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Thursday, 8 August 2013

Valley Fever: instead of closing infected prisons, CDCR will shuffle the prisoner deck

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VALLEY FEVER: Inland inmates may replace transferred prisoners

August 06, 2013; 06:36 PM

California’s prisons this week will start transferring inmates susceptible to Valley Fever from two Central Valley prisons, where infections from the airborne fungus sickened more than 1,800 prisoners between 2008 and 2012.
Valley Fever has been blamed for 62 deaths among California prison inmates statewide, most at the Avenal and Pleasant Valley facilities.
A report prepared by a court receiver looking into the illness in California’s prisons said 200 prisoners yearly spend 5,000 days in hospital for treatment of their severe conditions, at an estimated care cost of about $23.4 million. African-American and Filipino inmates are particularly susceptible to Valley Fever, as are prisoners who have weakened immune systems.
Along with death, the disease can leave some with permanent disabilities.
The court-ordered transfer affects as many as 2,600 inmates at Avenal and Pleasant Valley.
At Pleasant Valley State Prison in Coalinga the rate of infection was 38 times that of residents in Coalinga, and 600 times the rate of the entire Fresno County. A court document that cited those figures did not detail outbreak numbers for the Avenal prison, which is in the city of the same name in Kings County.
While the disease is not contagious, experts believe people exposed to it constantly may develop immunities, and there may be disproportionately more prisoners who are vulnerable to the disease.
In the state’s crowded correctional system, the transfers mean inmates from throughout California -- including prisons in Riverside and San Bernardino counties -- will have to take the places of those moved from Avenal and Pleasant Valley. Men’s state prison locations in Riverside and San Bernardino counties include Norco, Chino, and two prisons near Blythe.
The replacements will be chosen from prisons around the state, said Bill Sessa, a spokesman for the California Department of Corrections and Rehabilitation. “We are taking a system-wide look at the candidates to go. They will not be people who have the susceptibilities described in the court action.”
“Inmates, generally speaking, don’t have any choice about where we assign them,” Sessa said. “We move inmates around all the time for various reasons.”
The transfers were ordered after the Prison Law Office, a prisoner advocacy group, filed court papers citing high rates of Valley Fever infections in the prisons and alleging that the corrections department had not taken adequate action to protect inmates who might develop complications.
The exact number of inmates who will be transferred from Avenal and Pleasant Valley remains uncertain. Prisoners there can ask not to be transferred, even if they are considered susceptible to Valley Fever.
Some prisoners will be required to transfer, including “seriously immuno-suppressed inmates,” said Warren George of the Prison Law Office in Berkeley. “How that shakes out between the number of inmates who cannot opt out, and those who can, is still ongoing,” he said in a telephone interview.
George said physicians and registered nurses were “talking with the prisoners and informing them of their right to be transferred out, and walking them through the waiver process; some are choosing to waive their right to be transferred.”
Deaths caused by Valley Fever at individual prisons are difficult to track – extremely ill prisoners are transferred to the system’s medical facility at Vacaville, or to local hospitals, and their deaths are recorded there, George said.
But he said the high rates of Valley Fever at Pleasant Valley and Avenal would make it a “fair conclusion” that many of the deaths can be associated with those two prisons.
George said the transfers will begin sometime this week and continue into September. The Corrections Department has 90 days to complete the transfers, ordered on July 1.
The action was filed as part of Plata vs. Brown, the ongoing federal court case that went to the U.S. Supreme Court. In 2011, the justices upheld a lower court ruling that found California had unconstitutionally denied adequate medical and mental health care to its prisoners; the state was ordered to reduce its prison population by more than 30,000 inmates this year.
The fungus that causes Valley Fever exists naturally in the soil in the southwestern United States, particularly Arizona, California’s southern San Joaquin Valley and southern Texas. When the fungus spores are sent airborne by the wind or farming, a small number of people develop flu-like symptoms.
The number of cases has risen in recent years. Between 2001 to 2006, the incidence of Valley Fever nearly doubled in California, largely because of the population explosion at prisons, according to the state Department of Public Health.
About 150,000 cases nationwide are diagnosed annually. About 1,200 of those people go on to develop pneumonia. In about 600 people per year, the fungus gets into the bloodstream causing meningitis, stroke, infections that eat away at vertebrae in the back and, for some, death, said John Galgiani, a professor at the University of Arizona medical school and founder of the Valley Fever Center for Excellence in Arizona.
Galgiani in April filed a declaration in support of the Prison Law Office’s action.
Galgiani said there could be several reasons for a higher rate of infection in the prisons: Increased awareness may be bringing more testing; a lack of protocol for deciding when and whom to test for the disease; a mix of prisoners who are more prone to Valley Fever.
In his April declaration, Galgiani classified the outbreak in the two prisons as a public health emergency that puts lives at “substantial risk.”
“The only reasonable public-health decision to be made is to cease placing prisoners in Pleasant Valley State Prison and Avenal State Prison altogether,” Galgiani wrote.
He criticized the prison system’s management of the disease as ineffective and cited four deaths in Central Valley prisons that he said could have been avoided if they had been properly diagnosed. In each case, a diagnosis of Valley Fever wasn’t made for months, bringing on complications that eventually killed the men, Galgiani said.
“Medical staff at prisons … are still slow to recognize the early signs of Valley Fever, particularly in African-American men, and are slow to begin timely and proper treatment for the disease,” he wrote.
Dr. Benjamin Park of the U.S. Centers for Disease Control and Prevention, who heads up an epidemiological team investigating the outbreaks, said some geographical areas have very high concentrations of Valley Fever spores. The prisons could be among the hotspots, he said.
“Part of the issue might be there are a number of prisoners who are from outside the endemic area and because their bodies are not immune they may have a higher risk,” Park said.
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