California Tests State Prisoners for Valley Fever Amid Lawsuits, Deaths

by Derek Gilna

The State of California is taking steps to minimize the number of cases of coccidioidomycosis, a fungal infection commonly known as “valley fever,” at two prisons in the rural Central Valley area, including testing prisoners for the disease. Valley fever has claimed the lives of more than 50 prisoners and sickened thousands of others, and advocacy groups say the state should have acted sooner based on recommendations made as early as 2006.

Meanwhile, attorneys representing current and former prisoners who contracted valley fever filed a class-action suit in U.S. District Court in Sacramento, claiming that the California Department of Corrections and Rehabilitation (CDCR) had known for years that the incurable disease was prevalent at prisons in the Central Valley but failed to take action. The lawsuit, filed on July 9, 2013, alleges that by failing to act the state imposed on affected prisoners “a lifelong, crippling and sometimes fatal disease in addition to their lawfully determined sentences.”

On August 20, 2014, U.S. District Court Judge Lawrence O’Neill denied a motion to dismiss the plaintiffs’ Eighth Amendment claims and race-based allegation that the CDCR violated the equal protection rights of black prisoners. According to the amended complaint, the CDCR and the state knew, or should have known, that black prisoners were nine times more likely to develop the terminal form of valley fever but failed, either intentionally or negligently, to protect them from the disease. The ruling cleared the way for discovery in the case, which remains pending. See: Jackson v. State of California, U.S.D.C. (E.D. Cal.), Case No. 1:13-cv-01055-LJO-SAB.

The lawsuit seeks compensation for prisoners who have been affected by valley fever since July 2009 as well as lifelong medical care following their release, according to Jason Feldman, one of the attorneys representing the plaintiffs. Feldman said the prisoners may have been convicted of crimes, but “they didn’t buy in for a chronic illness that will never go away, that could kill them, and greatly affects their quality of life.”

A second lawsuit on behalf of current and former CDCR prisoners who contracted valley fever was filed in federal court in October 2013. A number of other cases raising similar claims were consolidated with the second lawsuit, which grew to 159 plaintiffs. That suit also remains pending, though on May 19, 2015 a magistrate judge recommended dismissal based on qualified immunity. See: Smith v. Schwarzenegger, U.S.D.C. (E.D. Cal.), Case No. 1:14-cv-00060-LJO-SAB.

Valley fever is caused by the soil-borne fungus Coccidioides immitis, which occurs naturally in dry conditions. In July 2014 the Centers for Disease Control recommended that prisoners undergo testing for the disease. The CDCR administered the tests six months later to about 90,000 prisoners, according to Joyce Hayhoe, a spokeswoman for the federal court-appointed receiver who oversees medical care in California’s prison system. State prison officials reportedly spend around $9 million a year on treatment for valley fever and $2.4 million for antifungal care.

The tests are used to determine how many prisoners are immune to the fungus and therefore can be safely housed at the Avenal State Prison and Pleasant Valley State Prison, which combined accounted for 83% of the valley fever cases reported in the CDCR during a 2011 outbreak.

California’s Central Valley, as well as Arizona, New Mexico and parts of northern Mexico, have experienced a severe multi-year drought that produced conditions in which the fungus thrives. An aerial view of the Pleasant Valley prison shows the huge complex surrounded by barren dirt fields on all sides – the very places likely to harbor the fungus.

Medical studies have shown that Filipinos, blacks, Hispanics and people suffering from diabetes and HIV are more susceptible to valley fever, meaning that prisoners in the Central Valley – where 16 of California’s 33 adult prisons are located – are especially vulnerable. For example, blacks comprise just 6.6% of California’s general population but make up 29% of the state’s prison population.

Some prisoners believe that race plays a large factor in the state’s lackluster response to valley fever. In a letter to Mother Jones, Arthur Jackson, a Pleasant Valley prisoner who contracted the disease in 2011, raised questions about how the CDCR has responded to the fungal infection.

“I often wonder if this disease were to have affected all races alike, would the response of prison officials have been the same or would more have been done to protect and treat us?” he asked. “Two years after contracting this disease, I suffer from loss of vision, severe and often debilitating headaches and joint pain, weight loss, fatigue, and numerous other ailments for which I am consistently denied treatment.”

