## Facts

- Newark sought to prevent transmission of active, communicable tuberculosis (TB) during a local resurgence of the disease.
- J.S., a 40-year-old homeless man, had active TB confirmed by sputum testing and also had HIV disease.
- Hospital staff reported repeated noncompliance with infection-control measures and treatment, including leaving isolation, failing to wear a mask, and attempting to leave the hospital against medical advice.
- J.S. was found outside isolation in common areas, including the hospital lobby, and at one point entered a pediatrics ward.
- After prior discharges, J.S. failed to comply with therapy and missed outpatient follow-up, leading providers to view him as noncompliant.
- Newark filed a verified complaint and obtained an ex parte temporary commitment order and an order to show cause.
- At the return date, the court conducted an adversarial commitment hearing with counsel for J.S., sworn testimony, and cross-examination; participation occurred by speaker telephone linking chambers and J.S.’s hospital room.
- Newark narrowed its request to hospital confinement only while J.S. was receiving treatment for active TB.

## Issues

1. Whether New Jersey’s TB control statute authorizes involuntary hospital commitment of a person with active, communicable TB.
2. If commitment is authorized, what procedures and evidentiary standards are required to satisfy due process under the federal and state constitutions.
3. Whether involuntary confinement of a person with TB and HIV complies with the Americans with Disabilities Act when less restrictive alternatives are considered.

## Decision

- The court held that New Jersey law authorizes involuntary hospital commitment for TB when the person is a menace to the community.
- The court required that TB-commitment applications follow the standards and procedures used for involuntary civil commitment proceedings.
- The court ruled that, when those procedures are followed and the least restrictive means is selected, the requirements of due process and the ADA are met.
- The court found that the City proved the need for J.S.’s commitment based on active contagious TB and demonstrated noncompliance creating a risk of transmission.
- The court entered a final order confining J.S. in the hospital during treatment for active TB, with confinement tied to continuing necessity and cessation of infectiousness.

## Legal Principles

- Statutory public-health authority to confine infectious TB patients must be implemented through judicial civil-commitment procedures rather than unstructured detention.
- The government must prove the necessity for involuntary confinement under civil-commitment standards, including clear and convincing evidence and findings that the person’s conduct and condition create a danger to others (a “menace to the community” in the TB context).
- Required procedural safeguards include notice, counsel, an adversarial hearing, sworn testimony, the opportunity for cross-examination, and a record.
- Due process requires consideration of less restrictive alternatives; inpatient confinement must be the least restrictive means consistent with preventing transmission and securing effective treatment.
- The ADA applies to TB and HIV in this setting; a public entity may impose confinement only when the individual poses a direct threat that cannot be adequately reduced by reasonable modifications or less restrictive measures.

## Conclusion

The court upheld Newark’s request to confine a noncompliant, actively infectious TB patient in a hospital, holding that TB commitments must be handled as civil commitments with full procedural protections and a least-restrictive-means approach that satisfies due process and the ADA.


City of Newark v. J.S., 279 N.J. Super. 178, 652 A.2d 265 (N.J. Super. Ct. Law Div. 1993)