City of Milwaukee v. Washington
2007 WI 104, 304 Wis. 2d 98, 735 N.W.2d 111 (2007)
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Rule of Law:
Under Wisconsin's tuberculosis control statute, a court may order a non-compliant individual with tuberculosis confined to a jail if the jail can provide proper medical care and prevent the spread of the disease, and no less restrictive alternative placement exists. A court may only consider the cost of placement options after determining that multiple facilities meet these primary statutory requirements and that none is significantly less restrictive than the others.
Facts:
- On June 17, 2005, Ruby Washington was diagnosed with tuberculosis.
- After receiving initial medication, Washington, who was homeless, missed her next two appointments for directly-observed therapy and could not be located by the City of Milwaukee Health Department.
- On August 22, 2005, health officials found Washington at Aurora Sinai Medical Center after she had given birth and served her with treatment and isolation orders.
- After Washington threatened to leave the Medical Center, the parties stipulated that she would be released but must reside with her sister and report for treatment.
- Two days after her release, Washington left her sister's residence, was found by health officials appearing incoherent and agitated, and was detained by police.
- After being mistakenly released from the Milwaukee County Criminal Justice Facility (CJF) where she was being held, Washington went missing again.
- Upon being found on October 5, 2005, Washington admitted to the court that she had not taken her tuberculosis medication because 'it had slipped her mind.'
Procedural Posture:
- The City of Milwaukee petitioned the Milwaukee County Circuit Court to enforce treatment and isolation orders against Ruby Washington.
- After Washington violated a stipulated agreement for her release, the City filed a motion seeking her confinement in the Milwaukee County Criminal Justice Facility (CJF).
- The circuit court found Washington in violation of its prior orders and ordered her confined to the CJF pursuant to Wis. Stat. § 252.07(9).
- Washington, the appellant, appealed the placement decision to the Wisconsin Court of Appeals, arguing the CJF was not the least restrictive alternative.
- The court of appeals affirmed the circuit court's order, with the City of Milwaukee as the appellee.
- The Supreme Court of Wisconsin granted Washington's petition for review.
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Issue:
Does Wis. Stat. § 252.07(9) authorize a court to order a non-compliant tuberculosis patient confined to a jail, rather than a less restrictive medical facility, by considering the cost to taxpayers as a determining factor?
Opinions:
Majority - Louis B. Butler, Jr., J.
Yes. Wis. Stat. § 252.07(9) authorizes a court to order confinement to a jail if specific conditions are met. The court reasoned that the statutory term 'facility' is broad enough to include a jail, and the legislature's use of the word 'confine' rather than 'isolate' or 'quarantine' suggests a more secure placement was contemplated. The court held that the statute's 'no less restrictive alternative' requirement applies not only to the decision to confine but also to the choice of the place of confinement. Therefore, a court must first determine that no less restrictive alternative exists that can provide proper medical care and prevent the spread of the disease. Only after this analysis, if two or more facilities meet these criteria and are not substantially different in their level of restriction, may the court consider the relative cost as a tie-breaking factor. The court also disavowed the court of appeals' alternative holding that the confinement was justified under the remedial contempt statute, stating that the specific tuberculosis control statute was the exclusive and appropriate authority.
Analysis:
This decision provides a crucial interpretation of public health statutes that impinge on individual liberty. It establishes a clear, multi-step framework for courts to follow when ordering involuntary confinement for public health reasons, prioritizing medical necessity and the least restrictive means over fiscal concerns. By allowing cost to be considered only as a secondary, tie-breaking factor, the court balances the practical realities of public finance with the constitutional imperative to minimize intrusions on personal freedom. This case sets a precedent for how courts must analyze the placement of individuals in non-punitive, health-related confinement, ensuring that facilities like jails are a last resort rather than a first choice driven by budget.
