All inmates at risk of developing a serious form of valley fever must be removed from two Central California state prisons within the next 90 days. That’s what a U.S. District Court judge ruled Monday, upholding a directive from the federal official in charge of prison health care. The ruling comes over the objections of the state Department of Corrections and Rehabilitation, which balked at the complexity of the policy. Valley Public Radio’s Rebecca Plevin takes us behind the prison gates to explain how the state and inmates are coping with the problem.
The southern San Joaquin Valley is ground zero for valley fever, a potentially fatal disease that’s practically unheard of in the rest of the state. It’s also home to ten state and federal prisons. And it’s where Arjang Panah became sick.
“I had big welts all over my body,” Panah recalls. “I was sweating profusely, I lost complete appetite, I was in extreme pain, as in my joints, I could not walk.”
In 2006, Panah was serving time at the Taft Correctional Institution for possession of meth with the intent to sell. When he first became sick, doctors diagnosed him with pneumonia and prescribed antibiotics. The drugs didn’t work, and his symptoms got worse.
“One of the other, embarrassing symptoms that I also suffered was a disease called hydrocele, which is the enlargement of your testicles,” he says. “One of my testicles was the size of a grapefruit.”
Those drugs didn’t work, because Panah didn’t have pneumonia. Doctors finally diagnosed him with valley fever. It’s a fungal disease caused by inhaling spores that live in the soil in this dry, arid region. Once the spores lodge in your lungs, they never fully leave your body.
“I realized I did a wrong and I should do my time for it, but I didn’t believe that I should pay for my crimes with my life, which is pretty much what I was sentenced to,” he says.
Panah was a federal inmate in Kern County, which has the highest rate of valley fever in California. The disease is also a huge problem in the region’s state prisons.
In April, the federal official overseeing health care in the state prisons recommended that all inmates at high-risk of contracting the serious form of the disease be removed from two Central Valley prisons. The policy affected thousands of inmates at Pleasant Valley and Avenal state prisons, including all African Americans and Filipinos.
The state Attorney General raised questions about the plan. But on Monday, a federal judge upheld a modified version of the order.
In his ruling, Judge Thelton Henderson said that without the policy, at-risk inmates would, quote, “continue to suffer unnecessary and unreasonable harm.”
This latest ruling comes days after a three-judge panel ordered the state to reduce the prison population in order to improve prisoner health. Citing the prison health care lawsuit, Henderson said the state’s position on valley fever demonstrates its, quote, “unwillingness to respond adequately to the health care needs of California’s inmate population.”
Jeffrey Callison, with the Department of Corrections, says the state is still reviewing the ruling.
In a court filing, Receiver J. Clark Kelso described the state’s response to the threat as “anemic,” saying that officials have known about the problem since 2006. But Callison says the prison system takes the disease seriously, and has implemented measures to curb the disease.
Of all the state’s prisons, Pleasant Valley in Coalinga has the highest rate of valley fever. Between 2006 and 2010, the rate of valley fever there was 1,001 times higher than the rate statewide.
On a June morning, Lt. Kirk Geringer travels around Pleasant Valley in a golf cart. He points out the recreation yard, where inmates kick soccer balls and throw Frisbees. Just a tall fence and a layer of soil cement separate them from the dusty ground where the fungus thrives.
“What soil cement does, is prevents the upkick of dust,” Geringer explains over the roar of the golf cart motor. “The valley fever spore is in the dust, and when it gets kicked up and carried through the air, that’s generally how you’re made susceptible to it.”
To further protect inmates, he says prison officials offer inmates surgical masks, and raise awareness about the disease through posters and television commercials. They have also tried planting grass on the prison grounds.
“The grass is supposed to keep the dirt down, and there would be less dust,” he says. “However, unfortunately, the winter when we planted it was pretty dry, and the seed didn’t take.”
So why is the valley fever rate so high in these prisons? Dr. Felix Igbinosa is the chief medical executive at Pleasant Valley.
“The majority have abused alcohol, drugs, and a majority also have issues related to trauma, and they don’t have access to health care while they’re in the community,” Igbinosa says. He says they are also more likely to have chronic health problems like diabetes and lung disease, which puts them at higher risk for valley fever, too.
Inmates also spend lots of time in the dusty prison yard. And, because many come from outside the region, they haven’t built up immunity against the fungus.
“Once they relocate to a valley fever-endemic area and are exposed to valley fever, they are not prepared by way of natural immunity to fight the disease,” he says.
Finally, he says, prison doctors might be more aware of the disease, and therefore more likely to diagnose it.
But no matter the reason, taxpayers are already paying a price for valley fever. The state prisons spend an estimated $23.4 million a year on valley fever among inmates.
Last year, the federal government agreed to pay Arjang Panah a settlement of $425,000, while admitting no fault. Panah says he’s grateful for the money, which will provide relief if he gets sick again. Still, he says he’d do anything to not have the disease.
“One of my dear friends came up to me and said, ‘Arjang, how much money would you pay for you not to have this disease? If you added an extra 0 to the settlement, I would pay that much money not to be sick from it,” Panah says.
The receiver’s order is intended to prevent thousands of state inmates from facing the same fate. According to the judge's ruling, all inmates affected by the receiver's policy must be transferred out of the two prisons within three months.