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Prisons as Incubators and Spreaders of Disease and Illness
America’s lockups are turning from prisoner dumping grounds into infectious disease breeding grounds. Isolation is intended to be the punishment inflicted by society upon prisoners. But concentrating prisoners in the process of isolating them, and then denying them adequate medical care, is having the perverse effect of punishing society by propagating serious contagious diseases that released prisoners “give back” to the non-incarcerated public.
Thus, the populist hatred that inheres against criminals, which permits inhumane healthcare to persist in jails and prisons, is itself a contributing cause to such growing public health menaces as tuberculosis (TB), Hepatitis C (HCV), AIDS (HIV) and Methicillin Resistant Staphylococcus Aureus (MRSA). Myriad other diseases flourish inside overcrowded, unsanitary prisons as well – and extend beyond to local communities – as discussed in this introspection into infections in detention facility settings. This is nothing new. Prisons and jails have been the incubators of disease for centuries. But with notions of public health, better awareness of disease contagion, etc., it is all the more remarkable that not only does prison health remain a threat to the public health of all citizens, but that it has grown as the number of prisoners has grown.
One-third of the world’s population is believed to carry the TB bacillus – mostly in densely (over)populated impoverished third-world nations. Despite international humanitarian efforts, TB persists and kills millions annually. TB usually affects the lungs but can also damage the kidneys, spine or brain, and if untreated can be deadly. It is spread through airborne germs.
The TB infection rate in the United States is only 4.6 per 100,000 population, but approximately 90% of known cases occur among prisoners. The combination of low socioeconomic status (with its attendant poor healthcare) and crowded living conditions in prisons and jails provide fertile ground for TB. Past efforts to curb the disease’s spread among America’s incarcerated have been inadequate, resulting in new standards announced by the National Centers for Disease Control (CDC) in 2006. [See related article, this issue]. The Advisory Council for the Elimination of Tuberculosis recommends that all prisons and jails have a TB infection control plan.
In Arizona, a patient with TB can be locked up in a hospital jail ward without having committed any crime. Robert Daniels, 27, was raised in Scottsdale but returned to his native Russia ten years ago, where he caught a strain of multi-drug-resistant (MDR) TB known as XDR-TB. When he began coughing up blood he returned to Arizona to obtain better medical treatment. His virulent infection of the highly contagious XDR-TB required his hospitalization in an aerobically isolated room. The only one available was at the jail ward at the Maricopa County Medical Center, where Daniels has been “guarded” around the clock for almost a year to prevent his infecting others.
During his involuntary incarceration he has been deprived of a television, radio and personal phone; he is unable to shower, and the lights in his bare room are on constantly. Yet he has not been charged with or convicted of any crime, only deemed a public health risk. The Arizona ACLU filed a lawsuit on his behalf in May 2007 seeking relief from such restrictive housing conditions, but this action pits Daniels’ rights against the public welfare. “It’s good news for me,” Daniels said of the suit. “I finally have a chance to get out of this black hole.” See: Daniels v. Maricopa County, USDC AZ, Case No. 2:2007-cv-01080.
Alabama reported three prisoner TB cases in 2006. At the Tutwiler women’s prison, two unrelated infections were reported in May and June. The June case involved a county jail transferee from Houston County. While that prisoner was placed in isolation, another 106 prisoners who had come into contact with her had to be quarantined as well. On September 22, a Kilby Correctional Facility prisoner was placed in respiratory isolation. He had arrived at Kilby, an intake facility, on August 11. All who came in contact with him at the Talledega County Jail and at Kilby were isolated and monitored for three weeks pending test results.
In February 2007, 8 out of 24 Escambia County, Florida jail prisoners tested positive for TB after one had became infected and contagious.
More recently, forty-five Coconino County, Arizona jail prisoners and employees were notified in June 2007 that they may have been exposed to active TB from a sick prisoner. The prisoner, who was not named, had symptoms of TB infection when he was being booked into the facility. “We will be following up to make sure the individual is complying with treatment,” stated County Health Director Barbara Worgess.
It was also reported in June 2007 that a female prisoner at the Corrections Corporation of America-operated Gadsden Correctional Facility in Florida had been diagnosed with TB. She was taken to the Capital Regional Medical Center for treatment; she had reportedly experienced symptoms for a week before being diagnosed.
