Tuberculosis (TB) is an infectious disease of global burden. While Delaware has low incidence of active TB compared to other locales, because of its small size these few cases tend to garner widespread attention. In this article, a study of one such case of active TB is presented. This case serves as a didactic example of the public health response to the complexities of treatment, including institutional, transient settings, and patient refusal. This consequently led to ordered directly observed therapy of the individual. The article concludes with a discussion of the law and legal implications for such cases in Delaware.