Title: City of Milwaukee v. Ruby Washington
Citation: 2007 WI 104
Docket Number: 2005AP003141
State: Wisconsin
Issuer: Wisconsin Supreme Court
Date: July 17, 2007

2007 WI 104 
 
SUPREME COURT OF WISCONSIN 
 
 
 
 
 
CASE NO.: 
2005AP3141 
 
 
COMPLETE TITLE: 
 
 
In the interest of Ruby Washington: 
 
 
City of Milwaukee, 
          Petitioner-Respondent, 
     v. 
Ruby Washington, 
          Respondent-Appellant-Petitioner. 
 
 
 
 
REVIEW OF A DECISION OF THE COURT OF APPEALS 
2006 WI App 99 
Reported at: 292 Wis. 2d 258, 716 N.W.2d 176 
(Ct. App. 2006—Published) 
 
 
OPINION FILED: 
July 17, 2007   
SUBMITTED ON BRIEFS: 
        
ORAL ARGUMENT: 
November 1, 2006   
 
 
SOURCE OF APPEAL: 
 
 
COURT: 
Circuit   
 
COUNTY: 
Milwaukee   
 
JUDGE: 
Clare L. Fiorenza 
 
 
 
JUSTICES: 
 
 
CONCURRED: 
        
 
DISSENTED: 
        
 
NOT PARTICIPATING:         
 
 
 
ATTORNEYS: 
 
For the respondent-appellant-petitioner there were briefs 
by William J. Tyroler and Karl Otto Rohlich, assistant state 
public defenders, and oral argument by William J. Tyroler. 
 
For the petitioner-respondent there was a brief and oral 
argument by Stuart S. Mukamal, assistant city attorney, with 
whom on the brief was Grant F. Langley, city attorney. 
 
An amicus curiae brief was filed by Laurence J. Dupuis and 
ACLU WI Foundation, Milwaukee; Colleen D. Ball and Appellate 
Counsel, S.C., Wauwatosa, on behalf of The American Civil 
Liberties Union of Wisconsin Foundation, Inc. 
 
An amicus curiae brief was filed by Kimberly Allegretti 
Nass and Washington County Attorneys Office, West Bend; Steven 
 
 
2 
J. Rollins and Manitowoc County Corporation Counsel, Manitowoc, 
on behalf of the Wisconsin Association of County Corporation 
Counsels. 
 
 
2007 WI 104
NOTICE 
This opinion is subject to further 
editing and modification.  The final 
version will appear in the bound 
volume of the official reports.   
No.  2005AP3141  
(L.C. No. 
2005CV7563) 
STATE OF WISCONSIN  
 
 
   : 
IN SUPREME COURT 
 
 
In the interest of Ruby Washington: 
 
City of Milwaukee, 
 
          Petitioner-Respondent, 
 
     v. 
 
Ruby Washington, 
 
          Respondent-Appellant-Petitioner. 
 
FILED 
 
JUL 17, 2007 
 
David R. Schanker 
Clerk of Supreme Court 
 
 
 
REVIEW of a decision of the Court of Appeals.  Affirmed. 
 
¶1 
LOUIS B. BUTLER, JR., J.  Ruby Washington seeks review 
of a published decision of the court of appeals1 affirming a 
circuit court order confining her to the Milwaukee County 
Criminal Justice Facility ("CJF") for failure to comply with 
                                                 
1 City of Milwaukee v. Washington, 2006 WI App 99, 292 
Wis. 2d 258, 716 N.W.2d 176. 
No. 
2005AP3141   
 
2 
 
prior court orders for treatment of tuberculosis.2  The Milwaukee 
County Circuit Court, Honorable Clare L. Fiorenza, found that if 
Washington continued to refuse treatment she would become 
contagious and threaten the public health, and issued an order 
of confinement pursuant to Wis. Stat. § 252.07(9) (2005-06)3, the 
long-term confinement provisions of the tuberculosis control 
statute.  Washington asked to be confined to Aurora Sinai 
Medical Center ("Medical Center"), but the circuit court ordered 
her confined to the CJF.   
¶2 
The court of appeals affirmed the circuit court on two 
independent grounds.  City of Milwaukee v. Ruby Washington, 2006 
WI App 99, 292 Wis. 2d 258, 716 N.W.2d 176.  First, the court of 
appeals 
agreed 
that 
Wis. Stat. § 252.07(9) 
authorized 
Washington's confinement to the CJF, concluding that statutory 
language referring to "no less restrictive alternative" applied 
only to the fact of confinement itself, and not the place of 
confinement.  Washington, 292 Wis. 2d 258, ¶12.  Thus, the court 
of appeals concluded that once confinement is determined to be 
necessary, the statute does not require placement to the least 
                                                 
2 The City of Milwaukee contends that the appeal is moot 
because Washington was released from jail confinement on May 26, 
2006, and any decision issued by this court will have no 
practical effect upon her confinement.  While we agree that our 
decision is moot as to Washington, we will proceed to the merits 
because the issues raised in this appeal are of great public 
concern and are likely to recur.  See State v. Michael S., 2005 
WI 82, ¶6, 282 Wis. 2d 1, 698 N.W.2d 673.  
3 All references to the Wisconsin Statutes are to the 2005-
2006 version of the statutes unless otherwise noted.  
No. 
2005AP3141   
 
3 
 
restrictive facility.  Id.  It further concluded that a circuit 
court may consider the relative cost of different placement 
options when determining the place of confinement.  Id., ¶14.  
Second, 
the 
court 
of 
appeals 
concluded 
that 
Wis. Stat. 
§ 785.04(1), the remedial contempt statute, provided the circuit 
court with an alternate basis to confine Washington to the CJF.  
Id., ¶¶18-19. 
¶3 
We conclude that Wis. Stat. § 252.07(9)(a) authorizes 
confinement 
to 
a 
jail 
for 
a 
person 
with 
noninfectious 
tuberculosis who is at a high risk of developing infectious 
tuberculosis and fails to comply with a prescribed treatment 
regimen, provided the jail is a place where proper care and 
treatment will be provided and the spread of disease will be 
prevented, and that no less restrictive alternative exists to 
jail confinement.  We further conclude that a circuit court may 
take into account the cost of placement options when determining 
the place of confinement under § 252.07(9), but only after 
determining that two or more placement options fulfill the 
statutory requirements of proper medical treatment and disease 
prevention, and that none of these options is significantly less 
restrictive than the other(s).   
¶4 
In this case, the circuit court engaged in a careful, 
deliberative process in which it demonstrated appropriate 
concern for both the public health of the community and the care 
and treatment of Ruby Washington.  We conclude the circuit court 
did 
not 
erroneously 
exercise 
its 
discretion 
in 
ordering 
Washington's confinement to the CJF.  We therefore affirm on 
No. 
2005AP3141   
 
4 
 
these grounds the court of appeals' opinion affirming the 
circuit court's order of confinement.4   
¶5 
We further conclude that Washington's confinement was 
not 
authorized 
by 
the 
remedial 
contempt 
statute, 
Wis. Stat. § 785.04(1), and disavow the court of appeals' 
discussion of contempt as a separate basis for confinement to 
jail in this case.  Washington, 292 Wis. 2d 258, ¶¶16-19.   
I 
 
¶6 
On May 19, 2005, Ruby Washington was evaluated for 
tuberculosis at the Keenan Health Center Tuberculosis Control 
Clinic ("TB Clinic"), operated by the City of Milwaukee Health 
Department ("Department").  Sputum specimens were taken and 
tested for tuberculosis.  On June 17, 2005, Washington was 
diagnosed with tuberculosis.  Washington received tuberculosis 
medication at the TB Clinic on June 21, 2005.  Washington was 
living in a shelter and had no fixed address at the time.  TB 
Clinic staff provided Washington with bus tickets to ensure that 
she 
would 
return 
for 
periodic 
directly-observed 
therapy.5  
Washington did not show up for her next two appointments to 
receive her medication, and could not be located. 
                                                 
4 In future cases, we expect that courts determining place 
of 
confinement 
for 
persons 
subject 
to 
a 
petition 
under 
Wis. Stat. § 252.07(9) will apply the methodology set forth in 
this opinion. 
5 Wisconsin Admin. Code § HFS 145.08(5) defines "directly-
observed therapy" as "ingestion of prescribed anti-tuberculosis 
medication that is observed by a health care worker or other 
responsible person acting under the authority of the local 
health department." 
No. 
2005AP3141   
 
