Earlier this summer, word spread among Hawaii prisoners at the Saguaro Correctional Center: A fellow prisoner had died of valley fever, an insidious airborne fungal disease endemic to the desert Southwest.
As it happened, just three days earlier, the Hawaii Department of Public Safety had instituted a new policy allowing prisoners to be tested for valley fever.
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. This article follows up on what the state is doing to protect Hawaii prisoners from a disease that’s not found in the islands.
By all accounts, the requests for the test began pouring in, but not all prisoners got their wish: The department has been testing only a small subset of prisoners and turning away others, even when they submit a formal medical request for the test.
Toni Schwartz, public safety spokeswoman, says the department has so far tested 215 prisoners at Saguaro, a 1,896-bed prison in Eloy, Arizona, where about 1,400 Hawaii prisoners are housed.
Those who have been tested are all African-American or Filipino — two populations identified by the department as being at “high risk” of contracting valley fever.
Schwartz says other prisoners who requested the test — 68 in all — were told to place “a routine sick-call” for further evaluation.
Critics say the department’s policy to not offer the test, which costs $71 each, to all prisoners is shortsighted.
“To me, spending $100,000 — if that’s what it takes to test all of them — is worth it,” said state Sen. Clarence Nishihara, chair of the Senate Public Safety Committee. “You could easily blow that amount if you get sued by a sick inmate who didn’t get tested.
“If it’s treatable, you want to treat the disease early on, rather than later, anyway,” Nishihara said. “That’s a humane thing to do. (The prisoners) are not there to come down with a nasty infection as part of their sentence.”
Kat Brady, coordinator of the Community Alliance on Prisons, says the test should be offered even to those who were released recently from Saguaro, given that valley fever’s incubation period can last up to a month.
“This is the problem with (the Department of) Public Safety in my view — it’s all very insular; they’re only focused on what’s happening inside,” Brady said. “But that’s not their only kuleana. Whatever they do inside impacts the community when people come out.”
It’s hard to pinpoint exactly how many Saguaro prisoners have been infected with valley fever.
According to the Department of Public Safety, four cases have been reported at Saguaro. But the count goes back only to cases from 2014, and the department has admitted that it doesn’t have a system in place to track older cases.
Meanwhile, under Arizona’s mandatory reporting requirement, nearby hospitals and clinical labs have reported five cases since Saguaro — owned and operated by Corrections Corporation of America — was opened just for Hawaii in 2007.
An additional 17 cases have been reported at three adjacent prisons run by CCA — the Eloy Detention Center, the La Palma Correctional Center and the Red Rock Correctional Center — during the same period.
In one sense, the presence of valley fever in the prisons isn’t surprising: The disease is rampant across Arizona.
In most cases, valley fever presents only mild symptoms — or none at all. But about 40 percent of the cases can cause flu-like symptoms or lead to full-blown pneumonia.
In rare cases, valley fever can disseminate from lungs to other parts of the body — bones, lymph nodes and other vital organs — and trigger life-threatening complications.
For reasons still unknown, African-Americans and Filipinos are more susceptible to disseminated valley fever. According to one study, African-Americans are 14 times more likely than whites to suffer complications from the disease, while Filipinos are 192 times more likely to die from it.
“They don’t want to test because, once they test and get positive results, they have to treat the inmates. And that’s expensive.” — Caroline Isaacs, program director of the American Friends Service Committee
Schwartz says that’s why the department has reserved the test — after “an extensive research review conducted by our lead physician” — for the two groups.
“People who are not of those two identified descents are not likely to develop the disseminated version” of valley fever, Schwartz said.
But a number of studies have shown that other populations are also at risk — including Hispanics, Native Americans, newcomers to an area where the disease is endemic, as well as people who are older than 60, have diabetes or have compromised immune systems.
Caroline Isaacs, program director of the American Friends Service Committee in Tucson, Arizona, says that, given the risk, testing all prisoners is a “very reasonable” accommodation.
“But they don’t do it. And this is always a problem we run into — they don’t want to test because, once they test and get positive results, they have to treat the inmates. And that’s expensive,” said Isaacs, who has long opposed prison privatization in Arizona. “In their mind, ‘If we don’t know, we don’t have to pay for (treatment).’ That’s why you get a denial and runaround.”
Schwartz maintains that the department isn’t turning away any prisoner who gets sick.
“All inmates have been told that if they feel they have symptoms to ask for an evaluation by a health care provider. The provider will then check for symptoms,” Schwartz said. “Those individuals who do not fall in the higher-risk category, and who do not exhibit any symptoms, do not require further testing.”