## Facts

- Ruby Washington was diagnosed with tuberculosis (TB) at a City of Milwaukee clinic, began medication, then stopped returning for follow-up and could not be located due to homelessness.
- The City obtained a court order requiring isolation and directly observed treatment under Wis. Stat. § 252.07.
- About two months later, the City served the order when Washington was hospitalized to deliver a baby; she threatened to leave, and the City sought judicial enforcement.
- Pending a hearing, Washington agreed to remain at the medical center; after the hearing, she agreed to live with her sister and report to the TB clinic for directly observed therapy.
- Washington soon left her sister’s home, failed to report for treatment, and was later arrested.
- The City sought contempt and long-term confinement under Wis. Stat. § 252.07(9), requesting confinement at the Milwaukee County Criminal Justice Facility (CJF) with treatment.
- Although Washington’s TB was not infectious at that time, the circuit court found that without treatment she would become contagious and threaten public health, and ordered confinement in the CJF for treatment.
- The court of appeals affirmed, concluding § 252.07(9) authorized confinement at the CJF and the placement did not violate constitutional rights.

## Issues

1. Whether Wis. Stat. § 252.07(9) authorizes a circuit court to confine a noncompliant TB patient in a county jail, or instead requires confinement in a medical facility and/or the least restrictive placement.
2. Whether confining a noncriminal TB patient in a jail facility for treatment under § 252.07(9) violates substantive due process or other constitutional protections.

## Decision

- The Wisconsin Supreme Court affirmed the court of appeals and the circuit court’s confinement order.
- The court held that § 252.07(9) permits confinement in the CJF and does not require confinement in a medical facility.
- The court construed the statute’s “no less restrictive alternative” language as addressing whether confinement is necessary, not requiring selection of the least restrictive facility once confinement is justified.
- The court held that, on this record, confinement in the CJF for treatment was not unconstitutional because it served a compelling public health purpose, followed statutory safeguards, and was tied to health necessity rather than punishment.

## Legal Principles

- A court may order long-term confinement of a noncompliant TB patient under Wis. Stat. § 252.07(9) when statutory prerequisites and findings supporting public health protection are met.
- Under § 252.07(9), the “no less restrictive alternative” requirement governs the decision to confine, not the selection of a least restrictive physical facility for confinement.
- Civil confinement for communicable disease control satisfies substantive due process when it is reasonably related to preventing disease spread, supported by evidence and judicial findings, implemented with procedural protections, and not excessive in relation to the public health objective.
- Confinement in a jail facility is not per se unconstitutional for civil public health purposes when the confinement is for treatment and public protection, not punishment, and is limited to the period reasonably necessary.

## Conclusion

The Wisconsin Supreme Court upheld a long-term TB confinement order placing a noncompliant patient in a county jail, concluding the TB statute allowed that placement once confinement was warranted and that the order, supported by medical findings and judicial oversight, did not violate due process.


City of Milwaukee v. Washington, 735 N.W.2d 111 (Wis. 2007)