5 
 
 
¶7 
The Department issued Washington a directly-observed 
therapy order ("treatment order") and an isolation order on July 
27, 2005, which it intended to serve upon Washington as soon as 
she could be located.  On August 22, 2005, a nurse at the 
Medical Center informed the Department that Washington had been 
admitted to the hospital and was giving birth to a baby.  The 
Department served the orders for treatment and isolation on 
Washington later that day, and requested that Washington stay at 
the Medical Center.   
¶8 
The next day, after Washington threatened to leave the 
Medical Center, the City of Milwaukee petitioned the circuit 
court under Wis. Stat. § 252.07(9)6 for enforcement of the 
                                                 
6 Wisconsin Stat. § 252.07(9) provides, in part: 
(a) The department or a local health officer may 
petition any court for a hearing to determine whether 
an individual with infectious or suspect tuberculosis 
should be confined for longer than 72 hours in a 
facility where proper care and treatment will be 
provided and spread of the disease will be prevented. 
The department or local health officer shall include 
in the petition documentation that demonstrates all of 
the following: 
1. That the individual named in the petition has 
infectious 
tuberculosis; 
that 
the 
individual 
has 
noninfectious tuberculosis but is at high risk of 
developing 
infectious 
tuberculosis; 
or 
that 
the 
individual has suspect tuberculosis. 
2. That the individual has failed to comply with the 
prescribed 
treatment 
regimen 
or 
with 
any 
rules 
promulgated by the department under sub. (11); or that 
the disease is resistant to the medication prescribed 
to the individual. 
No. 
2005AP3141   
 
6 
 
treatment and isolation orders.  The Milwaukee Circuit Court, 
Honorable Maxine A. White, appointed an attorney from the State 
Public 
Defender's 
Office 
to 
represent 
Washington. 
 
See 
Wis. Stat. § 252.07(9)(d).  Counsel for the parties reached a 
stipulation whereby Washington would remain confined at the 
Medical Center, at least until a status hearing on September 27, 
2005, at which point the circuit court would assess the progress 
of Washington's treatment and her possible release from hospital 
confinement.   
¶9 
At the September 27, 2005, hearing before the circuit 
court, Honorable Clare L. Fiorenza, the City noted that 
Washington's recovery had progressed to the point where the 
Department believed that Washington no longer needed to be 
confined for medical reasons.  Counsel for the parties reached a 
second stipulation under which Washington would be released from 
confinement at the Medical Center, but would report to the TB 
Clinic at regular intervals to receive medication by directly-
observed 
therapy, 
consistent 
with 
the 
July 
27 
order.  
Additionally, the stipulation required that Washington follow a 
                                                                                                                                                             
3. That all other reasonable means of achieving 
voluntary 
compliance 
with 
treatment 
have 
been 
exhausted and no less restrictive alternative exists; 
or that no other medication to treat the resistant 
disease is available. 
4. 
That 
the 
individual 
poses 
an 
imminent 
and 
substantial threat to himself or herself or to the 
public health. 
 
No. 
2005AP3141   
 
7 
 
nine-month treatment plan and live with her sister, Alwiller 
Washington, during that time.  The stipulation provided that  
in the event that . . . Washington fails to fully and 
completely comply with the provisions of this Order 
[the stipulation], she may be subject to imprisonment, 
to 
renewed 
isolation 
and 
inpatient 
confinement 
pursuant to Wis. Stat. §§ 252.07(8) and (9) and/or to 
such other and additional sanctions for contempt of 
court as this Court may determine.   
¶10 On 
September 
29, 
2005, 
Alwiller 
Washington 
("Alwiller") called Irmine Reitl, program manager of the TB 
Clinic, to report that Ruby Washington had left Alwiller's 
residence shortly after being released from the Medical Center 
on the 27th, and had yet to return.  Alwiller said a friend had 
spotted (Ruby) Washington near the Jewel/Osco store on North 
35th Street in Milwaukee that morning.  Reitl and an officer of 
the Milwaukee Police Department drove to the Jewel/Osco and 
found Washington in the store parking lot.  Reitl caught up with 
Washington and talked with her on the curb for a few minutes.  
In an affidavit to the court, Reitl averred that Washington 
"said many things that [Reitl] was unable to understand" and 
that Washington "seemed less than coherent in her thoughts."   
¶11 A Milwaukee Police Department squad car arrived in the 
parking lot, and Washington left the area and entered a 
convenience store at the corner of 36th Street and North Avenue.  
Two additional squad cars arrived, and officers detained 
Washington.  Reitl averred that  
Ruby was crying and yelling while the police spoke to 
her.  After a few minutes, Ruby was handcuffed and 
placed in a squad car.  While in the police car, she 
No. 
2005AP3141   
 
8 
 
continued to be agitated and was kicking her feet out 
of the squad car window and kicking the inside roof of 
the squad car, all the while loudly screaming, yelling 
and crying. 
Washington received an assessment from the Medical Center and 
was transported to the CJF.  The City filed a "Motion of 
Contempt" 
with 
the 
circuit 
court 
seeking 
Washington's 
confinement to the CJF for noncompliance with the prior 
treatment order.  Washington was held in the CJF pending a court 
hearing scheduled for October 3, 2005, on the City's motion. 
 
¶12 On October 1, 2005, Washington was mistakenly released 
from the CJF and went missing.  The October 3 hearing was 
adjourned because the City had yet to locate Washington.  On the 
morning of October 5, Washington was found at the home of a 
friend, and was detained by police.  She was taken to the 
Medical Center to be evaluated, and then held at a district 
police station for a period of hours. 
 
¶13 Judge Fiorenza convened a hearing later that afternoon 
at which Washington contested the City's allegation that she was 
in violation of the treatment order.  The City called Irmine 
Reitl of the TB Clinic, who explained that Washington was 
diagnosed with pulmonary tuberculosis, a disease that becomes 
colonized in the lungs and may be transmitted by coughing, 
sneezing or otherwise forcing bacteria out of the lungs and into 
the air.  She noted that Washington had one previous bout with 
tuberculosis, for which she had been successfully treated.  She 
stated that for patients like Washington who have recurrent 
tuberculosis, a nine-month course of treatment is necessary, 
No. 
2005AP3141   
 
9 
 
which starts with administering a regimen of four medications at 
regular intervals.  Reitl testified that she believed Washington 
was not presently contagious, but that if she did not resume 
treatment, she would become contagious, perhaps within a week, 
and "certainly within a month."  Reitl explained that "for 
[Washington's] 
own 
health 
and 
everyone's 
health 
in 
the 
community," Washington "must strictly adhere to the treatment 
regimen."   
¶14 Reitl gave testimony about Washington's combativeness 
when detained by officers on September 29.  Reitl also testified 
that Washington was "incoherent" when Reitl encountered her on 
September 29, and Reitl believed, based on her training and 
experience as a nurse, that Washington was "under the influence 
of something."  
 
¶15 Washington testified on her own behalf.  Washington 
admitted that she stayed at a friend's house and not with her 
sister upon her release from the Medical Center on September 27.  
She also admitted that she had not taken her tuberculosis 
medication on October 2 as ordered because "[i]t had slipped 
[her] mind."  Based on these statements, which the circuit court 
determined were admissions of noncompliance, the court found 
Washington to be in violation of the prior treatment orders.  
The circuit court concluded that, as a consequence, confinement 
was appropriate.  
 