Detention facilities are not the only institutions at risk of TB transmission. In June 2006, three mental health care patients from group homes in Devine, Texas were hospitalized with active TB. Because the victims in one group home had interacted with patients at other homes, some 200 people were placed at risk.
California logs approximately 2,900 cases of TB each year, inclusive of prisoners. This has resulted in a state law requiring annual TB tests for all DOC staff and prisoners (Penal Code BB 6006.5, 7570 et seq.), as well as testing when prisoners are transferred between facilities. All new county jail arrivals are tested within 72 hours; however, TB still persists.
In June 2006, a Modesto County Jail prisoner tested positive for TB at intake but the results weren’t announced for seven days. All prisoners and staff were subsequently tested. At the California State Prison (Solano), more than 6,000 prisoners and 1,400 staff had to be tested in September 2006 after two prisoners came down with active TB.
Additionally, a prisoner arriving from the San Diego County Jail tested positive upon his November 2006 arrival at the R.J. Donovan State Prison. His possible exposure to the disease since his incarceration on August 22 was traced to six jail transfers and four other bus transports.
Hepatitis C and HIV
An estimated forty percent of America’s 2.3 million prisoners carry the Hepatitis C (HCV) virus; many are also afflicted with HIV. According to a study by the Centers for Disease Control released in January 2003, approximately 1.3 million Hepatitis-infected prisoners were paroled in 1996, representing 29% of the nation’s HCV cases. 39% of all HCV-infected Americans will cycle through prisons and jails this year. Left untreated, this hotbed of disease is a ticking public healthcare time bomb.
HCV and HIV are very different viruses but they attack largely the same population since they are both blood-borne. Thus, injection drug use, tattooing and unprotected anal intercourse are as likely to spread HCV as HIV. Unfortunately, prisoners are at the top of this high-risk behavior list. According to the World Health Organization (WHO), the rate of HIV infection is up to twenty times higher among prisoners than in the general population worldwide, and the rate of HCV infection is up to 100 times higher. In the United States it is estimated the HIV infection rate is three times higher among prisoners, while HCV is twenty times more prevalent in prisons. This pales in comparison to South Africa, though, where 12% of prisoners (totaling over 13,700) are HIV-positive.
Both HCV and HIV are treatable but they suffer from a dangerous trait: those who carry either disease, or both, often don’t know it because testing in prison is not widely available. This “don’t ask, don’t tell” policy is favored by prison officials who want to avoid the expensive cost of treatment. Yet they must know that delaying or denying a $10,000 HCV treatment regimen (and potential cure) today will cost 10 to 100 times more for palliative terminal healthcare later.
One of the few states to openly acknowledge this pending financial disaster, and to do something about it, is North Dakota. State medical director Kathleen Bachmeier instituted 100% HCV screening after a methamphetamine “epidemic” tripled her state’s prison population and brought with it high rates of HCV infection. As a public health initiative, North Dakota seeks out and treats those who are deemed medically treatable and who agree to stop using drugs.
At least ten states, including Texas, have implemented mandatory HIV screening for all prisoners. [See: PLN, March 2007, p.40]. Alabama and Missouri test prisoners when they both enter and exit the prison system. A federal bill, the “Stop AIDS in Prison Act” (H.R. 1943), introduced by Rep. Maxine Waters in April 2007, would require mandatory HIV testing for federal prisoners. The bill is presently in a subcommittee where hearings were held on May 22.
Still, treatment for infected prisoners, as opposed to testing, remains the exception rather than the rule. Fewer than 10% of prisoners who know they have HCV receive treatment. In many states where litigation has forced treatment programs, the combination of waiting lists, delays in liver biopsies, onerous “pre-conditions” (e.g., attending drug counseling for one year first) and minimum remaining-length-of-stay restrictions have effectively denied treatment to most HCV-afflicted prisoners, or have delayed it until they are released on parole or are too sick to respond to treatment. The latter result is doubly damning, because treatment is denied until the patient is sicker and then released back into the community with an advanced stage of the disease. Most prisoners have no private health insurance, and the public healthcare budget can’t handle the burden that results from thousands of infected ex-cons.
Other countries faced with HCV prison epidemics have taken a strong position in favor of treatment. In June 2007, the High Court of Sindh in Pakistan directed the superintendent of the Central Prison Khairpur to expedite the medical treatment of over 100 prisoners with Hepatitis B and C. The Pakistani high court noted that “a prisoner does not shed his basic rights at the prison gate and as long as he is in custody, his health and well being are the responsibility of the state.” Few prison authorities in the United States seem to share the same view in regard to HCV treatment.
