A Washington state woman who refused treatment for tuberculosis for more than a year remains free three months after a civil warrant was issued for her arrest, officials said this week.

Tacoma-Pierce County Health Department he said on Monday that the woman, identified in court documents as VN, was still refusing treatment and that a judge on Friday extended a civil injunction he issued in February authorizing law enforcement to detain her.

Sometime after that, the woman was seen leaving her home and taking a city bus to a local casino, according to an April court filing. VN’s lawyer did not immediately respond to a request for comment on Tuesday.

The Ministry of Health said so it was only the third time in 20 years that she had to seek a court order to detain a patient refusing treatment for TB, the world’s second-biggest infectious disease killer after Covid-19. TB, a disease caused by the bacteria Mycobacterium tuberculosis that spreads from infected people through the air, killed 1.6 million people in 2021, according to the World Health Organization.

A local health department official, who was not named, “found or had reason to believe” that the woman still had TB, according to a May 10 court filing. It was not clear from the region’s last statement what her condition was this week.

At a hearing Friday, Pierce County Superior Court Judge Philip Sorensen extended the warrant he first issued on Feb. 24.

In a February order, Judge Sorensen said he was issuing the warrant after the woman refused or failed to comply with previous orders to take medication or self-isolate. He also said she “did not resume treatment,” suggesting the woman had taken medication at one point.

Sgt. Darren Moss, spokesman for the Pierce County Sheriff’s Department, said in an email Tuesday that the woman is not in custody.

“I can’t give any information about how we’re trying to find her, where we’re looking, or any other details because that might frustrate the efforts of our agents,” he said.

If the warrant is executed, the woman will be held at the Pierce County Facility. She would be tested and treated at the facility until she was determined not to pose a threat to public health.

Patricia Jackson, chief of the Pierce County Sheriff’s Department’s Bureau of Corrections, said in an April court filing that she ordered surveillance on the woman to get information so officers could make a safe arrest.

That happened after a police officer saw her go to a local casino, the filing said. The constable said that in the following days, the woman was not at home and her family members did not respond to attempts to contact them. Ms. Jackson said in the filing that she ordered the officer to stop the surveillance until a later date.

On May 1, a person who identified himself as the woman’s son called the health department and asked if his mother had missed an appointment and when the next appointment would be, according to court filings. The next meeting is scheduled for June 23.

According to the Department of Health, there are about 20 cases of active TB in Pierce County each year, and active, untreated infections are a risk to the community. Symptoms depend on where the infection is in the body and may include a severe cough that lasts for three weeks or more, fatigue, weight loss and fever, according to the Centers for Disease Control and Prevention. Most people recover fully from TB with medication, but it can be fatal if left untreated.

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