¶16 The City asked that Washington be confined to the CJF.  
The City stated that it "d[id] not believe that there [was] any 
facility . . . other than the [CJF] that would serve the purpose 
No. 
2005AP3141   
 
10 
 
of protecting the public health under these very unusual and 
extraordinary circumstances."   
¶17 Counsel for Washington requested confinement to the 
Medical Center, arguing that her prior placement there "worked 
out very well and she was under guard and I would assume she 
would still be under guard."  Alternatively, counsel asked that 
the circuit court consider confining Washington to the Milwaukee 
County Mental Health Complex (Mental Health Complex).  Counsel 
urged the court to consider "any alternative other than jail 
. . . .  The [Medical Center] situation worked.  The Court could 
order her there for a period while other alternatives are 
explored."   
¶18 The City opposed Washington's confinement to the 
Mental Health Complex, arguing that security there was "not 
assured."  The City also opposed placement in the Medical 
Center, arguing "it would be grossly unfair to the taxpayers of 
this City to require that [Washington] be placed under police 
guard on a 24/7 basis, which would be required for a period of 
nine months.  The jail already has security.  It would not cost 
our taxpayers any more."  Counsel for Washington responded that 
cost 
to 
taxpayers 
was 
not 
a 
permissible 
factor 
in 
a 
Wis. Stat. § 252.07(9) confinement proceeding.   
¶19 The circuit court considered the City's request to 
confine Washington, and determined that it would proceed under 
Wis. Stat. § 252.07(9), the long-term confinement subsection of 
the 
tuberculosis 
control 
statute, 
and 
not 
under 
Wis. Stat. § 785.04(1), the remedial contempt statute:  
No. 
2005AP3141   
 
11 
 
THE COURT:  Well, actually, you know, I was reading 
over the statute as to this type of hearing because it 
is an unusual type of action.  It's under [sec.] 
252.05 of the statutes regarding tuberculosis.  And 
that statute does allow the Court to confine a person 
for the treatment of the tuberculosis.  What the 
Court——What the statute requires is that if I'm going 
to order a person in confinement more than six months, 
I have to have a review every six months if I'm going 
to order her confined.  I don't know if that's the—— 
[CITY ATTORNEY]:  That's exactly how we're proceeding. 
THE COURT:  This is the only way I know how to proceed 
is under this statute because it's a specific statute 
if someone has tuberculosis. 
[CITY ATTORNEY]:  That's what I'm asking the Court 
proceed under.  This statute, no other. 
THE COURT:  Yeah.  And I don't know——really know if 
the Court has to find contempt per se . . . .  You 
know, [Wis. Stat. § 252.07(9)] allows for the Court to 
confine an individual.  That's how I read the statute 
. . . . 
[CITY ATTORNEY]:  That's how I would read it, your 
Honor.  The only reason that I brought it in the form 
of a [motion for] contempt was because we did have a 
prior order that we contend was violated.  But in the 
alternative, even if that weren't the case, if the 
case is serious enough, I believe——I think it's 
252.07(8) and (9) would be sufficient.  
The circuit court's written order of confinement stated that 
Washington "is and remains a threat to the public health and 
safety as a consequence of her failure to comply with" the 
court's previous treatment orders.  The court's order did not 
reference contempt.   
¶20 The circuit court found Washington to be in violation 
of the prior treatment orders based in part on Washington's 
admissions that she did not stay with her sister upon her 
No. 
2005AP3141   
 
12 
 
release from the Medical Center, and that it had "slipped her 
mind" to take her medication.  The court found that "[t]here is 
a huge threat to our community if Miss Washington is walking 
around our community not taking her medicine for tuberculosis."  
The court determined that "by not taking [her] medication," 
Washington was "making decisions for other people in our 
community.  She's becoming a huge health risk."   
¶21 The circuit court rejected Washington's request that 
she be confined to the Medical Center, citing fiscal reasons, in 
part:   
With respect to the order that I place a guard at the 
hospital and allow her to stay at the hospital for the 
remainder of her treatment[,] I refuse to require 
taxpayers to pay 24 hour around the clock guard at her 
door to make sure she stays put.  I don't think that's 
appropriate.   
The court also rejected confinement to the Mental Health 
Complex, stating:   
If your client for whatever reason would qualify to go 
to the mental health complex, that's fine with me, but 
I'm not ordering that she be placed there . . . .  I 
don't know what the qualifications are for somebody to 
be placed there, and I have none of that information 
in front of me.7  
¶22 The circuit court ordered Washington confined to the 
CJF for an indeterminate period of time, with a review of her 
confinement in six months, pursuant to Wis. Stat. § 252.07(9).  
                                                 
7 For reasons that are unclear from the record and filings, 
Washington appears to have abandoned the Mental Health Complex 
as an alternate less restrictive place of confinement to jail.  
Her briefs focus exclusively on the Medical Center as the 
alternate less restrictive place of confinement.  
No. 
2005AP3141   
 
13 
 
The circuit court stated that "the [CJF] certainly qualifies" as 
"a facility where treatment can be rendered."  Addressing 
Washington's counsel, the court stated "if you can find some 
other locked facility for your client [than the CJF]  . . . the 
Court would be happy to order her placed somewhere else, and I'm 
sure the City would agree."  The court added:  
If any kind of change of circumstances come[s] up, you 
bring the matter and I'll hear this matter . . . on 
very short notice . . . .  If you find some other 
place to have her placed, you want me to order 
something, sir, I'll be happy to look at whatever you 
have found. 
 
¶23 Washington 
appealed 
to 
the 
court 
of 
appeals, 
challenging only her placement to the CJF instead of a less 
restrictive facility, and not whether the court had grounds to 
order 
her 
confinement. 
 
She 
contended 
that 
Wis. Stat. 
§ 252.07(9) 
required 
that 
confinement 
be 
to 
the 
least 
restrictive place available, that the Medical Center was 
suitable and less restrictive than the CJF, and that the circuit 
court erred in considering fiscal matters in making its 
confinement decision.  The court of appeals ordered briefing on 
several issues, including whether "this may be an appeal from 
what is functionally a contempt order."  
 
¶24 The court of appeals unanimously affirmed the circuit 
court, 
concluding 
that 
"no 
less 
restrictive 
alternative" 
language in Wis. Stat. § 252.07(9)(a) applied to the fact of 
confinement 
only, 
and 
not 
to 
the 
place 
of 
confinement.  
Washington, 292 Wis. 2d 258, ¶12.  The court of appeals further 
concluded that a circuit court may consider the cost to 
No. 
2005AP3141   
 
14 
 
taxpayers 
in 
determining 
the 
place 
of 
confinement 
under 
Wis. Stat. § 252.07(9).   
¶25 A majority of the panel concluded that the order of 
confinement was also lawful under Wis. Stat. § 785.04(1), which 
authorizes orders of remedial contempt.  Id., ¶19.  One judge 
dissented as to this point.  Washington seeks review of the 
decision of the court of appeals affirming the circuit court's 
order of confinement to jail.   
II 
 
¶26 A circuit court's decision concerning where to confine 
a person with tuberculosis who fails to comply with a prescribed 
treatment regimen is discretionary.  "A proper exercise of 
discretion requires that the trial court rely on facts of 
record, the applicable law, and, using a demonstrable rational 
process, reach a reasonable decision."  State v. Manuel, 2005 WI 
75, ¶24, 281 Wis. 2d 554, 697 N.W.2d 811.  Whether the circuit 
court applied the correct legal standard is a question of law 
that we review de novo.  Landwehr v. Landwehr, 2006 WI 64, ¶8, 
291 Wis. 2d 49, 715 N.W.2d 180.   
 
¶27 This case requires us to interpret the long-term 
confinement provisions of the tuberculosis control statute, 
Wis. Stat. § 252.07(9), 
and 
the 
remedial 
contempt 
statute, 
Wis. Stat. § 785.04(1).  Statutory interpretation is a matter of 
law that is subject to de novo review.  See Landwehr, 291 Wis. 
2d 49, ¶9.  
No. 
2005AP3141   
 
15 
 
III 
 
¶28 The tuberculosis control section of the communicable 
disease 
chapter 
of 
the 
Wisconsin 
statutes, 
Chapter 
252, 
authorizes the confinement of an individual with tuberculosis 
under certain circumstances.  The statute contains subsections 
that set forth procedures for confinement of persons with 
tuberculosis for up to 72 hours, Wis. Stat. § 252.07(8), and for 
periods of indeterminate length, § 252.07(9).   
¶29 Wisconsin Stat. § 252.07(8) 
permits 
the 
Wisconsin 
Department of Health and Family Services ("DHFS") or a local 
health officer8 to order the confinement of a person with 
tuberculosis.  Under this subsection, the DHFS or local health 
officer must notify a court in writing of the confinement, and 
include the following in its filing:  (1) A statement of a 
doctor or advanced practice nurse prescriber that the person has 
infectious tuberculosis or suspect tuberculosis;9 (2) evidence 
                                                 
