We agree with Richard Coker¹ that the vast majority of non-compliant cases of tuberculosis can be dealt with by a mixture of directly observed therapy (DOT) and inducements. However, when DOT fails in a few cases each year, despite intensive team effort and carrots such as housing or food vouchers, the Public Health Act may have to be invoked. We have had recourse to this measure four times in the past six months but, though providing valuable breathing space, it is extremely costly and proved ineffectual as a solution each time.

Once the patient is admitted there are still potential problems. Treatment cannot be enforced and patients can abscond. There have also been instances of patients assaulting staff, physically and sexually, issuing death threats, breaking hospital property, and terrorising other patients, even interfering with others' oxygen therapy. Dealing with such patients puts hospital staff and patients under unacceptable pressure and . . . [Full text of this article]