CONCORD, N.H. — A homeless man refusing medical treatment for active tuberculosis is stirring public health concerns in New Hampshire, where state officials are scrounging for resources to protect others from the contagious infection.
For more than eight months, the state has been working with local health departments in Manchester and Nashua to give the man a variety of options for medical care, but he has rejected their offers, according to the New Hampshire Department of Health and Human Services. The state has tried forcing him into treatment at three different hospitals by issuing a series of isolation orders, but he just keeps defying them.
His noncompliance has gone on for so long that DHHS asked a judge last month for a warrant to require that he be isolated and treated at the men’s prison in Concord, which is equipped with a negative pressure room for controlling airborne infections. But the attorney general’s office raised legal and practical concerns about placing him in the custody of the New Hampshire Department of Corrections in this manner, so officials abandoned that idea.
The complex situation has strained the state’s public health operations at a time when DHHS has been slashing programs to fulfill cost-cutting directives from the Legislature, officials said.
Iain N. Watt, director of the New Hampshire Division of Public Health, said during a court hearing on March 31 that his team is grappling with a “budget crunch.” Watt noted that lawmakers directed DHHS to find more than $25 million per year in savings, without specifying what to cut. That’s leading to tough questions about balancing competing priorities while dealing with the uncooperative man, he said.
Elizabeth Maynard, a DHHS attorney, said the state has provided tuberculosis testing clinics and contact-tracing services to help anyone who may have been exposed to the bacterial infection. Maynard said she has been advised that those efforts are a better use of public resources than compelling an individual to comply.
“We’ve expended a lot of resources on this case,” she said.
Six months ago, on Oct. 1, the state said it had identified more than 650 people who were potentially exposed to a person with active tuberculosis at certain homeless and correctional settings in Nashua and Manchester during the first half of 2025. Testing for more than 100 of those people revealed two additional active TB cases linked to the first. The state hasn’t provided an update, so it’s unclear how many additional people may have been tested or potentially exposed since then.
The state, which typically reports about 12 cases of tuberculosis per year, has yet to release its 2025 tally.
Jake Leon, a DHHS spokesperson, declined to confirm whether the uncooperative man was among those three previously announced active TB cases. He said the state cannot disclose an individual’s private medical information beyond what was communicated in court.
“In situations involving a potential communicable disease, the department evaluates and pursues all reasonable options to provide care and limit risks to the public,” he said. “Our priority remains ensuring that individuals receive medically appropriate treatment while protecting the health of the broader community.”
This case landed on a judge’s desk because the uncooperative man, Nearro F. Forbes, 41, signed a form in March contesting the state’s latest isolation order, according to court records. Under state law, that triggered a public hearing. Forbes had a right to attend, but didn’t do so.
After discussing the situation at length with officials, Merrimack County Superior Court Judge Martin P. Honigberg issued an order on March 31 affirming DHHS’s isolation order as necessary in light of a serious public health threat. His order directed Forbes to “immediately isolate at a fixed place of his choosing” and submit to medical treatment and observation for at least 30 days. Failure to comply could lead to contempt proceedings.
Honigberg noted in his order that officials had already tried unsuccessfully to get Forbes to hunker down in a variety of relatively unrestrictive settings, including at an outpatient treatment facility for substance abuse, a transitional housing unit, or even a motel.
There are multiple medications to treat active and inactive cases of TB, according to the US Centers for Disease Control and Prevention. Depending on the treatment plan, it can take four months or even longer to treat active TB. (The orders that state officials issued to Forbes said he must remain isolated “for at least 30 days and until the DHHS determines that you are non-contagious.”)
In October, officials ordered Forbes into isolation at Elliot Hospital in Manchester, but he failed to comply, according to court records. In November, they ordered him into isolation for at least 30 days at Catholic Medical Center in Manchester, but he left after only a few hours. They lost track of him for about three months before he was spotted in early March at a warming station in Nashua, where he was exhibiting symptoms and deemed to be infectious.
The symptoms of active TB can include a persistent cough, unexplained weight loss, night sweats, and fever, according to state public health officials. The sickness is caused by bacteria that can spread through the air when an infected person coughs or sneezes. Most people don’t develop TB symptoms immediately, so testing is the only way to know if preventive treatment is needed.
Authorities intercepted Forbes again in March when he showed up for a court hearing on unrelated charges. They took him to Southern New Hampshire Medical Center in Nashua and ordered him to stay put, but he left — and authorities said the hospital won’t take him back unless the state provides a 24/7 security detail.
Maynard said the state has dealt with difficult patients in the past, but doesn’t have money this time around for a security detail. Watt said providing dedicated security for 30 days could cost tens of thousands of dollars. To free up that much money, he said his team would likely have to get by without a staff nurse who would otherwise be focused on longer-term initiatives.
Maynard said a hospital in Massachusetts that had previously cared for tuberculosis patients from New Hampshire isn’t currently accepting out-of-state patients, so her team is running out of options. That’s the context in which she suggested imprisoning Forbes as perhaps the state’s last resort.
After hearing concerns from the attorney general’s office, Maynard apologized to the court last week for having suggested the prison scenario, but Honigberg stopped her, saying she hadn’t done anything wrong and authorities had appropriately refrained from making any rash decisions.
“I’m still not sure what our options are, but you don’t need to apologize for brainstorming,” Honigberg said.
This isn’t the first time Forbes’s actions have posed a threat to public safety. His criminal convictions include drug-related offenses from 2021 in Nashua and 2023 in Manchester. In 2024, he was charged with second-degree assault and felony riot for allegedly participating with others to attack someone in the street outside the Families in Transition adult emergency shelter in Manchester.
Defense attorneys who have represented Forbes in his current and prior criminal cases did not respond to requests for comment, and efforts to contact Forbes directly were unsuccessful.
Forbes was released on bail in the riot case in October 2025, but he failed to appear for a hearing in March, so a warrant was issued for his arrest, according to court records.
If police take Forbes back into custody on the warrant, it’s unclear where he will be housed. Maynard said she hopes local authorities wouldn’t hold him at a county jail, to avoid exposing other detainees to his active case of tuberculosis.
Maynard noted during last week’s hearing that Forbes could potentially be charged with a misdemeanor for disobeying DHHS’s isolation orders. With that in mind, Honigberg forwarded a copy of his order to the attorney general’s office.
A spokesperson for the attorney general’s office did not respond to a request for comment.
Steven Porter can be reached at steven.porter@globe.com. Follow him @reporterporter.