The future looks bleak. HCV is already the most common disease of its type in America, and is becoming more entrenched as intravenous drug use grows. The place to interdict this disease with aggressive treatment is in the nation’s jails and prisons, where it can be readily screened, since fewer than half of those who carry HCV even know they are infected.
While one in five people with HCV will clear the disease out of their system naturally, the other four will go on – if untreated – to develop terminal liver disease within 20 years. 13,000 people died of HCV in 2000 and 39,000 with the disease are predicted to die in 2030. 375,000 HCV victims will suffer disabling cirrhosis of the liver by 2015. Although $1 billion is spent annually treating HCV in the United States, that is a miniscule amount compared to the future costs if containment of HCV in prisons and jails is not implemented nationwide.
In some recent cases litigation has forced prison officials to address the issue of HCV treatment. On June 4, 2007, the Supreme Court ordered the reconsideration of a lawsuit filed by Colorado prisoner William Erickson after his HCV treatment protocol was stopped by prison officials due to a disciplinary matter related to a missing syringe. The Court did not address Erickson’s treatment claim on the merits, but remanded the case on procedural grounds after finding that he had alleged sufficient injury (the termination of his HCV treatment) to sustain the suit. See: Erickson v. Pardus, 127 S.Ct. 2197 (2007).
The previous month, in March 2007, Delaware prisoner Richard Mark Turner won a pro se lawsuit – on a summary judgment motion – against Correctional Medical Services (CMS), in which he alleged deficient medical care related to his HCV treatment. Turner claimed that CMS employees had failed to properly train him to inject himself with Interferon, an HCV medication; the judge found that he had received “obviously inadequate” care and ruled in his favor. The issue of damages has not yet been decided. See: Turner v. CMS, USDC DE, Case No. 1:03-cv-00048-SLR.
And on February 27, 2007, New Jersey’s Supreme Court ordered the Department of Corrections to notify prisoners of any serious medical conditions requiring treatment, to allow prisoners access to their medical records, and to enact regulations that addressed the Department’s responsibility for prisoners’ health. The ruling resulted from a lawsuit filed by a prisoner identified only as “J.D.A.” who had HCV but whose prison medical records incorrectly indicated he had tested negative for the disease. It took four years for the records to be corrected, during which time he received no treatment. This delay and incompetence led the Court to criticize the DOC’s “refusal to acknowledge until the eleventh hour its ultimate responsibility for inmate medical care and record keeping.” See: J.D.A. v. New Jersey DOC, 189 N.J. 413, 915 A.2d 1041 (N.J. 2007).
The American Friends Service Committee has an aggressive on-going HCV education program for prisoners, but public health money is sorely needed to treat those already infected. Advocacy and educational materials regarding Hepatitis C are available from the National HCV Prison Coalition, P.O. Box 41803, Eugene, OR 87404; (541) 607-5725, www.hcvinprison.org.
Information about HIV treatment and related issues in a prison setting is available at TheBody website: www.thebody.com/index/whatis/prison.html, and PLN also distributes the book “Hepatitis and Liver Disease: What You Need to Know,” with details in the book order section of this issue.
Prison, reduced to its most basic element, requires providing a place for every prisoner to safely lie down and sleep. But even that is not sacred anymore, because today a vicious scourge awaits prisoners when they “hit the mattresses,” which are increasingly infected with a disfiguring and sometimes lethal staphylococcus (staph) infection, notably Methicillin-Resistant Staphylococcus Aureus (MRSA).
MRSA typically presents as oozing boils in moist areas under the arms or near the genitals. The bacteria enters minor breaks in the skin and rapidly colonizes. If the disease reaches one’s spinal fluid, death can occur within 24 hours. HIV immune-compromised victims often die from systemic MRSA infections. While the disease can be treated, it is resistant to common antibiotics. “Last resort” newer antibiotics such as vancomycin are given reluctantly, in fear that when a mutant MRSA strain develops that is resistant to them, the disease will become pandemic. The CDC reports that MRSA infections number in the tens of thousands annually – often, sadly, in hospitals – with about 17,000 deaths per year.