8 "Local health officer" means "the health officer who is in 
charge of the local health department."  Wis. Stat. § 250.01(5).   
9 Wisconsin Stat. § 252.07(1g) 
defines 
"infectious 
tuberculosis" and "suspect tuberculosis" as follows: 
(a) 
"Infectious 
tuberculosis" 
means 
tuberculosis 
disease of the respiratory tract, capable of producing 
infection or disease in others as demonstrated by the 
presence of acid-fast bacilli in the sputum or 
bronchial 
secretions or by chest radiograph and 
clinical findings.   
(d) "Suspect tuberculosis" means an illness marked by 
symptoms and laboratory tests that may be indicative 
of tuberculosis, such as a prolonged cough, prolonged 
fever, 
hemoptysis, 
compatible 
roentgenographic 
No. 
2005AP3141   
 
16 
 
that the person has refused to follow a prescribed treatment 
regimen, or, if the person has suspect tuberculosis, has refused 
to undergo a medical examination; and (3) a statement that the 
person poses an imminent and substantial threat to himself or 
herself or to the public health.  A law enforcement officer or 
other authorized person must transport, when necessary, the 
person subject to a confinement order under § 252.07(8), "to a 
facility that [DHFS] or [the] local health officer determines 
will 
meet 
the 
individual's 
need 
for 
medical 
evaluation, 
isolation and treatment."  § 252.07(8)(b).  A person may not be 
confined for more than 72 hours under § 252.07(8), excluding 
Saturdays, Sundays and legal holidays, "without a court hearing 
under sub. (9) to determine whether the confinement should 
continue."  § 252.07(8)(c).  
¶30 Under Wis. Stat. § 252.07(9)(a), 
[t]he [DHFS] or a local health officer may petition 
any court for a hearing to determine whether an 
individual with infectious or suspect tuberculosis 
should be confined for longer than 72 hours in a 
facility where proper care and treatment will be 
provided and spread of the disease will be prevented.10  
                                                                                                                                                             
findings 
or 
other 
appropriate 
medical 
imaging 
findings.   
10 We note that the first part of Wis. Stat. § 252.07(9)(a) 
refers to persons with infectious tuberculosis and suspect 
tuberculosis, but does not mention persons with noninfectious 
tuberculosis who are at a high risk of developing infectious 
tuberculosis.  Section 252.07(9)(a) cannot be read, however, 
without looking at the remainder of paragraph (9)(a).  We 
construe § 252.07(9)(a) as applying to persons mentioned in 
subparagraph (9)(a)1. who suffer from noninfectious tuberculosis 
who are at a high risk of developing infectious tuberculosis.   
No. 
2005AP3141   
 
17 
 
                                                                                                                                                             
Wisconsin Stat. § 252.07(9)(a)1. states that the petition 
seeking confinement must demonstrate either that the person has 
infectious tuberculosis, suspect tuberculosis or "that the 
individual has noninfectious tuberculosis but is at high risk of 
developing tuberculosis."  This portion of subdivision 1., which 
immediately follows paragraph (a), would be rendered meaningless 
surplusage if § 252.07(9)(a) were not construed to include 
persons with "noninfectious tuberculosis" who are at a high risk 
of becoming infectious.  See Mueller v. McMillian Warner Ins. 
Co., 2006 WI 54, ¶27, 290 Wis. 2d 571, 714 N.W.2d 183 ("A 
statute should be construed so that no word or clause shall be 
rendered surplusage and every word if possible should be given 
effect.") (citation omitted).  There is absolutely no reason to 
include this category of persons in a petition for confinement 
if that person cannot be confined under the statute.  Such a 
reading would render the statute nonsensical. 
The remainder of Wis. Stat. § 252.07(9)(a) makes it clear 
that, with respect to a person with noninfectious tuberculosis 
at a high risk of developing tuberculosis who has a nonresistant 
form of the disease, the petition must allege under subdivision 
(9)(a)2. that the individual has failed to comply with the 
prescribed treatment regimen or rules promulgated by the DHFS.  
The petition must further, under subdivision (9)(a)3., allege 
that 
all 
other 
reasonable 
means 
of 
achieving 
voluntary 
compliance 
have 
been 
exhausted 
and 
no 
less 
restrictive 
alternative exists.  Finally, under subdivision (9)(a)4., the 
petition must allege that the individual poses an imminent and 
substantial threat to himself or herself or to the public 
health.  There is no point in including these allegations in a 
petition seeking confinement unless the court has the power to 
act on the petition and order confinement.  The introductory 
portion of § 252.07(9)(a) must be read with the remainder of the 
paragraph if the statute is to make any sense.   
In addition, a construction that did not include such 
persons would exempt from the tuberculosis control statute an 
entire category of persons with tuberculosis who pose a greater 
public health threat than persons with "suspect tuberculosis."  
Such a result would be absurd and contrary to the public health 
objectives of the statute.  See Strenke v. Hogner, 2005 WI 25, 
¶48, 279 Wis. 2d 52, 694 N.W.2d 296 ("Laws must be interpreted, 
considering the legal and practical consequences, to avoid 
unreasonable and absurd results.") (citation omitted). 
No. 
2005AP3141   
 
18 
 
The statute further provides that DHFS or a local health officer 
"shall include in the petition documentation that demonstrates 
all 
of the following:"  (1) the person has infectious 
tuberculosis, has noninfectious tuberculosis but is at a high 
risk of developing infectious tuberculosis or has suspect 
tuberculosis; (2) the person "has failed to comply with the 
prescribed 
treatment regimen . . . or that the disease is 
resistant to the medication prescribed" to the person; (3) "all 
other reasonable means of achieving voluntary compliance with 
treatment 
have 
been 
exhausted 
and 
no 
less 
restrictive 
alternative exists; or that no other medication to treat the 
resistant disease is available"; and (4) the person "poses an 
imminent and substantial threat to himself or herself or to the 
public health."  § 252.07(9)(a)1.-4.  A person confined under 
§ 252.07(9) "shall remain confined until the department or local 
health officer . . . determines that treatment is complete or 
that the individual is no longer a substantial threat to himself 
or herself or to the public health."  § 252.07(9)(c).  If the 
person is to be confined for more than six months, "the court 
shall review the confinement every [six] months."  Id.  DHFS is 
authorized under § 252.07(11) to promulgate rules to assist in 
the administration and enforcement of the section, which are 
contained in Wis. Admin. Code §§ HFS 145.08-145.13 (Dec. 2003).11  
                                                 
11 All references to Wis. Admin. Code § 145 are to the 
version published December 2003 in the administrative register, 
No. 576.   
No. 
2005AP3141   
 
19 
 
A 
¶31 Washington does not challenge the circuit court's 
basis for ordering her confinement under Wis. Stat. § 252.07(9).  
She asserts only that the court lacked authority under the 
statute to order confinement to the CJF.  Washington first 
contends that a jail is not a "facility" as the term is used in 
§ 252.07(9)(a), which authorizes confinement to a "facility 
where proper care and treatment will be provided and spread of 
the disease will be prevented."  Washington disputes the court 
of appeals' conclusion that the absence of an explicit bar on 
jail confinement makes jail a permissible placement option, see 
Washington, 292 Wis. 2d 258, ¶12, asserting that the absence of 
an express authorization of jail confinement demonstrates that 
it is an impermissible placement option, given the statute's 
nonpunitive, public health purpose.  Further, Washington notes 
that § 252.07(8), like § 252.07(9), also authorizes confinement 
to a "facility."  She argues that to construe "facility" to 
include a jail would give DHFS and local health officers the 
authority under § 252.07(8) to confine a person to jail for up 
No. 
2005AP3141   
 
20 
 
to 72 hours without prior judicial approval, a result Washington 
asserts the legislature would never have intended.12 
 
¶32 When interpreting a statute, we "begin[] with the 
language of the statute.  If the meaning of the statute is 
plain, we ordinarily stop the inquiry."  State ex rel. Kalal v. 
Circuit Court, 2004 WI 58, ¶45, 271 Wis. 2d 633, 681 N.W.2d 110 
(citations omitted).  In general, statutory language is given 
its common, ordinary and accepted meaning.  See id.  We often 
consult a recognized dictionary to determine the common, 
accepted meaning of a word.  Robin K. v. Lamanda M., 2006 WI 68, 
¶16, 291 Wis. 2d 333, 718 N.W.2d 38 (citations omitted).  
However, when construing a word or phrase that is a legal term 
of art, we give the word or phrase its accepted legal meaning.  
Wis. Citizens Concerned for Cranes & Doves v. DNR, 2004 WI 40, 
¶6, 270 Wis. 2d 318, 677 N.W.2d 612; see also Wis. Stat. 
§ 990.01(1).  We do not search for statutory meaning in 
extrinsic sources of interpretation such as legislative history 
unless 
the 
statutory 
language 
is 
ambiguous, 
"although 
legislative history is sometimes consulted to confirm or verify 
                                                 
