Transferred inmates fearful of valley fever

Reporting on Health CollaborativeSeptember 1, 2013 

California prisoner Louis Baca and his family tried everything they could think of to keep the convicted murderer out of Pleasant Valley State Prison.

They pleaded with prison counselors. They called the office of the federal receiver who manages California inmates' health care. Baca himself tried to appeal the decision to move him from Mule Creek State Prison southeast of Sacramento to the prison in Fresno County.

Their big fear? Valley fever.

As a result of a federal court order, the state is moving hundreds of inmates deemed to be at higher risk of developing serious cases of valley fever out of Pleasant Valley and Avenal state prisons.

Rates of valley fever among prisoners at those two facilities have been substantially higher than among the rest of Californians: more than 1,000 times higher at Pleasant Valley and 189 times higher at Avenal.

But as those high-risk prisoners leave, the state is moving hundreds of new inmates, including Baca, into those two prisons.

The inmate and his family believe that the 35-year-old man, who is serving a life sentence for first-degree murder, will be in jeopardy of contracting valley fever at Pleasant Valley.

"My nephew got a life sentence, not a death sentence, and this is a potential death sentence," said Gilbert Robledo, Baca's uncle. "If he comes down with (valley fever), somebody's got to be accountable."

In five years, more than 1,000 Pleasant Valley inmates have fallen ill with valley fever, the perplexing and sometimes deadly disease that has been a bane for the California Department of Corrections and Rehabilitation for years.

Caused by inhaling fungal spores the disease costs the state prison system about $23 million annually in inmate health care and has opened it up to a class-action lawsuit on behalf of current and former inmates who contracted the disease while in prison.

"I just feel like my life's on the line here and I don't know what's going to happen after this," Baca said in a phone call from Mule Creek prior to his transfer.

Since 2006, 29 inmate deaths have been attributed to valley fever, and the disease was pegged as a secondary cause of death in 11 inmates and a tertiary cause of death in five other cases. Of the inmates killed by valley fever, 64 percent were black, 20 percent were Latino and 16 percent were white, according to the federal receiver's office.

Certain inmates, including blacks and Filipinos, as well as prisoners with diabetes, HIV and other immune-suppressing conditions, were identified as members of groups that should be excluded from the two prisons, according to the court order.

By mid-August about 815 inmates had been moved out of Avenal and Pleasant Valley and about 300 prisoners were expected to have been moved into the two prisons, according to the California Department of Corrections and Rehabilitation.

Families of the inmates being moved into the two prisons wonder, if those prisons aren't safe for some inmates, are they safe for their loved ones?

About two-thirds of valley fever cases identified among California's state prisoners from 2008 to 2012 occurred in Pleasant Valley and Avenal state prisons, according to data from the receiver's office.

Although most people with valley fever will never experience any symptoms of the disease, a small percent develop an excruciating illness that can spread to their brain, bones and skin.

Doctors and valley fever experts don't know why some people get so sick and others remain healthy.

Dr. Royce Johnson, professor of medicine at UCLA and Kern Medical Center's chief of infectious disease, said the solution of moving certain inmates out of Avenal and Pleasant Valley is an oversimplified approach to a complicated disease.

Illness is complex

"The decision-making process about Pleasant Valley does not, in my mind, square with the science of cocci," Johnson said, referring to the shortened version of the disease's scientific name, coccidioidomycosis.

Although black men are more likely to develop valley fever that spreads beyond their lungs, Johnson said not enough is known about the disease to pinpoint who will be more likely to get a serious case.

"You can't really tell by sitting in front of someone and looking at their age and race and sex and know exactly what their risk is," Johnson said. "They've decided, literally, that life is black and white. There's nothing black and white about this disease. Everything is complicated, actually amazingly complicated."

Jeffrey Callison, press secretary for the California Department of Corrections and Rehabilitation, said shutting down the prisons is not an option, especially when the state is under a federal court order to reduce its prison population.

That court order requires the state's prison system to reduce its population by about 10,000 inmates by the end of the year.

"We can't just close these prisons," he said of Avenal and Pleasant Valley. "We have to keep them open. We can't have two half-empty prisons."

Prisoners deemed to be at high risk at Avenal and Pleasant Valley can elect to stay if they don't want to be moved. For inmates who don't want to be transferred into those prisons, the process is not as straightforward, Callison said. Inmates have to file an appeal form to protest their transfer.

"I know that there have been a lot of the inmates and their families (who) have expressed concerns," Callison said.

Whether the prisons are safe for anyone is "a very good question that hasn't been answered at this moment," said Donald Specter, director of the Berkeley-based Prison Law Office.

"We don't really have the answer," Spector said.

In addition to moving out high-risk inmates, the court order also required the state to seek help from the Centers for Disease Control and Prevention and the National Institute of Occupational Safety and Health conducting an epidemiological evaluation at the two prisons.

The courts likely will have more to say about the way the prison system is handling valley fever in the months and years to come.

In July, a class-action lawsuit was filed on behalf of current and former inmates who contracted valley fever while at Avenal or Pleasant Valley.

One of the law firms involved in the case helped secure a $425,000 settlement from the federal government last year for a former inmate who developed valley fever while incarcerated at Taft Correctional Institution.

In the days after Baca's transfer to Pleasant Valley State Prison, his family members were still struggling with the move.

"I was really heartbroken," said Mary Robledo, Baca's maternal grandmother and the person who raised him.

Corrections spokesmen said the department does not release information about individual inmate transfers for security reasons and that Mule Creek is not involved in the transfers stemming from the court order regarding valley fever.

Christopher Meyers, director of the Kegley Institute of Ethics at California State University, Bakersfield, said the families' concerns highlight the key ethical dilemma at hand with the transfers under way.

"Being sentenced to life in prison for murder isn't the same as being sentenced to situations where life and health is threatened," Meyers said. "Long term we clearly have to figure out a better way to do this."

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