Many incidents of MRSA in prisons and jails have been reported in the past few years. At the Greenville County Detention Center in South Carolina, 26 prisoners and 5 guards joined forces in May 2006 to address serious MRSA infections at the facility. The U.S. District Court granted a motion for immediate discovery, allowing a medical examiner to inspect the detention center. Twenty-five prisoners subsequently filed suit on August 22, 2006. See: Jackson v. Greenville County, USDC SC, Case No. 6:2006-mc-00073, and Boyd v. Greenville County, USDC SC, Case No. 6:2006-cv-02339.
New York’s Washington County Jail had four confirmed cases of MRSA in September 2006. The infection had spread to one prisoner’s bloodstream and required hospitalization.
A King County, Washington jail prisoner, Patrick A. Harrington, Jr., died due to a MRSA infection on January 25, 2004. He had complained about his painful and abscessed arm, and was seen at the jail clinic two days later. Despite being rushed to a hospital he died the next day.
Harrington’s girlfriend, who had also been jailed, died the following month soon after her release; she also had a MRSA infection.
Massachusetts’ Worcester County Jail reported four guards and four prisoners infected with MRSA. One guard had passed the disease to his 18-month-old son; in response, the jail began sanitizing common surfaces and sterilizing laundry. State prisons in Massachusetts reported that 75 prisoners and one guard had become infected in 2005. Rhode Island reported that 20 state prisoners and one guard came down with MRSA in November 2006; the guard had to be hospitalized.
In Northampton County, Pennsylvania, four prisoners were confirmed to have MRSA in October 2006. The previous year three other prisoners at the facility were infected, while four more contracted MRSA at the Warren County Jail. The Allegheny County Jail reported one guard becoming infected in November 2004; two female prisoners had died at the jail due to MRSA that same year.
But nothing compares to the Bucks County (Pennsylvania) Jail, where MRSA was rampant and prisoners were left without treatment in moldy, damp and filthy conditions. Lawsuits flew, and two prisoners obtained $1.2 million in jury awards in January 2005 after their MRSA infections went untreated and ignored by jail staff. [See: PLN, July 2005, p.20].
Litigation also commenced in June 2006 after five Woodbury, New Jersey guards contracted MRSA at their jail jobs and then infected their wives. The guards claimed officials didn’t warn them of “possible exposure” to MRSA – a claim that has been raised by prisoners at the jail who likewise have filed suit. See: Collins v. County of Gloucester, USDC NJ, Case No. 1:06-cv-02589-JMS-JS.
Michigan’s Calhoun County Jail suffered two deaths from MRSA within 13 hours on March 1, 2005. Jail staff disinfected the dorm the two men had shared, and are now emphasizing education on hygiene and sterilization of all laundry. A female nurse at the jail had to have part of her foot amputated to stem an infection she said she contracted from an infected prisoner who sneezed. Also in Michigan, Oakland County reported 51 MRSA cases in 2006, while the Macomb County Jail logged 11 cases in December 2006 alone. A former nurse at the Oakland County jail, Laura Peck, filed suit on January 9, 2007, alleging she was infected with MRSA as a result of a needle prick while treating an infected prisoner. See: Peck v. Oakland County, USDC ED MI, Case No. 2:07-cv-10167-PJD-PJK.
Contract doctor Adil Yamour was barred from working for the Ohio DOC in 2004 following a MRSA outbreak involving dozens of prisoners at the Pickaway Correctional Institution that resulted in one death. Prisoner Sean Schwamberger, 19, died on April 29, 2003 after a culture sample was not ordered and prescribed antibiotics failed to work. Dr. Yamour was criticized for lancing the infectious boils, which contributed to the spread of the disease. A common vector in many of the Pickaway infections was dirty tattoo needles.
At the Federal Prison Camp in Duluth, Minnesota, five cases of MRSA were reported in April 2005. Doctor Rajash Prabhu, an infectious disease specialist at St. Mary’s Duluth Clinic, stated that he sees three cases of MRSA per month.
An assistant public defender in West Palm Beach, Florida almost lost an arm to MRSA in 2004. It was believed that he had contracted the disease from a client at the 2,100-prisoner county jail, where 198 MRSA cases occurred between January 1 and March 28, 2004. Doctors were using the antibiotic Cipro to treat the disease, which likely resulted from poor sanitary conditions.