12 The City correctly notes that Washington conceded before 
the court of appeals that a jail was a "facility" under 
Wis. Stat. § 252.07(9)(a), and contends that Washington has 
therefore waived the right to argue otherwise here.  For the 
sake of clarifying the law, we chose to address the question of 
whether a jail is a "facility" under this statute.  See Clean 
Wisconsin, Inc. v. Pub. Serv. Comm'n of Wisconsin, 2005 WI 93, 
¶270, 282 Wis. 2d 250, 700 N.W.2d 768 (stating that waiver is a 
rule of judicial administration, and as such, a reviewing court 
has the inherent authority to disregard a waiver and address the 
merits of an unpreserved issue).   
No. 
2005AP3141   
 
21 
 
a plain-meaning interpretation."  Kalal, 271 Wis. 2d 633, ¶¶46, 
51 (citations omitted). 
¶33 To determine whether Wis. Stat. § 252.07(9)(a) permits 
confinement 
to 
a 
jail 
for 
a 
person 
with 
noninfectious 
tuberculosis 
with 
a 
high 
risk 
of 
developing 
infectious 
tuberculosis who is noncompliant with a prescribed treatment 
regimen, we begin with the statutory language, considering the 
meaning of operative terms singly, and in relation to the 
statute as a whole.  See Kalal, 271 Wis. 2d 633, ¶46 
("[S]tatutory language is interpreted in the context in which it 
is used; not in isolation, but as a part of the whole.").  The 
statute provides that the place to which a person with 
infectious tuberculosis, noninfectious tuberculosis with a high 
risk 
of 
developing 
infectious 
tuberculosis, 
or 
suspect 
tuberculosis who fails to comply with a prescribed treatment 
regimen may be confined is "a facility where proper care and 
treatment will be provided and spread of the disease will be 
prevented." 
 
§ 252.07(9)(a). 
 
Because 
Washington 
had 
noninfectious tuberculosis but was at a high risk of developing 
tuberculosis,13 we address only whether § 252.07(9)(a) authorizes 
                                                 
13 For the sake of readability, we refer to persons with 
"noninfectious tuberculosis who are at a high risk of developing 
tuberculosis" as persons with "noninfectious tuberculosis" in 
the remainder of this opinion.  
No. 
2005AP3141   
 
22 
 
placement to jail for persons with noninfectious tuberculosis 
who are at a high risk of developing tuberculosis.14   
¶34 While Wis. Stat. § 252.07(9)(a) does not explicitly 
authorize placement in jail of persons with noninfectious 
tuberculosis who are noncompliant with a prescribed treatment 
regimen, the plain language of the statute also does not 
preclude such a placement.  The statute authorizes confinement 
to a "facility," a word not defined in Chapters 250 (health 
administration) or 252 (communicable diseases) of the statutes, 
nor in the tuberculosis subchapter of the administrative code.  
We therefore turn to a dictionary to ascertain the meaning of 
the word.  See Landwehr, 291 Wis. 2d 49, ¶16.  Webster's defines 
"facility" as "something (as a hospital, machinery, plumbing) 
that is built, constructed, installed or established to perform 
some particular function or to serve or facilitate some 
particular end."  Webster's Third New International Dictionary 
812-13 (1986).  Under this commonly accepted meaning of the 
term, "facility" is broad enough to encompass many placement 
options, including jail. 
¶35 The 
use 
of 
the 
word 
"confine" 
in 
Wis. Stat. 
§ 252.07(9)(a) further indicates that jail is a placement option 
permitted for persons with noninfectious tuberculosis who are 
noncompliant with a prescribed treatment regimen.  "Confine" is 
                                                 
14 The issue of whether jail is a place of confinement 
authorized by the statute for persons with infectious or suspect 
tuberculosis is not before us.  The issue we have addressed 
involves persons with noninfectious tuberculosis who are at a 
high risk of developing tuberculosis. 
No. 
2005AP3141   
 
23 
 
not defined within Chapters 250 (health administration) nor 252 
(communicable 
diseases) 
of 
the 
Wisconsin 
Statutes. 
 
The 
tuberculosis control subchapter of the administrative code 
defines 
"confinement" 
as 
"restriction 
of 
a 
person 
with 
tuberculosis to a specified place in order to prevent the 
transmission 
of 
the 
disease 
to 
others, 
to 
prevent 
the 
development of drug-resistant organisms or to ensure that the 
person receives a complete course of treatment."  Wis. Admin. 
Code § HFS 145.08(2).  This definition essentially repeats the 
language of § 252.07(9)(a), which provides that the facility 
must be one in which "proper care and treatment will be provided 
and spread of the disease will be prevented."  
¶36 Elsewhere in Wis. Stat. § 252.07 and in other sections 
of Chapter 252, "isolate" and "quarantine," or variants of these 
terms, are used rather than "confine."  Section 252.07(1g)(c) 
defines "isolation" as "the separation from other persons of a 
person with infectious tuberculosis in a place and under 
conditions that prevent the transmission of infection."  The 
term "quarantine" is not defined in Chapters 250 or 252.  
Webster's definition of "quarantine" is "to isolate as a 
precaution against contagious disease."  Webster's Third New 
International Dictionary 1859 (1986).   
¶37 By contrast, the word "confine" has a somewhat 
different meaning than "isolate" or "quarantine."  Webster's 
defines "confine" as "to keep in narrow quarters," listing 
"imprison" as a synonym.  Webster's Third New International 
Dictionary 476 (1986).  "Confine" thus connotes not only 
No. 
2005AP3141   
 
24 
 
isolation, but suggests something about the nature of the place 
to which a person may be isolated or quarantined that is 
consistent with placement in jail.  Because the legislature in 
Wis. Stat. § 252.07(9)(a) did not use "isolate" or "quarantine," 
terms used frequently in § 252.07 and throughout Chapter 252, 
but used "confine" instead, we presume that the legislature was 
aware of the precise meanings of these terms and intended a 
different meaning by use of "confine."  See Landwehr, 291 Wis. 
2d 49, ¶27.  We conclude that, together, the commonly accepted 
meanings 
of 
"facility" 
and 
"confined" 
indicate 
that 
the 
legislature intended jail to be a permissible placement option 
under Wis. Stat. § 252.07(9)(a) for persons with noninfectious 
tuberculosis who are noncompliant with a prescribed treatment 
regimen, provided that "no less restrictive alternative exists" 
to such placement, infra, ¶¶48-59, and that the particular jail 
to which a person is to be confined is a place where proper care 
and treatment will be provided and spread of the disease will be 
prevented, infra, ¶44.15  
   
¶38 We find support for this interpretation in the 
legislative history of the statute.  See Kalal, 271 Wis. 2d 633, 
¶51 ("[L]egislative history is sometimes consulted to confirm or 
verify a plain-meaning interpretation.") (citations omitted).  
Subsections (8) and (9) of Wis. Stat. § 252.07 were created in a 
                                                 
15 This assumes, of course, that the circuit court has 
already found that the person poses an imminent and substantial 
threat to 
himself 
or herself or to the public health.  
Wis. Stat. § 252.07(9)(a)4. 
No. 
2005AP3141   
 
25 
 
1999 revision of the tuberculosis control statute, authored at 
the request of the DHFS and included in the biennial budget 
bill.  See 1999 Wis. Act 9, §§ 2400rn, 2400ro.  In a memo 
addressed to the legislative drafting attorney critiquing an 
early draft of the proposal, a Department of Administration 
("DOA") official suggested that the revised statute include a 
definition of "facility":  "The [DOA] would like to have a 
definition of 'facility' which could include something other 
than a health care facility.  For example, if the person is 
incarcerated the facility would be a jail, which would be 
treating 
the 
person 
for 
[tuberculosis]." 
 
