On Monday afternoon, the federal receiver in charge of health care in California’s prisons ordered the state prison to remove inmates from two Central Valley prisons who are especially at risk of contracting valley fever. A day later, the state and experts are digesting that directive. Valley Public Radio's Rebecca Plevin reports, as part of the Reporting on Health Collaborative’s investigation into the disease.
The day after a federal receiver ordered two state prisons to exclude inmates especially vulnerable to valley fever, experts hailed the directive as a step toward addressing an alarming public health problem.
Meanwhile, the state is grappling with how to digest the directive.
Jeffrey Callison is the spokesman for the California Department of Corrections and Rehabilitation. He says the agency is still evaluating the receiver’s authority to decide where inmates are housed.
“Obviously, the receiver has full authority from the court over the provision of health care, and CDCR has provision over custody issues, in other words, where people are held," Callison says. "This obviously is an issue that might be in between, so that needs to be resolved.”
In his directive, medical receiver J. Clark Kelso ordered that inmates who are at high-risk of contracting valley fever and more likely to die from the disease should be expelled from Pleasant Valley State Prison in Coalinga and Avenal State Prison in Avenal. The goal of the policy is to reduce the risks of the disease to a “reasonable level.”
The order includes African Americans and Filipinos, inmates older than 55, and inmates with HIV or suppressed immune systems.
Joyce Hayhoe is with the department of California Correctional Health Care Services. She says the directive addresses a major health issue in the state prison system. The policy will impact about 40 percent of the population at the two state prisons.
"Since 2006, we've had 40 deaths statewide where valley fever was either the primary or the secondary cause of death, so it's more than just one or two cases here or there," she says.
Donald Specter is the executive director of the Prison Law Office in Berkeley. His organization brought the lawsuit that resulted in the prison’s medical care system being put under receivership. He says valley fever is another health issue that the state hasn’t responded to appropriately.
“Unfortunately, they have not treated it like it’s a public health emergency," he says. "They’ve treated it just as business as usual. If this kind of injury or death had happened in the free world, those institutions would have been closed long ago.”
He calls the receiver’s directive a “significant interim measure.” The receiver has also instructed the prison system to request the help of the Centers for Disease Control and Prevention, and the National Institute of Occupational Safety and Health, to evaluate the valley fever cases at the two prisons. Specter says this data could help determine the next steps.
“We are interested to hear those results," he says. "They will tell us whether there are any ways the risk can be mitigated and if not, closing the prisons might be the only alternative.”
Jason Feldman is a Venice-based lawyer that helped a former Taft Correctional Institution inmate earn a settlement from the U.S. government after he acquired valley fever in the federal prison. He also says the health care directive is a step in the right direction. But he says he would like to see the directive expanded.
“We’d like to see this go even further – this focuses on the two prisons that have the largest problem, but there are several other prisons and institutions in the San Joaquin Valley that could use a directive like this, or similar to this,” he says.
But Callison, of the Department of Corrections, says relocating thousands of prisoners, just from the Pleasant Valley and Avenal state prisons, would be a major endeavor. It’s complicated by other considerations, like inmates’ security levels, and medical, mental health and rehabilitation needs.
“Whether or not thousands of inmates are moved out of those two prisons and into other prisons, and then a corresponding number of inmates are moved out of the prisons and moved into the two Valley prisons, would be a major undertaking, and complicated,” he says.
Health experts say that both Pleasant Valley and Avenal State Prison are in located areas where prisoners are exposed to the airborne fungus that causes valley fever. In 2005, the valley fever rate at Pleasant Valley was 600 times the rate of Fresno County.
Experts say there are several reasons inmates experience high rates of valley fever. Many come from outside the region, so they have never been exposed to the fungus that causes the disease. They spend lots of time outdoors in the dusty prison yard, where they could inhale the spores. And, many inmates already have weakened immune systems, due to disease like AIDS or hepatitis.