And in Atchison, Kansas, County Sheriff John Calhoun was surprised to find numerous cases of MRSA cropping up (two requiring hospitalization) despite a new jail opening in early 2006. Neighboring Missouri had 59 MRSA infections in the St. Louis County Jail in 2005. The small Siskiyou County Jail in Eureka, California found five active cases in June 2006 that were detected upon intake exams.
The Los Angeles County Jail suffered over 4,000 cases of MRSA between 2003 and 2004, 70 of which required hospitalization. [See: PLN, Jan. 2006, p.34]. San Quentin State Prison’s North Block recently suffered 70 staph infections among its 820 occupants, while four Connecticut prisons experienced outbreaks in March 2007 and a MRSA infection affecting four prisoners at the Edmonton Remand Centre in Canada was reported in May 2007.
The good news is that MRSA is preventable by the most elementary of techniques – personal hygiene. Frequent hand washing with soap and hot water can largely avoid MRSA. But crowded prisons and jails are typically as filthy as pig sties. The great unwashed are hauled in from the streets and packed like sardines onto communal mattresses. Rarely sterilized between uses, the mattresses become breeders of active disease. Facility sanitizing, hygienic wash basins, clean towels, clean bedding and sterile mattresses elude detention management’s attention, permitting MRSA to continue to fester.
PLN has previously reported on the prevalence of MRSA in prisons and jails previously, but not much has changed except the growing number of infections and deaths. [See: PLN, Dec. 2003, p.10].
You no longer have to book a cruise to catch the norovirus, which spreads quickly in crowded populations and is sometimes called the “cruise ship virus,” as it has increasingly come to prisons. While California’s San Quentin State Prison began as a barge on San Francisco Bay in 1852, it seemed like the S.S. San Quentin in December 2006 when over 800 of the facility’s 5,200 prisoners, plus 49 employees, became infected with norovirus within a matter of days. From the mainline to isolated areas of Death Row, the disease was quickly passed via unsanitary preparation of food in the main kitchen.
Prisoner workers on the serving line were observed alternately dipping their gloved hands into the food pans, then putting them in their mouths, then rubbing them on their pants in a disgusting repetitive cycle only interrupted by wiping their noses and scratching themselves. It took weeks to break this vicious cycle of re-infection, as contagious prisoner kitchen workers (often clueless that they were carriers) were pressed into service without medical clearances.
Norovirus, also known as Norwalk virus, is a virulent gastroenteritis that causes stomach cramps, vomiting and diarrhea. Often a 24-hour episode, it can last up to a week and is spread person-to-person. Sick prisoners at San Quentin were locked in their two-man cells, which sport Kafkaesque electrically-triggered toilets that are restricted to only three 2-second flushes per six-minute interval (subject to a one-hour lockout penalty for an untimely fourth flush). With two sick cellmates timing their vomiting and diarrhea attacks for days, it was a very demeaning experience. Norovirus outbreaks occurred at eleven other California prisons at about the same time, sickening thousands. The nearly three-week quarantine at San Quentin was lifted in January 2007.
Gambling fever was overtaken by norovirus in Las Vegas in March 2007, when at least 150 prisoners and seven guards succumbed at the Clark County Jail. The jail’s two towers were decontaminated; the spread of the disease was traced to kitchen workers in the 3,100-bed lockup. Thousands of citizens in the community had been sickened by norovirus since December 2006.
In the Richmond (Virginia) City Jail, five guards and 57 prisoners fell ill to the virus in March 2007. Placed on quarantine, the jail shut its doors to incoming prisoners. Since the jail has only three toilets and one sink in each 150-bed housing unit, cross-infection (and re-infection) was a significant problem due to the lack of sufficient sanitation.
Chicken pox (varicella zoster virus) is not kid stuff when it attacks adults. A mild childhood disease that most Americans get in school, adult-onset chicken pox can lead to painful shingles – a herpes-related rash – and even death. Symptoms include the characteristic rash and red blisters, but may lead to swelling of the brain, called encephalitis, and pneumonia. It is spread through coughing and sneezing.
In November 2006, four employees and four prisoners became infected at Florida’s Manatee County Jail. The facility was promptly quarantined since the disease infects 70-80% of those who have not had it before. In July 2006, Florida’s Pasco County Jail was also quarantined when one prisoner came down with the disease in a 56-man pod. Thirteen other prisoners were isolated because they had never previously had the disease.