DOA Memo 
to 
Legislative Reference Bureau, p. 1, 1/20/99, Drafting File of 
1999 LRB-0183.  The drafting attorney responded:  "[P]lease note 
that I did not include a definition of 'facility' because I was 
unsure how the department wanted it defined (other than to make 
sure it included a penal facility).  I do not believe it's a 
problem to leave it undefined.  It would just take a rather 
broad dictionary definition."  Drafter's Note, p. 1, 1/25/99, 
Drafting File of 1999 LRB-0183 (emphases added).  As the bill's 
authors anticipated, we have applied the dictionary definition 
of "facility" and concluded that the statute authorizes jail as 
a place of confinement.  The above exchange indicates that the 
authors of the bill intended jail to be a permissible place of 
confinement 
and 
treatment 
for 
persons 
with 
noninfectious 
No. 
2005AP3141   
 
26 
 
tuberculosis who are noncompliant with a prescribed treatment 
regimen.16 
 
¶39 Washington 
contends that because the purpose of 
confinement for those with tuberculosis who have not complied 
with 
a 
treatment 
regimen 
is 
nonpunitive, 
Wis. Stat. 
§ 252.07(9)(a) should be construed to preclude confinement to a 
jail in the absence of express statutory authorization for such 
a placement.  We agree that the purpose of any placement is not 
to punish the noncompliant person for failing to follow a 
prescribed treatment regimen, but to provide treatment and to 
prevent him or her from infecting others.  The statutory scheme 
ensures that jail is not a placement of first resort, but rather 
is permitted only in cases in which no less restrictive 
alternate placement is available.  Additionally, the particular 
facility to which a person is to be confined, whether a penal 
institution or other type of facility, must be a place where 
                                                 
16 One might suggest that this legislative history indicates 
only that the bill's authors intended jail to be a permissible 
place of confinement for persons who contract tuberculosis while 
incarcerated.  However, this view would suggest a double 
standard for tuberculosis treatment that would rest on the 
following untenable interpretation of Wis. Stat. § 252.07(9)(a):  
For incarcerated persons, jail is "a facility where proper care 
and treatment will be provided and spread of the disease will be 
prevented," but for persons not already incarcerated it is not.  
Of course, persons who contract tuberculosis in a penal facility 
are presumably there for a criminal justice reason, while a 
person with noninfectious or suspect tuberculosis who is 
noncompliant with prescribed treatment regimen is there only to 
ensure compliance with the treatment regimen and prevention of 
the spread of the disease. 
No. 
2005AP3141   
 
27 
 
proper care and treatment will be provided and spread of the 
disease will be prevented.   
¶40 Washington and amicus the American Civil Liberties 
Union also argue that a penal facility is not "a facility where 
proper care and treatment will be provided and spread of the 
disease will be prevented" because the rate of infection is 
reportedly significantly higher in correctional facilities than 
among the general population, and the dense congregation of 
individuals in a jail increases risk of transmission.17  We take 
these concerns seriously.  Nevertheless, the legislature has 
provided that confinement is an option, provided all the 
statutory requirements have been met.18  
¶41 While the statute's plain language and legislative 
history demonstrate the legislature contemplated confinement to 
jail as a category of placement for persons with noninfectious 
tuberculosis who are noncompliant with a prescribed treatment 
regimen, a confining court must still determine whether the 
particular place of confinement is "a facility where proper care 
                                                 
17 See Lawrence O. Gostin, "The Resurgent Tuberculosis 
Epidemic in the Era of AIDS:  Reflections on Public Health, Law 
and Society," 54 Md. L. Rev. 1, 51 (1995). 
18 We emphasize that this opinion applies only to persons 
with noninfectious tuberculosis——that is, persons who will not 
become infectious if they receive proper treatment and are 
forced to comply with a prescribed treatment regimen.  For 
persons with infectious tuberculosis or with the most highly 
drug-resistant strains of the disease, we doubt that jail would 
be an appropriate placement under Wis. Stat. § 252.07(9)(a) 
because such a placement would almost certainly increase, not 
prevent, the risk of transmission of the disease. 
No. 
2005AP3141   
 
28 
 
and treatment will be provided and spread of the disease will be 
prevented."  Wis. Stat. § 252.07(9)(a).  If conditions at a 
particular jail (or other facility) are such that proper care 
and 
treatment 
would 
be 
unavailable, 
or 
contrary 
to 
the 
prevention of the spread of the disease, such a placement would 
not be authorized under § 252.07(9)(a).  Whether a facility 
meets these requirements is a fact-intensive question and is 
addressed to the circuit court's discretion.  
B 
¶42 Washington next argues that if jail is a permissible 
place of confinement under Wis. Stat. § 252.07(9), confinement 
to jail is not permitted whenever some less restrictive 
placement is available, citing "no less restrictive alternative" 
language in § 252.07(9)(a)3.  The court of appeals construed 
this language to apply only to the fact of confinement and not 
to the place of confinement.  Washington, 292 Wis. 2d 258, ¶12.  
The City asks us to adopt the court of appeals' interpretation.  
We adopt Washington's interpretation because we conclude it is 
more reasonable.  We interpret Wis. Stat. § 252.07(9)(a)3. to 
require that "no less restrictive alternative" applies to the 
place of confinement as well as the fact of confinement. 
¶43 Wisconsin Stat. § 252.07(9)(a)3. provides that DHFS or 
the local health official petitioning for confinement of a 
person with tuberculosis who is noncompliant with a treatment 
regimen must demonstrate "[t]hat all other reasonable means of 
achieving 
voluntary 
compliance 
with 
treatment 
have 
been 
No. 
2005AP3141   
 
29 
 
exhausted and no less restrictive alternative exists; or that no 
other medication to treat the resistant disease is available."   
¶44 The City argues that the language "no less restrictive 
alternative exists" applies to the fact of confinement only 
because the other items listed under Wis. Stat. § 252.07(9)(a) 
apply only to the fact and not place of confinement.  It asserts 
that the place of confinement need only be, as § 252.07(9)(a) 
provides, "a facility where proper care and treatment will be 
provided and spread of the disease will be prevented."  The City 
also argues that the fact that other statutes more explicitly 
require 
"least 
restrictive" 
placement, 
citing 
Wis. 
Stat. 
§§ 51.20(9)(b), 
51.30(4)(b)5., 
51.35(1)(d)1., 
55.06(9)(a),19 
938.33(a), 938.355(1), and 938.357(4)(c)1., demonstrates that 
the legislature did not intend for "no less restrictive 
alternative" language to apply to the place as well as the fact 
of confinement. 
¶45 Washington argues that the full context in which 
Wis. Stat. § 252.07(9)(a)3. 
appears, 
as 
well 
as 
certain 
provisions of the administrative code, indicate that "no less 
restrictive 
alternative" 
language 
applies 
to 
place 
of 
confinement as well as fact of confinement.  She notes that the 
tuberculosis control statute also includes a provision for 
short-term confinement, Wis. Stat. § 252.07(8)(c).  She further 
notes that many (if not most) persons subject to a petition for 
                                                 
19 Wisconsin Stat. § 55.06(9)(a) was amended and renumbered 
by 2005 Wis. Act 264 and the relevant language is now contained 
in Wis. Stat. § 55.12(3). 
No. 
2005AP3141   
 
30 
 
long-term confinement under Wis. Stat. § 252.07(9) have already 
been confined to a specified place under the short-term 
confinement statute, which provides that if a person is to be 
held for more than 72 hours, there must be "a court hearing 
under sub. (9) to determine whether the confinement should 
continue."  Wis. Stat. § 252.07(8)(c).  She argues that because 
the judicial proceeding under the long-term confinement statute 
seeks to continue "the confinement"——not confinement in the 
abstract, but a confinement to a specified place——failure to 
apply the "no less restrictive" standard to the place of 
confinement would mean that the initial place of confinement 
ordered by DHFS or the local health official without prior 
judicial approval under the short-term confinement provision 
would 
be 
essentially 
unreviewable, 
no 
matter 
its 
restrictiveness.  
¶46 Both parties present reasonable interpretations of the 
statute, but we conclude that Washington's view is more 
reasonable.  Confinement of a person who is noncompliant with a 
prescribed treatment regimen is not confinement in the abstract, 
but confinement to a specified place.  A person already confined 
under 
the 
short-term 
tuberculosis 
confinement 
statute, 
Wis. Stat. § 252.07(8), 
is 
confined 
to 
a 
specified 
place 
selected by DHFS or a local health officer.  For the person 
subject to a petition for long-term confinement who is already 
confined under § 252.07(8), the court determines whether the 
existing confinement should be continued.  See § 252.07(8)(c) 
No. 
2005AP3141   
 
