, what a nightmare.