Thirty prisoners at the Mountainview Youth Correctional Facility in New Jersey were placed in quarantine in April 2007, after 27 tested positive for chicken pox. The quarantine was scheduled for up to 14 days. That same month almost 200 prisoners at a jail in Pima County, Arizona were quarantined after a chicken pox outbreak. While in quarantine they weren’t allowed to attend religious services, self-help programs or court hearings, according to jail officials.
At San Quentin State Prison, the Men’s Advisory Council maintains a list of prisoners who previously had the disease, because the medical department “loses” its records of previously quarantine-exempt prisoners. This is necessary to prevent quarantine of the mainline prison population when chicken pox cases crop up several times a year due to non-medically cleared Reception Center prisoners being co-mingled with the general population.
“There’s a fungus among us.” Valley Fever is a soil-borne fungus that causes an incurable disease which results in aching joints, pneumonia and lung infections. Known also as “coccidioidomycosis,” the disease is endemic to California’s San Joaquin Valley and parts of Sacramento Valley, where the fungus is kicked loose during intense farming operations. However, the disease has shown up in state prisons on a regular basis, too. Valley Fever is not contagious but can be fatal.
In Kings County, 90 of the 114 cases reported in 2006 were at Corcoran State Prison, the nearby Substance Abuse Treatment Facility and Avenal State Prison. Between 2000 and 2006, 263 prisoners were diagnosed with the disease in Kings County alone, with one death. Seven of nine prisons in the San Joaquin Valley area have reported incidents of Valley Fever since 2003.
Nineteen prisoners at the Pleasant Valley State Prison (PVSP) in Fresno County were transferred following an outbreak of the disease in 2005 that resulted in 166 infections and four deaths (including 37 infections and one death among prison staff). According to a subsequent investigative report released in January 2007, the rate of Valley Fever infections at PVSP was 38 times higher than for the non-incarcerated population in Coalinga, where the prison is located.
In May 2007 a resurgence of Valley Fever was projected in Kern County, where 1,084 cases were reported countywide in 2006. “This is going to be a big year,” warned Ronald Talbot, a retired lab director for the Kern County Department of Public Health. Several prisons are located in or near Kern County, including the North Kern State Prison and Wasco State Prison.
There were approximately 700 new cases of Valley Fever diagnosed among California prisoners in 2006 according to Richard Hector, Project Director of the Valley Fever Vaccine Project. No explanation has been advanced to explain the prevalence of Valley Fever within state prisons. Additional information about this disease, including vaccine research, is available at www.valleyfever.com.
The east coast has reported two recent cases of Legionnaire’s Disease, so named after a 1976 outbreak at an American Legion convention in Philadelphia, where the bacterium was first identified. This bacterial organism is found in damp, unclean ventilation systems – often air-conditioner ducts. The non-contagious pneumonia-like illness is spread through the inhalation of water droplets carried in recycled air.
In October 2006, the water supply at Maryland’s 1,750-man Roxbury prison was found to be contaminated after a former prisoner came down with the illness. This forced the shut-off of showers and a switch to bottled drinking water in one 200-man unit where tests confirmed the bacterium was present. Legionella bacteria were found in tap water in the unit and in the administration building’s air conditioning system.
In April 2007, two Massachusetts prisoners were hospitalized with Legionnaire’s Disease at MCI-Shirley. Both men fell ill within three days; they were in the same housing unit, which was subsequently isolated. Prison officials responded quickly by flushing the water pipes with superheated water to kill the bacteria.
Traces of the disease were also discovered at HMP Bronzefield in Ashford, Middlesex, England in June 2007; no infections were reported.
Meningitis is caused by an airborne bacterium. Because of the overcrowded conditions in prisons and jails, it is imperative to isolate incarcerated victims quickly. Unfortunately help did not come soon enough for 20-year-old Zachary Harris at the Gwinnett County Detention Center in Lawrenceville, Georgia. On May 3, 2006, Harris died in the hospital of a bloodstream infection. His symptoms began on April 18 with a sore throat.
Ten days later he was hospitalized when his blood pressure dropped precipitously. The state health department responded with 1,400 units of the antibiotic Rifampin to give to all 146 potentially exposed prisoners and 27 staff at the jail. Healthcare at the Gwinnett facility is contracted through Prison Health Services.
