The bricklayer from Nicaragua had failed to complete a six-month regimen of 12 daily pills to fight the tuberculosis that had wracked him with chills and fever in Miami in October 2002. So a judge had him locked up in A.G. Holley State Hospital in Lantana -- the country's last freestanding TB sanatorium. There, Vallecillo has been treated for the airborne disease under strict supervision. He is one of 60 mostly immigrant and minority patients who, after violating Florida's tuberculosis control laws, live a quarantined existence.

National experts point to A.G. Holley as a model of TB control and care. But civil rights advocates say the hospital also has a history as a holding pen for patients who were once arbitrarily detained for failing to take their medications.

Whatever its role in the enforcement of public health laws, local officials say A.G. Holley is a relic that serves only a fraction of the state's 1,100 annual TB cases. They want to convert the site into a mall or housing development.

State Sen. Ron Klein and University of Miami officials would like the property used for a large research center with a link to The Scripps Research Institute, which recently chose Palm Beach County as its new home.

With competing interests closing in on its coveted 145 acres of land, the state's only public health hospital faces an uncertain future.

Founded in 1950, A.G. Holley's four-story pink building is a monument to the heyday of tuberculosis. Its second floor is plastered with photographs of patients -- who once numbered 500 -- doing arts and crafts, learning to type and playing cards. Green oxygen machines and long steel rods used to perform lung biopsies are strewn in an old patient's room as part of the hospital's museum display.

Though potent antibiotics all but wiped out TB in the United States by 1970, the rise in immigration from countries where the disease still flourishes, as well as the arrival of HIV, afforded it a comeback in the 1980s, experts say.

That resurgence saved A.G. Holley from extinction and turned it into a leading treatment and research center for multidrug-resistant TB, said David Ashkin, its medical director.

No longer a social hub of white convalescents, about one-third of the patients are from Latin America, Haiti or other parts of the Third World -- where TB claims 3 million lives yearly. Half suffer from AIDS, a disease that has "partnered up" with the TB bacterium that thrives in a weakened immune system, Ashkin said.

And almost 60 percent are court-committed to A.G. Holley for violating Florida's TB-control laws for not taking pills daily in the presence of a health care worker. More than half suffer from mental disorders and drug addiction.

A.G. Holley's patients typically arrive with a drug-resistant strain of the illness. Left untreated, it can gouge cavities in the lungs and cause death. That strain, according to Ashkin, accounted for most of the state's 55 TB deaths in 2002 and compels health officials to make sure patients complete their mandated treatments.

"I didn't know what I had. I had fever, pain in my bones. Everything hurt," said Vallecillo, who was committed in August. He was first hospitalized for TB at Jackson Memorial Hospital a year ago, where he signed a document agreeing to meet a drug regimen supervised by public health-care workers.

"But I stopped taking my medications, and I stopped meeting with the nurse. My schedule was so erratic. So one day they called me in and told me I would get a certificate for completing the program. When I got there, two policemen handcuffed me and took me to Ward D, where I was shackled to the bed," he said.

Ward D is a holding center at Jackson Memorial Hospital where noncompliant TB patients stay while a judge decides whether they'll be sent to A.G. Holley, said Janelle Hall, spokeswoman for Miami-Dade County's Corrections Health Services.

Vallecillo began his stay at A.G. Holley as all its patients do -- confined to an isolation room for several days. Today, he is well past his days in the sanatorium, where patients roam the halls and greet nurses who wear protective masks.

"It's like a hotel here. You get your medications. You go on outings. ... Eventually, I'll get out and go forth with my life," Vallecillo said.

According to the Centers for Disease Control, Florida is one of 42 states with laws allowing the "commitment" of TB patients who fail to complete their drug therapies. Those laws, CDC officials say, are why TB deaths are at an all-time low, with 750 reported in 2001.

In Florida, the state health department can issue an order of detainment for a patient who has repeatedly failed to complete treatment. The order to commit is made by a judge at a court hearing, where a patient is represented by an attorney.

Detainment orders last 180 days, state officials must go back to court to request an extension if a patient still isn't well.

Health officials say the laws are necessary to control the disease's spread and protect the public. But only after civil rights advocates challenged the state's practice of arresting and confining patients to A.G. Holley with little freedom did a comprehensive TB control program that emphasized patients' rights come into existence under Ashkin.

Jim Green of the American Civil Liberties Union filed a constitutional challenge to the state's TB statutes in the late 1980s. He said the state regularly detained patients and banished them to A.G. Holley without access to attorneys or other freedoms.

"There were dozens of people at A.G. Holley who were being locked down with fewer rights than prison inmates," Green said. He said patients had no visitation rights, no access to a library and were deprived of written correspondence. "It was a throwback to the 19th century."

In the complaint, Green argued that because TB detention is a "civil commitment" similar to the Baker Act -- a law that allows the psychiatric detainment of anyone considered to be a threat to himself or others -- it needed to include similar due process protections.

The state agreed, and the law was amended, Green said. The amendment was written to protect patients' rights while guarding the public from a potentially lethal contagion, he said.

With time and the recovery of health, A.G. Holley's patients earn back their freedom -- symbolized in the green wristbands worn by those who require little supervision on hospital grounds and are soon due for release.

But those tagged in red aren't always grateful to be in a locked center. One patient, a 37-year-old woman who suffers from TB and AIDS, had just been ordered held at A.G. Holley for another six months, and she was in tears.

"You can't judge a person by their past," said the woman, who didn't want her name to be used because of her illness. She once worked as a nurse's aide in Tampa but was diagnosed with AIDS and TB in 2000 after months of chest and stomach pains. The Hillsborough County Health Department ordered her to participate in a treatment program, but she didn't take her medications, used crack cocaine to ease the pain and was committed to A.G. Holley in April.

"I had a hard time coping. I gave up on life. I didn't care. But now I know that there are things you can and can't do just to stay alive."

A.G. Holley staff and health department representatives told her in a recent hearing that she is not yet ready to be out on her own and follow her treatment plan. Unlike other patients, she bristles at her confinement.

"At least here I'm not out on the streets, but it's nothing like having your own freedom," the woman said.

Jim Cobb, head of the state's tuberculosis and refugee health program, said health care workers make every effort to work with patients before reporting them for noncompliance.

But fear and ignorance still keep TB care in the dark ages in some parts of Florida, and one former patient is fighting the stigma attached to the disease.

Theresa Quezada, 44, of Arcadia, was exposed two years before she was diagnosed with TB. She was finally tested for the illness when she went to an emergency room coughing up blood.

"Here I am, a 44-year-old white woman who owns my own home. I didn't fit the criteria, even though I had every symptom on the list, but they didn't test me," said Quezada, who now volunteers at A.G. Holley.

Quezada, who worked as a store clerk, discovered she had been exposed to TB by a co-worker before quitting her job in 2000. Throughout 2001, private doctors treated her for bronchitis and pneumonia after she came down with high fevers and chills. It was later learned she had infected 13 people during that time, including her 2-year-old granddaughter, who required lung surgery.

Quezada spent several days at a Desoto County hospital, where she said staff members refused to change her bed linen or clean the room for fear of catching her disease.

"I can remember hearing my grandma talking about a bunch of people dying of TB, so when they said I had it, I figured I'd been given a death sentence," said Quezada, now an A.G. Holley volunteer.

Released in June 2002 after voluntarily entering A.G. Holley, she credits Ashkin and A.G. Holley with her new roles as a DeSoto County health department outreach worker and Holley volunteer.

"TB didn't die in the 1950s. It's still right here in the community, and people need to know that you can still treat a person like a human and protect yourself," she said.

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