Under a provision in the Arizona Administrative Code, administrators of correctional facilities are required to report “all cases or suspected cases” of communicable diseases — including valley fever — to the local health authority.
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Civil Beat is examining how the state manages its troubled, overcrowded prison system, which includes four prisons and four jails in Hawaii, and a contract private prison in Arizona.
But a Civil Beat review of disease surveillance reports submitted to the Pinal County Public Health Services District found that CCA has not reported a single case of valley fever at Saguaro, a 1,896-bed prison in Eloy, Arizona, where about 1,400 Hawaii prisoners are housed.
That’s despite the fact that, according to the Hawaii Department of Public Safety, at least four Saguaro prisoners have been infected with valley fever since 2014 — two cases in 2016 and one case each in 2015 and 2014.
The department doesn’t have a system in place to track older cases, but Civil Beat has confirmed another case in which a Hawaii prisoner was diagnosed with valley fever in 2013.
Still, CCA spokesman Jonathan Burns denies that the company has been violating the regulations.
“CCA always strives to fulfill applicable state rules, and we have no reason to believe that appropriate reporting of valley fever incidences at (Saguaro) have not been made,” Burns said.
The list of communicable diseases that trigger Arizona’s mandatory reporting requirement is long — 88 in all, ranging from anthrax and smallpox to hepatitis and Lyme disease.
Among them is coccidioidomycosis, the medical term for valley fever — an insidious airborne fungal disease that can lead to fatal complications.
According to the Department of Public Safety, one Hawaii prisoner with valley fever died in June, though it’s still unclear whether the disease was the cause of his death.
As Civil Beat reported, another Hawaii prisoner named Melvin Wright, who was infected with valley fever in 2013, died shortly after he was transferred back to Hawaii in 2014. He died of a heart attack, but valley fever was a contributing cause, according to his autopsy report.
The Pinal County records, obtained by Civil Beat through a public-records request, showed that the Public Health Services District has been notified about five cases of valley fever among the residents at 1250 E. Arica Road in Eloy — the address of Saguaro.
The first report was submitted in 2008, followed by two more reports in 2011. Two additional reports were submitted earlier this year.
But CCA submitted none of the reports. Instead, it was nearby hospitals and clinical labs — other “mandated reporters” under the regulations — that reported the cases.
Graham Briggs, administrator of the infectious diseases and epidemiology section at the Public Health Services District, says his agency usually relies on hospitals to report the cases of communicable disease — since they are typically the ones conducting the tests.
But, if hospitals aren’t involved, Briggs says it’s up to other “mandated reporters” — including prisons — to submit the reports when the tests come back positive. Failing to do so would be a clear violation of the regulations.
It’s unclear why at least three Saguaro cases from 2013, 2014 and 2015 — the ones counted by the Department of Public Safety — have not been reported to the Public Health Services District.
Burns wouldn’t say why the cases are missing from the records.
Briggs says it could be that, when prisoners showed up with symptoms of pneumonia or valley fever, Saguaro’s doctors simply treated them with broad-spectrum antibiotics and antifungal medications without conducting any tests.
“The department should be monitoring CCA better, making sure that it’s following the law.” — Kat Brady, coordinator of the Community Alliance on Prisons
In such cases, “it’s a little bit subjective as to whether they would be required to report or not,” Briggs said.
But the regulations specify that even a suspected case of communicable disease should be reported at the time of their “diagnosis, treatment or detection,” regardless of whether it’s confirmed by a test.
Briggs acknowledges the point. “In an ideal world, if they’re suspecting valley fever, it would be good to get a report,” he said.
Under the regulations, a failure to follow the mandatory reporting requirement could be a Class 3 misdemeanor punishable by up to 30 days in jail and a fine of up to $5,000.
“I obviously think that the department should be monitoring CCA better, making sure that it’s following the law,” Brady said. “But they have a cozy relationship; the company hasn’t been penalized for anything. That needs to change.”
In a statement, Toni Schwartz, public safety spokeswoman, said the department wasn’t aware of any violations by CCA.
“We are looking into this allegation and will respond appropriately if we do find evidence of any violations,” Schwartz said.
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