31 
 
("a court hearing under sub. (9) to determine whether the 
confinement should continue.").   
¶47 Portions of Chapter HFS 145 of the administrative code 
provide 
additional 
support 
for 
this 
interpretation.  
"Confinement" as defined in the tuberculosis control subchapter 
of HFS 145, means "restriction of a person with tuberculosis to 
a specified place" to achieve the goals of treatment and 
prevention of disease transmission.  Wis. Admin. Code § HFS 
145.08(2) (emphasis added).  This language further demonstrates 
that the tuberculosis control statute contemplates confinement 
to a particular facility.  Likewise, a related subchapter of HFS 
145 concerning control of communicable diseases states that the 
remedy for noncompliance with prescribed treatments should be 
that which "is the least restrictive on the respondent which 
would serve to correct the situation and protect the public's 
health."  Wis. Admin. Code § HFS 145.06(5).  A remedy that 
includes confinement would be to a particular place with 
prevention 
and 
treatment 
as 
goals, 
and, 
taken 
with 
Wis. Admin. Code § HFS 145.08(2), these provisions indicate that 
officials must consider whether no less restrictive alternative 
exists to the place of confinement.   
¶48 In light of the legislature's choice to permit 
confinement to jail of a person with noninfectious tuberculosis 
who is noncompliant with a prescribed treatment regimen, we 
conclude that the legislature intended the "no less restrictive 
alternative" language to apply to the place of confinement as 
well as the fact of confinement.  The legislature did not intend 
No. 
2005AP3141   
 
32 
 
jail to be a placement of first resort for persons with 
tuberculosis who are noncompliant with a prescribed treatment 
regimen.   
C 
 
¶49 Next, Washington argues that the circuit court erred 
in considering the relative costs to taxpayers of different 
placements in making its confinement decision.  She asserts that 
cost may not be considered in determining place of confinement 
because it is not one of the placement criteria set forth in 
Wis. Stat. § 252.07(9).  Washington cites D.E.R. v. La Crosse 
County, 155 Wis. 2d 240, 248, 455 N.W.2d 239 (1990), superseded 
by statute as stated in Dunn County v. Judy K., 2002 WI 87, ¶16, 
254 Wis. 2d 383, 647 N.W.2d 799, for the proposition that costs 
are an impermissible factor in determining placement in an 
involuntary confinement.   
¶50 In D.E.R., this court reversed a circuit court's order 
of protective placement under Wis. Stat. § 55.06(9)(a) (1987-
88)20 where the circuit court denied placement to the "least 
restrictive environment" as required by statute because it would 
have imposed greater financial burden on the county. D.E.R., 155 
Wis. 2d at 242.  No county matching funds were available for the 
placement.  Id. at 245.  Washington asserts that D.E.R. requires 
that a statute expressly provide that cost may be a factor in 
                                                 
20 The protective placement statute was later amended to 
permit consideration of fiscal matters in placement.  See Dunn 
County v. Judy K., 2002 WI 87, ¶16, 254 Wis. 2d 383, 647 N.W.2d 
799; Wis. Stat. § 55.06(9)(a) (1997-98).   
No. 
2005AP3141   
 
33 
 
placement for the circuit court to consider cost, citing the 
following:  "The legislature has not expressly limited the 
county's responsibility in ch. 55 to make placements to the 
least restrictive environment to funds available from state or 
federal sources and county matching funds."  Id. at 252.   
¶51 The City responds that a court may take cost into 
consideration when determining place of confinement because 
Wis. Stat. § 252.07(9) does not preclude a court from doing so.  
Moreover, the City notes that the D.E.R. court explicitly 
declined to address the question that Washington raises here: 
This case does not pose the question of whether the 
circuit court may ever consider the costs of the 
proposed placement. Counsel for D.E.R. and M.D.A. 
acknowledged at oral argument that there may be cases 
in which the costs of the proposed placement are so 
exorbitant and the benefits to the individual so 
minimal that it is not reasonable for a professional 
to recommend the placement or for a circuit court to 
order such a placement. 
D.E.R., 155 Wis. 2d at 253. 
¶52 We turn to Wis. Stat. § 252.07(9)(a) and interpret its 
language in a manner that is consistent with the purposes of the 
statute.  Kalal, 271 Wis. 2d 633, ¶49 (statutes should be 
interpreted in a manner that is consistent with their manifest 
purpose).  The statute does not explicitly address whether costs 
may be a factor in determining place of confinement.  However, 
the factors a court must consider in determining the place of 
confinement under the statute include:  The place of confinement 
must be a facility (a) where proper care and treatment will be 
provided, (b) where spread of the disease will be prevented, and 
No. 
2005AP3141   
 
34 
 
(c) that is not more restrictive than an alternate place of 
confinement.  See Wis. Stat. § 252.07(9)(a).   
 
¶53 We conclude that a circuit court may take into account 
cost 
when 
determining 
place 
of 
confinement 
under 
Wis. Stat. § 252.07(9).  A court must first determine that the 
place of confinement is a facility where proper care and 
treatment will be provided, spread of the disease will be 
prevented, and that no less restrictive alternative to the 
proposed placement exists.  Once the court has engaged in this 
analysis, and two or more placement options remain, a court may 
consider cost as a factor in making its determination.  A party 
requesting that a court take into account the cost of various 
placements must offer some proof to support its assertions for 
the court to consider cost as a factor in placement. 
IV 
 
¶54 We turn now to the question of whether the circuit 
court's 
order 
confining 
Washington 
to 
jail 
under 
Wis. Stat. § 252.07(9) was a proper exercise of its discretion.  
"We affirm discretionary decisions if the circuit court applies 
the proper legal standard to the relevant facts and uses a 
rational process to reach a reasonable result."  Robin K., 291 
Wis. 2d 333, ¶12 (citations omitted). 
 
¶55 Washington contends that the circuit court confined 
her to jail instead of the Medical Center based solely on its 
conclusion that the costs to local taxpayers of confinement to 
the Medical Center were too burdensome.  We agree that the 
court's stated reasons for its placement decision were fiscal in 
No. 
2005AP3141   
 
35 
 
part.  However, we conclude the transcript of the circuit court 
hearing demonstrates that other factors, including the public 
health of 
the community and the treatment and care of 
Washington, were paramount.   
 
¶56 The circuit court found that Washington posed a "huge 
health risk" to the community by repeatedly failing to take her 
medication for tuberculosis.  The record shows that Washington 
had been previously treated for tuberculosis and was therefore 
at greater risk of developing a more dangerous, drug-resistant 
strain of the disease.  The court concluded that Washington had 
a history of disappearing from sight, that the Department 
previously had great difficulty locating her, and that there was 
nothing in the record to show that she would voluntarily turn 
herself in to start taking her medicine again.  When placed in 
the community under supervised conditions, Washington walked 
away from that placement.  The court was concerned that 
Washington "cannot comply with Court orders."  It heard 
testimony that if Washington were to escape custody yet again 
she would "certainly" become contagious within a month, perhaps 
in as soon as a week.  The court was also concerned that 
tuberculosis could "become resilient [sic] to medications."   
¶57 The circuit court did not want to confine Washington 
to jail, but felt it had no choice.  The court kept open the 
door to alternative placements: 
[I]f you can find some other locked facility for your 
client that would agree to take her, the Court would 
be happy to order her placed somewhere else, and I'm 
sure the City would agree.  The problem is that I need 
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2005AP3141   
 
