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By Courtesy of Kevin Walker
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By Rebecca Plevin/Vida en el Valley fever - Lawyers Jason Feldman, left, and Ian Wallach, right, have received hundreds of letters, e-mails and voice mails from inmates with valley fever seeking help. (Rebecca Plevin/Vida en el Valle)
BY REBECCA PLEVIN Reporting on Health Collaborative
Kevin Walker arrived at Taft Correctional Institution, a federal prison in western Kern County, in December 1999 to serve a 14-year sentence for attempted possession of cocaine.
But another kind of sentence awaited him, one far more painful than confinement alone.
ABOUT THIS SERIES
Why are people still dying from valley fever and tens of thousands getting sick? Misdiagnosis. A lack of public awareness. And a long history of inaction by government agencies.
In this series, we've been exploring the startling rise of cases, the science of studying the disease, the high costs to patients and taxpayers, the weak federal and private interest in funding treatments and vaccines, and the public health response.
To read the rest of our "Just One Breath" series so far, go to www.bakersfieldcalifornian.com/special-sections/just-one-breath.
In July 2001, fluid-leaking boils broke out across Walker’s face and body. Once he was diagnosed with valley fever, doctors put him on an antifungal drug — amphotericin B — but the drug was so powerful that it caused his kidneys and liver to begin failing.
He was switched to another antifungal drug — fluconazole — and transferred to a prison in Ft. Worth, Texas. But the disease continued to spread throughout his body, even into his bone marrow. Boils, then holes, developed on his spinal column and clavicle.
“That 14-year sentence turned into a life sentence,” said Walker, who was released from prison in 2010. “Because I have this disease for life, and no one has accepted responsibility for putting me in that situation.”
Taxpayers are also paying a price. Californians spend about $23.4 million a year to treat state inmates with valley fever. And the federal prison system recently agreed to pay $425,000 – while admitting no fault – to another inmate who contracted the disease at the Taft prison.
The California prison system estimates about 200 inmates are hospitalized every year due to valley fever. Most of them are diagnosed with the disease while serving sentences in eight institutions in the San Joaquin Valley, where the airborne fungus that causes valley fever is rampant. That doesn’t include federal inmates at prisons like Taft, which was described in one lawsuit as a “petri dish for valley fever.”
A study by the state prison health system found that the rate of valley fever in Pleasant Valley State Prison in Coalinga was 600 times the rate found outside the prison walls in Fresno County.
When you add up all the time state inmates spend in the hospital for valley fever, it amounts to an average of 5,000 days, or about 25 days for every inmate. The gruesome details of inmates’ experiences with the fungal disease, and the disease’s long-term impact on their lives, remain largely hidden from the public’s view.
But stories like Walker’s, and those of other inmates, points to a larger question: Is it fair to incarcerate inmates in an area where they are hundreds of times more likely to contract valley fever?
Because most inmates are brought in from outside the valley, they have no built-in immunity to the disease, which is the best defense for most valley residents.
“It’s mind-bogglingly egregious,” said Brad Brockmann, executive director of the Center for Prison Health and Human Rights in Providence, R.I. “It’s a human and civil rights outrage that people’s lives could be compromised because by the luck of the draw, they end up at Pleasant Valley State Prison. That’s outrageous.”
On top of that, research studies have shown that blacks are far more likely to develop the most serious form of the disease. The prison population has a higher proportion of blacks than whites, and prisoner advocates criticize state and federal agencies for putting black inmates in harm’s way.
PRISONERS MORE LIKELY TO DEVELOP DISEASE
The rates of valley fever in the communities surrounding the prisons in Central California already are high. Someone in Bakersfield, Fresno, Stockton or Merced has a much higher chance of contracting the disease compared to someone in Los Angeles, according to the California Department of Public Health.
But the rates inside the prisons are worse. An April 2012 study found that at Pleasant Valley State Prison, the rate of valley fever was 7,011 cases for every 100,000 people. In states that report cases, fewer than 20 people out of every 100,000 are diagnosed with the disease.
There are several reasons inmates in the prison system experience high rates of valley fever. In addition to the fact that most are brought into the valley from the outside, they also spend lots of time outdoors in the dusty prison yard, where they could inhale the spores. Also, many inmates already have weakened immune systems because of AIDS or hepatitis.
“I don’t think I’ll ever be back 100 percent,” said Gregory Edison, who is serving time at Taft for manufacturing drugs. Valley fever, he said, left him with chills, migraine headaches, dry, scaly skin, exhaustion, weight loss and an uncomfortable tightness in his lungs.
“I think that if they are going to give you all this time, they are supposed to take care of you so you can go back to your family,” he said. “You’re not sentenced to death in prison.”
BLACK INMATES PARTICULARLY SUSCEPTIBLE
Experts also question whether it’s fair to house black inmates — such as Walker and Edison — in valley prisons, when medical studies have repeatedly found blacks are at increased risk for the serious, disseminated form of the disease.
A 2012 study in the journal Emerging Infectious Diseases found the rate of hospitalization from disseminated cocci among blacks in California was 8.8 times higher than for whites.
A report from the state prison system does not provide details about cases of disseminated disease, like Walker’s, but it does acknowledge that black inmates died of the disease at disproportionate rates.
Of the 27 state inmates who died of valley fever between 2006 and 2010, 18 — or 68 percent — were black, according to the report. The rate of death due to valley fever among blacks was twice that among non-black inmates.
“Although we did not systematically examine risk factors for severe disease and death due to cocci, we did find that African-American inmate men died with cocci as a cause at higher rates than the general inmate population and much higher rates than African-American men in California,” the report concluded.
Kings County health officer Dr. Michael MacLean raised this issue during a valley fever town hall meeting in Bakersfield in October hosted by state Sen. Michael Rubio, D-Shafter.