Another prisoner death occurred at the Santa Rita Jail in Alameda County, California on April 2, 2007 as a result of bacterial meningitis, a form of the disease that is spread through direct contact. Jeremiah Woodman, 23, died in an isolation cell two days after being booked into the jail; no other prisoners or staff were infected.
In January 2007, an employee at Connecticut’s Manson Youth Institute, a prison for offenders age 14 to 21, was diagnosed with bacterial meningitis. The facility’s 680 prisoners and 350 staff members were provided with antibiotics, and visits were temporarily canceled.
“Meningitis can be extremely contagious in a prison environment,” stated Dr. Ramesh Vemulapalli, a specialist in infectious diseases. “It can come on very fast. Left untreated, it can kill.”
The Outlook is Sick
The issue of contagious diseases in detention settings is gaining attention in the medical community. In December 2006, the World Health Organization (WHO) announced that it was launching a prison health database to raise awareness of and monitor problems related to communicable diseases in prisons. The database will be part of WHO’s Health in Prisons Project (HIPP), which was implemented in 1995. WHO advocates the improvement of healthcare available to prisoners and stresses the importance of health promotion in prisons, to better protect both prisoners and the general public. See: www.euro.who.int/prisons.
In the United States, many local communities are preparing for a major flu pandemic, notably Asian bird flu. Rachel Schwartz., Ph.D., a researcher at the Institute for Biosecurity at the Saint Louis (Missouri) University School of Public Health, has warned that prisons and jails are totally unprepared for such outbreaks. At her presentation at the Correctional Medicine Institute’s 2006 conference in Baltimore, Maryland, Dr. Schwartz called America’s two million plus prisoners “a highly vulnerable population.”
A January 11, 2007 article in the prestigious New England Journal of Medicine addressed the issue of HIV among prisoners, describing prisons and jails as “reservoirs” of HIV infection. The article’s author, Dr. Susan Okie, noted that U.S. prison systems do not meet international guidelines for reducing HIV because they do not make clean needles or condoms available to prisoners, protocols that have been proven to reduce HIV transmission.
Further, Dr. Felipe Arias, the statewide HIV medical director for the Pennsylvania DOC, spoke about the need to address HIV among prisoners at Kentucky’s statewide HIV/AIDS Conference held from May 9-11, 2007. Dr. Arias noted that around 25% of people with HIV will be incarcerated at least once, which means prisons and jails are an ideal location to make an impact on the disease.
Internationally, a working paper entitled Tackling Blood Borne Viruses in Prison, released by the National AIDS Trust in conjunction with the Prison Reform Trust on April 30, 2007, emphasizes HIV and HCV education and guidance in the United Kingdom’s prison system. Another recent research study examined the treatment of HIV-positive prisoners in Thailand.
Such attention and concern may be too little, too late. A health care disaster is in the making each day as the public turns its back on over two million prisoners in overcrowded facilities, disregards their medical needs, and ignores the contagious diseases they will transfer to communities upon their eventual release. Third world countries may have similar problems but there are crucial differences.
First and foremost is the sheer number of prisoners in the United States. With 5% of the world’s population, the United States has over 25% of the world’s prisoners. Each year at least 650,000 prisoners are released from prisons back to their communities and millions cycle through the nation’s jails each year. Put in perspective, England and Germany both have around 80,000 prisoners each, less than Florida and New York. India has 313,000 prisoners, which is less than the combined prison populations of California and Texas. Second, to the extent poor countries have less resources to spend on prison health care, that is not the case in the United States where the resources are available but instead the political decision has been made that prisoners are an expendable population not worth spending money on for medical care. In this respect the “correctional” dumping grounds for America’s prisoners have become breeding grounds for infectious epidemics, with severe consequences for both prisoners and the public alike.
Sources: Columbus Dispatch, Baltimore Sun, Boston Herald Reporter, Hanford Sentinel, Atlanta Journal-Constitution, Bradenton Herald, Associated Press, Richmond Times-Dispatch, Los Angeles Times, Sacramento Bee, Montgomery Advertiser, AFSC The Vision, Siskiyou Daily, Post Star, Boston Telegram, Detroit News, N.J. Express Times, The Enquirer, Duluth News-Tribune, Palm Beach Post, Atchison Daily Globe, Pittsburg Tribune-Review, St. Louis Post-Dispatch, Express Times, Washington Times, San Antonio KENS 5 News, medicalnewstoday.com, democracynow.org, kentucky.com
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