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to have a locked facility where she is going to stay 
put . . . .  At this point the only place that I know 
where I can put her in a confined setting would be at 
the CJF, in jail . . . .  I refuse to require tax 
payers to pay 24 hour around the clock guard at her 
door to make sure she stays put.  I don't think that's 
appropriate.  Miss Washington was given an opportunity 
to receive treatment in the community and she failed 
to do that.  But, [counsel], if you find some other 
place that she can be placed, . . . I'll be happy to 
place her some place other than jail if you can come 
up with some alternative that would accept her, sir.  
I have no problem in doing that.  Actually, I'd 
welcome that.  But I don't know of any other facility 
at this time . . . .  If you find some other place to 
have her placed, you want me to order something, sir, 
I'll be happy to look at whatever you have found. 
¶58 We also note that Washington was highly belligerent 
toward police officers when she was picked up on September 27, 
that she "was kicking her feet out of the squad car window and 
kicking the inside roof of the squad car, all the while loudly 
screaming, yelling and crying." 
¶59 Additionally, we observe that the circuit court record 
indicates that in Washington's case, the CJF was a place where 
proper care and treatment would be provided and spread of the 
disease would be prevented.  The circuit court stated that "the 
[CJF] certainly qualifies" as "a facility where treatment can be 
rendered."  Moreover, we note that the court received expert 
testimony 
that 
Washington's 
tuberculosis 
was 
presently 
noninfectious.  
¶60 Based on these considerations, we conclude that the 
order confining Washington to jail was not an erroneous exercise 
of the circuit court's discretion.  Washington was at risk to 
develop a drug-resistant strain of the disease, had a history of 
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2005AP3141   
 
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disappearing from sight and was belligerent toward officers.  
The circuit court reasonably concluded from these factors that 
medical 
staff 
would 
not 
have 
been 
equipped 
to 
handle 
Washington's outbursts, and that the added security of jail was 
necessary 
to 
ensure 
that 
she 
would 
continue 
taking 
her 
medication and would not escape confinement.  Factoring in 
taxpayer costs as well was not an erroneous exercise of 
discretion.   
¶61 In future cases, courts should follow the guidelines 
set forth in this opinion when determining place of confinement 
under 
Wis. Stat. § 252.07(9). 
 
A 
court 
proceeding 
under 
§ 252.07(9) 
must 
ascertain 
whether 
a 
proposed 
place 
of 
confinement is a facility where proper care and treatment will 
be provided, spread of the disease will be prevented and that no 
less restrictive alternative placement exists.  After applying 
these criteria to potential placement options, if two or more 
placement options meet the statutory requirements for treatment 
and disease prevention, and none of these placement options is 
significantly less restrictive than the others, the court may 
take 
into 
account 
the 
relative 
costs 
of 
the 
different 
placements.  However, a determination based on cost must be 
supported by more than mere assumptions about the cost of 
particular placements. 
V 
 
¶62 Finally, we consider the court of appeals' conclusion 
that the confinement order was also authorized under the 
contempt statutes, specifically, Wis. Stat. § 785.04(1), which 
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2005AP3141   
 
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grants circuit courts the power to enter remedial sanctions.  
Section 785.04(1) lists remedial sanctions a court may impose, 
including, under paragraph (b), "[i]mprisonment if the contempt 
of court" involves disobedience of a court order pursuant to 
Wis. Stat. § 785.01(1)(b).  Paragraph (b) further provides:  
"The imprisonment may extend only so long as the person is 
committing the contempt of court or 6 months, whichever is the 
shorter period."  § 785.04(1)(b).   
¶63 Washington contends it was unnecessary for the court 
of 
appeals 
to 
address 
whether 
the 
confinement 
was 
also 
authorized under Wis. Stat. §  785.04(1)(b), and, regardless, 
the City should be judicially estopped from proceeding with this 
argument because the City expressly abandoned contempt as a 
basis for confining her to jail.  Washington further argues it 
was not within her power to "purge" the condition of her 
confinement (her disease, she asserts) and, therefore, remedial 
contempt may not be a basis for the order.  
¶64 We agree with Washington that the court of appeals' 
conclusion that the confinement was lawful under the remedial 
contempt statute was unnecessary.  To begin with, the circuit 
court never made a finding of contempt for this court to review.  
It is simply not part of this case.  Further, as Judge Kessler 
noted in dissent, such a conclusion violated the principle that 
"cases should be decided on the 'narrowest possible ground.'"  
Washington, 292 Wis. 2d 258, ¶25 (Kessler, J., concurring in 
part, dissenting in part) (quoting State v. Blalock, 150 Wis. 2d 
688, 703, 442 N.W.2d 514 (Ct. App. 1989)).  
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2005AP3141   
 
39 
 
 
¶65 Moreover, we agree with Washington that remedial 
contempt was not an appropriate sanction in this case.  A 
contemnor may be imprisoned "only so long as the person is 
committing the contempt of court."  Wis. Stat. § 785.04(1)(b).  
Once a contemnor complies with the prior court order, or 
"purges" the contempt, the person must be released.  "The purge 
provision must clearly spell out what the contemnor must do to 
be purged, and that action must be within the power of the 
person."  State ex rel. N.A. v. G.S., 156 Wis. 2d 338, 342, 456 
N.W.2d 867 (Ct. App. 1990) (citing Schroeder v. Schroeder, 100 
Wis. 2d 625, 638, 302 N.W.2d 475, 482 (1981)).  "Thus, it is 
often said that contemnors 'hold the keys to their own jails.'" 
Id. (quoting State v. King, 82 Wis. 2d 124, 137, 262 N.W.2d 80 
(1978)).   
¶66 Of course, no express purge provision was provided in 
this case because the circuit court declined to proceed under 
the remedial contempt statute.  Thus, there was no reason for 
the court of appeals to reach this issue.21   
                                                 
21 The court of appeals stated that Washington "'purges' her 
contempt by complying with the treatment regimen for the 
medically required time.  After that purge, she will no longer 
be confined."  Washington, 292 Wis. 2d 258, ¶19.  Washington 
asserts that to purge the contempt under that analysis, she 
would need to be healed of tuberculosis, and because it is not 
within her power to heal herself, an order of remedial contempt 
would not lie.  
No. 
2005AP3141   
 
40 
 
¶67 Additionally, the legislature specifically addressed 
confinement for noncompliant and drug-resistant persons with 
tuberculosis in Wis. Stat. § 252.07.  As Judge Kessler noted in 
her dissent: 
The 
legislature . . . developed 
an 
elaborate 
and 
detailed system to protect the public from, provide 
treatment for, and protect the civil liberties of, 
individuals 
with 
contagious 
tuberculosis. 
 
The 
legislature has concluded that the statutory system of 
regulation, and enforcement, provides adequate tools 
to protect the public and to treat the infected.  
Washington, 292 Wis. 2d 258, ¶31 (Kessler, J., concurring in 
part, dissenting in part).   
¶68 We therefore disavow the court of appeals' discussion 
of remedial contempt under Wis. Stat. § 785.04(1) as a separate 
basis for confinement to jail in this case.  Washington, 292 
Wis. 2d 258, ¶¶16-19.   
VI 
¶69 In sum, we conclude that Wis. Stat. § 252.07(9)(a) 
authorizes confinement to jail for a person with noninfectious 
tuberculosis who fails to comply with a prescribed treatment 
regimen, provided that the jail is a place where proper care and 
treatment will be provided and the spread of disease will be 
                                                                                                                                                             
However, Washington was not confined merely because she had 
tuberculosis.  She was confined because she was diagnosed with 
tuberculosis and refused to comply with treatment orders.  Thus, 
had Washington been imprisoned on a remedial contempt order, she 
could have purged her contempt by complying with treatment 
orders, i.e., by taking her medication.  Once Washington took 
her medication, she would no longer be in contempt, and could no 
longer be held in jail under Wis. Stat. § 785.04(1)(b). 
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2005AP3141   
 
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prevented, and that no less restrictive alternative exists to 
jail confinement.  We further conclude that a circuit court may 
take into account the cost of placement options when determining 
the place of confinement under § 252.07(9), but only after 
determining that two or more placement options fulfill the 
statutory requirements of proper medical treatment and disease 
prevention, and that none of these options is significantly less 
restrictive than the other(s).  
¶70 We conclude the circuit court did not erroneously 
exercise its discretion in ordering Washington's confinement to 
the CJF, and therefore affirm on these grounds the court of 
appeals' 
opinion 
affirming 
the 
circuit 
court's 
order 
of 
confinement.   
¶71 Finally, we conclude that Washington's confinement was 
not authorized by the remedial contempt statute, Wis. Stat. 
§ 785.04(1), and specifically disavow the court of appeals' 
discussion of contempt as a separate basis for confinement to 
jail in this case.   
 
By the Court.—The decision of the court of appeals is 
affirmed. 
 
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2005AP3141   
 
 
 
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