“African Americans are disproportionately imprisoned, and African Americans clearly have a much higher risk of having a complicated, disseminated disease,” MacLean said.
Blacks comprise 29 percent of the state prison population, according to 2012 data from the Public Policy Institute of California, but 6.6 percent of the overall state population, according to 2011 census data.
“I think one of the challenges for California is that we probably should have concern that there is a very significant racial disparity going on with respect to inmates in California and valley fever,” MacLean said.
There are many factors that play into where an inmate is housed, said Terry Thornton, deputy press secretary for the California Department of Corrections and Rehabilitation.
As a policy, she said, “we only move inmates from endemic areas when medical staff identify an inmate is susceptible to valley fever, regardless of ethnicity.”
The problem might be exacerbated by the Central Valley prison-building boom that started in the 1990s. There are a disproportionate number of state prison beds in the valley. The largest percentage of prisoners come from Los Angeles County, but the Central Valley and the Inland Empire house the most prisoners, according to an analysis by public radio station KQED.
ARE INMATES DOUBLY PUNISHED?
Experts and inmates alike question whether it’s fair to doubly punish people — once for a crime, and again with a horrible disease whose symptoms and related costs could linger long after the prison sentence.
That’s a concern lawyers Ian Wallach and Jason Feldman hear on an almost daily basis. Since they took the case of a former Taft inmate who contracted valley fever — and this summer helped him earn a $425,000 federal settlement — the Venice-based lawyers have received hundreds of letters, phone messages and emails from inmates with valley fever seeking help.
Most of the letters come from prisons in Central California. Some letters are hand-written; a few are typed. Some include medical records as proof; others include newspaper clippings.
All the correspondence contains essentially the same message, Wallach said.
“They’re all scared about future medical expenses, and who is going to pay for this when they get out,” he said. “Whether they got it in Avenal, whether they got it in Pleasant Valley, wherever they got it — they want money for pain and suffering because they have been hurting.”
The inmates may have been convicted of a crime, Wallach said, but they weren’t sentenced to a punishment that included a debilitating and, in some cases, lifelong illness.
He read directly from one of the letters splayed across a dark wood table: “It’s one thing to pay back society for my crime, but to send me to a prison which could kill me is another thing.”
Messages like that underscore the need for humane imprisonment and compensation for inmates’ future medical costs, Wallach said.
“We took control over their lives; we took control over their liberty,” Wallach said. “We put them there, and, if as a result of us doing that they acquire an illness they have to pay for for the rest of their lives, why should that be their burden?”
Some inmates have asked the state to shoulder some of the burden. Between 2008 and 2010, 11 inmates filed claims related to valley fever with the state Victim Compensation & Government Claim Board. The largest claim was for $10 million for general and punitive damages related to valley fever.
They were all rejected.
In general, anyone who wishes to file a lawsuit against the state or its employees for damages must first pursue a remedy through the government claims program, said Anne Gordon, public information officer for the board. The valley fever-related claims were mostly rejected due to their complexity, she said.
“The Government Claims Program rejects many cases as the issues raised are complex and outside the scope of analysis and interpretation typically undertaken by the Board,” she wrote in an email.
“Our three-person Board is not set up like a courtroom where we can hear testimonies, hear from witnesses and examine other evidence,” she wrote. “The courts are the appropriate venue to resolve such claims, and rejection preserves the claimants’ right to pursue these matters in court.”
A LIFE SENTENCE
Arjang Panah is one of the many inmates whose health and productivity have been destroyed by his stint in a valley prison.
He contracted valley fever in 2006, while serving a seven-year sentence at Taft for distribution of methamphetamines. Years later, the fungus remains in his body.
When he catches a cold, he said, it turns into bronchitis or pneumonia, and “my recovery period is five times as long as anyone else’s.”
“On a daily basis, I have to take into consideration my disease, whether it’s prevention of catching a cold, or getting sick, or whether it is to deal with the symptoms of the illness, once I have caught a cold,” he said.
That impacts his ability to work. Panah earned a master’s degree in business administration while in prison, earned his PhD in business administration upon his release, and now works as an account executive selling jet fuel. But he’s often too sick to work.
“The disease causes me not to be my best about 50 percent of the time,” he said. A lingering cough racked his body as he spoke over the telephone.
California taxpayers contribute to the state prison system’s bill — about $23.4 million annually — for treating valley fever in state prisons. But the costs of supporting inmates sickened by valley fever, once they are released from prison, are more hidden.
With the help of Wallach and Feldman, Panah received a settlement from the federal government to cover the lifelong costs of treatment for his disease.
“If they offered me three times that amount — if they said, ‘You can have three times that amount, or not have this disease’ — I’d choose not having the disease,” Panah said. “It is an extremely unfortunate thing that happened to me.”
And Walker, the former Taft inmate, can only afford his medicine and medical care due to government aid. He sued the federal government to have his medical expenses covered, but the case stalled. He is currently considering suing again.
The disease has left Walker debilitated and unable to work. He has qualified for federal Supplemental Security Income and In-Home Supportive Services since he was released from prison in 2010.
Even with that support, some days are rough. The fungus has overtaken his joints, causing him pain when it’s cold or rainy outside. Sometimes, the disease and the powerful medicines sap his energy.
Others would have succumbed to the disease by now, he said. But, “fighting is just part of my blood stream, so giving up isn’t an option.”
The Reporting on Health Collaborative involves The Californian, Merced Sun-Star, Radio Bilingue in Fresno, The Record in Stockton, Valley Public Radio in Fresno and Bakersfield, Vida en el Valle in Fresno, the Voice of OC in Santa Ana and ReportingonHealth.org.
It's an initiative of The California Endowment Health Journalism Fellowships at USC's Annenberg School for Communication and Journalism.