Infection Hits a California Prison Hard

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Infection Hits a California Prison Hard

New York Times*

http://www.nytimes.com/2007/12/30/us/30inmates.html_r=1 & adxnnl=1 & oref

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COALINGA, Calif. — When any of the 5,300 inmates at Pleasant Valley

State Prison begin coughing and running a fever, doctors do not

think flu, bronchitis or even the common cold.

They think valley fever; and, more often than they would like, they

are right.

In the past three years, more than 900 inmates at the prison have

contracted the fever, a fungal infection that has been both

widespread and lethal.

At least a dozen inmates here in Central California have died from

the disease, which is on the rise in other Western states, including

Arizona, where the health department declared an epidemic after more

than 5,500 cases were reported in 2006, including 33 deaths.

Endemic to parts of the Southwest, valley fever has been reported in

recent years in a widening belt from South Texas to Northern

California. The disease has infected archaeologists digging at the

Dinosaur National Monument in Utah and dogs that have inhaled the

spores while sniffing for illegal drugs along the Mexican border.

In most cases, the infection starts in the lungs and is usually

handled by the body without permanent damage. But serious

complications can arise, including meningitis; and, at Pleasant

Valley, the scope of the outbreak has left some inmates permanently

disabled, confined to wheelchairs and interned in expensive long-

term hospital stays.

About 80 prison employees have also contracted the fever, Pleasant

Valley officials say, including a corrections officer who died of

the disease in 2005.

What makes the disease all the more troubling is that its cause is

literally underfoot: the spores that cause the infection reside in

the region's soil. When that soil is disturbed, something that

happens regularly where houses are being built, crops are being sown

and a steady wind churns, those spores are inhaled. The spores can

also be kicked up by Mother Nature including earthquakes and dust

storms.

" It doesn't matter whether you're custody staff, it doesn't matter

if you're a plumber or an electrician, " said A. Yates, the

warden at Pleasant Valley. " You breathe the same air as you walk

around out there. "

The epidemic at the prison has led to a clash of priorities for a

correctional system that is dealing with below average medical care

and chronic overcrowding.

Last fall, heeding advice from local health officials and a federal

receiver charged with improving the state's prison medical care, the

Department of Corrections and Rehabilitation delayed plans to add

600 new beds out of concern that the construction might stir up more

spores.

Officials at the prison blame the construction of a state hospital

nearby for causing a spike in valley fever. The construction was

under way from 2001 to 2005, and valley fever hit its peak here in

2006, when the disease was diagnosed in 514 inmates.

This year, about 300 cases have been diagnosed among inmates at the

prison, which sits along a highway lined with almond groves and

signs advertising new " semi-custom homes. " Felix Igbinosa, the

prison's medical director, said " the No. 1 reason " was thought to be

the soil disturbance from new construction.

The delayed expansion here was part of a $7.9 billion plan signed by

Gov. Arnold Schwarzenegger last summer to relieve overcrowding in

the state's prisons. Pleasant Valley was built in 1994 to house

2,000 inmates.

California reported more than 3,000 cases of valley fever in 2006,

the most in a decade. Explanations for the spike have included

increased residential development and changes in weather patterns

that have resulted in increased blooms of the fungus.

Other prisons in the Central Valley of California have had increases

in the number of fever cases in recent years, but in none has the

rate of infection been higher than at Pleasant Valley, where about

one inmate in 10 tested positive in 2006.

Even allowing for the nearby construction, experts say they do not

know why the disease is so rampant here.

" Is the soil surrounding Pleasant Valley different? " asked Dr.

Demosthenes Pappagianis of the University of California, .

" There's a lot we still need to know about it, " said Dr.

Pappagianis, a professor of medical microbiology and immunology who

has been studying valley fever for more than 50 years.

Early symptoms of the disease, which is clinically known as

coccidioidomycosis, mimic the flu, with symptoms that include a

cough, lethargy and a fever. Most of those who become infected

recover with little or no treatment and are subsequently immune.

In about 2 percent to 3 percent of the cases, the disease spreads

from the lungs and can attack the bones, liver, spleen and skin.

For the 11,000 non-inmate residents of Coalinga, about 200 miles

southeast of San Francisco, the disease has been a fact of life for

generations. " We just deal, " said Trish Hill, the city's mayor. " You

don't do stupid things like go out on windy days or dig in the dirt. "

Inmates appear to be especially susceptible to the disease, in part

because they come from areas all over the state and have not

developed an immunity to the disease. California corrections

officials are preparing new guidelines for prison design, including

ventilation and landscaping.

" Prisons tend to have a lot of bare dirt, and that has some security

benefit, " said Deborah Hysen, the corrections department's deputy

secretary of facility planning. " But in the case of valley fever,

you want to really contain the soil. "

At Pleasant Valley, officials say the outbreak of valley fever

places a burden on the institution, requiring guards to escort

inmates to local hospitals, where stays can last months and result

in medical and security costs of $1 million and more, said Dr.

Igbinosa, the medical director.

The disease also affects inmate morale, doctors say.

Gilbert Galaviz was convicted of murder and is serving a sentence of

25 years to life. Mr. Galaviz had been at Pleasant Valley for a week

or so when he started to feel sick. " I couldn't breathe, " he

said. " My chest starting hurting, I had pain all over like somebody

beat me up, and I would sweat bad at night. "

The cause was valley fever. After six months, Mr. Galaviz is still

weak, having lost 30 pounds, and is barely able to complete a lap in

the prison yard. Earlier this month, he was attacked and his jaw

broken.

" It wouldn't have been like that if it hadn't been for valley

fever, " Mr. Galaviz said, his jaw still wired shut. " They wouldn't

have got me. It would have been the other way around. "