A woman with tuberculosis is on the run from authorities after refusing to isolate. Here's a timeline of events, from her first treatment to evading arrest.

• A woman with untreated tuberculosis has refused 16 court orders to isolate at home.
• She was last spotted boarding a bus to a casino in Tacoma, Washington.
• Tuberculosis can be treated with antibiotics, but it can be contagious if left alone.

A Washington state woman known to be contagious with tuberculosis was recently spotted boarding a bus to a local casino, in defiance of several court orders to isolate at home and a warrant for her arrest, NBC News reported April 12.

The woman, whose name has not been released to the public but is referred to as "V.N." in court documents, has refused multiple orders from the Tacoma-Pierce County Health Department (TPCHD) to isolate and resume treatment for TB since she stopped taking her prescribed medication more than a year ago.

Tuberculosis infections were once extremely deadly, but now can be treated with the antibiotic isoniazid — though it must be taken daily for six to 12 months depending on the severity of disease. Not completing that course of treatment can make the disease harder to fight in the future, according to the American Lung Association.

Untreated TB can spread from person to person, but not as easily as the virus that causes COVID-19. Catching TB usually requires spending extended time with a contagious person in a closed space, local health officials said in a news release. Because of low rates of tuberculosis in the United States, most people in the US aren't vaccinated against the disease. 

For a disease that's as dangerous as TB, refusing treatment and ignoring isolation orders can lead to legal consequences. Here's a timeline of the Washington woman's treatment history and how she ended up on the run.

The patient started treatment for TB, but failed to complete it

The health department requested an involuntary isolation order for the infected woman on January 18, 2022, the Tacoma News Tribune reported. According to court filings obtained by the local newspaper, the woman started treatment for TB, but didn't complete the full course of medication.

Since the woman declined to follow through with her prescribed treatment, health officials enlisted the help of the Pierce County Superior Court to make sure she was not putting others at risk.

According to the News Tribune, the court issued an order stating that the patient must isolate at home for a set period of time and cooperate with testing and treatment. 

"This is less restrictive than a detention facility; however if such measures are not effective, more stringent measures may be requested," the court order read, per the News Tribune. 

As the patient flouted court orders, health officials doubled down

Through regular visits to the patient's residence and communication with the doctors in charge of her treatment, it was determined that she "[had] not remained in her residence in accord with the court's order, nor [had] she treated or tested to determine the status of her tuberculosis infection," according to court filings obtained by the News Tribune.

This resulted in two more court orders for involuntary isolation issued February 24 and March 24, the local news outlet reported.

In the request for renewal of these orders, health officials warned that one patient's actions could pose a threat to the health of the community. Failure to comply with TB treatment can fuel the development of antibiotic-resistant strains, which are much harder to treat and more dangerous to those infected.

In March, the court also ordered an attorney to represent the woman, according to the News Tribune.  

The court orders continued throughout 2022

On April 15 2022, the health department filed another petition alleging that the patient had not remained in her residence "in accord with the court's order." 

The court renewed its order for continued involuntary isolation on April 19, and then again on May 17, June 28, July 27, August 25, September 27, October 21, November 18 and December 16, according to the News Tribune.

"Most people we contact are happy to get the treatment they need," Nigel Turner, director of Communicable Disease Control at the Tacoma-Pierce County Health Department, said in a news release in January 2023. "Occasionally people refuse treatment and isolation. When that happens, we take steps to help keep the community safe." 

The patient was in a car crash in January 2023

On January 11 2023, health officials reported to the court that the patient was involved in a car wreck. She visited an emergency department complaining of chest pains the next day, the News Tribune reported.

"She reported that she was a passenger in a vehicle driven by another. This admission means that she was not in isolation," the health department's petition said per the News Tribune.  While the isolation order would permit her to leave her home for medical care, the petition alleged that the patient did not tell the ER staff that she had active TB, and therefore put them at risk.

X-rays taken during her ER visit revealed that the woman's TB had progressed, which would suggest that she was not complying with treatment, according to the health department. What's more, she also tested positive for COVID-19, further indicating that she was not isolating at home.

A judge issued a warrant for her arrest in March 2023

After two more court orders issued January 20 and February 24, Judge Philip Sorensen of the Pierce County Superior Court issued an arrest warrant for the woman who had refused TB treatment for more than a year, the News Tribune reported. This means that police officers have the ability to arrest and detain her and bring her to a facility where she will be treated for TB against her will. 

The judge also upheld his previous orders, which required that the woman be confined at the county jail or an alternative facility for treatment and isolation until she was deemed safe to be discharged.

The woman's court-appointed attorney, Sarah Tofflemire, has suggested that her client may need a legal guardian to help her understand what is going on, according to the News Tribune. Court records show that the woman has had a foreign language interpreter present for all proceedings, but she has still not acknowledged the existence of her own medical condition.

"She has primarily focused on how she dislikes papers coming to her home, and not the import of the process in which she finds herself," Tofflemire said, according to the News Tribune. "She has repeatedly threatened suicide in relationship to papers being served upon her home," and has also spoken erratically and out of turn during court proceedings.

Last week, she disappeared after boarding the bus to a local casino

In April, an officer who was following the woman saw her board a bus to a local casino, according to a court filing obtained by NBC News. For reasons unknown, the officer let her go.

Now, the woman has been found in contempt of the court and has been ordered to be treated against her will. But as of April 12, authorities had not located her since she was seen boarding the bus, NBC reported.