Jackson’s sentiments were echoed by fellow Pleasant Valley prisoner LaCedric Johnson in a similar letter to the magazine. Johnson was diagnosed with valley fever in 2011 and suffers from lung damage, joint pain and severe weight swings, among other symptoms. “Who gives a fuck,” Johnson wrote, “if a few thousand inmates are housed in a prison built on soil that contains a fungus in the ground that kills African Americans at a high rate?”

Don Specter, director of the Prison Law Office in Berkeley, California, called the testing for valley fever “way overdue.” It was the Prison Law Office that convinced a federal judge to issue a 2013 order requiring the state to transfer nearly 2,600 prisoners at high risk of contracting the disease out of the two Central Valley prisons.

The federal receiver in charge of overseeing medical care in California’s prison system had recommended the immediate transfer of high-risk prisoners – including black and Filipino prisoners – in 2012. Instead the CDCR went to court, filing a legal brief to explain why they should not be compelled to relocate such a large number of prisoners. The state’s lawyers argued that they should wait for “experts from the Centers for Disease Control and the National Institute for Occupational Safety and Health [NIOSH] to complete their study and evaluation before implementing such a drastic remedy.”

NIOSH issued a report in February 2014 that found employees at the Avenal and Pleasant Valley prisons were at greater risk of contracting the disease than members of the general population in the same region. The report noted that three CDCR employees had died due to valley fever and 103 were infected and sickened between 2009 and June 2013.

Symptoms of valley fever occur in about 40% of the cases, and when serious can resemble flu-like symptoms. But for 5% to 10% of the people infected the fungus can be debilitating, attacking the airways in the lungs first, where the spores lodge and reproduce, spreading even more of the fungus into the body. If the fungus moves into the bloodstream it can affect internal organs, leading to chronic pain, fever and exhaustion. Eventually the disease can attack the membranes around the brain and spinal cord, causing a painful death.

Since 2005 around 4,000 California prisoners have been diagnosed with valley fever; at least 53 have died from the disease. Prison officials reported 197 cases of valley fever in 2013, including four that led to prisoners’ deaths.

Dr. Mike MacLean, the Kings County public health officer, was blunt in his criticism of how the state has responded to valley fever outbreaks in the prison system: “I’m sure none of this would have happened if they weren’t prisoners,” he said.

State officials defended their efforts to combat the disease. “CDCR has been working to mitigate valley fever for years,” spokeswoman Deborah Hoffman wrote in an email to the Sacramento Bee. “We have put in place numerous measures in our prisons to reduce the amount of dust and the movement of dust, particularly into buildings.”

However, while the state provides medical care to infected prisoners and staff members, funding for further treatment is denied once prisoners are released. The disease can linger for years, even decades, but California officials have refused to pay for post-release treatment, which itself can be damaging. Closely resembling the body’s cells, the fungus can only be eradicated by drugs which may also attack the cells the fungus inhabit, causing side effects ranging from mild fever and rash to serious seizures and kidney failure.

Additionally, funding is hard to come by for research aimed at finding a cure. Because valley fever is prevalent in only a small geographical area compared to the rest of California and the nation, money to find ways to combat the disease is scarce.

“It’s always viewed as a highly regional specialty, so it’s always struggled to get a broad research base,” observed Michael Lancaster, former head of the Kern County Public Health Laboratory, one of the few labs in the nation that can successfully diagnose valley fever. “It’s a little bit frustrating. West Nile virus swept across the country. People died from West Nile – there’s no question. But if you look at the overall impact, it was nowhere near [valley fever].”

A draft report by two epidemiologists provided to California corrections officials in late 2006 recommended building improvements that could have reduced the incidence of the disease, including paving the area around the prisons to reduce the spread of fungal spores. The state declined to make the improvements due to the cost, which was estimated at $750,000 for one facility. In 2007 a panel of county health officials issued 26 detailed recommendations. The state ignored all but four.

The most recent lawsuits filed by current and former CDCR prisoners are just the latest to result from valley fever. In August 2012, the Bureau of Prisons (BOP) paid $425,000 to settle a suit brought by a federal prisoner who claimed the BOP had knowingly exposed him to the disease.

Arjang Panah was incarcerated at the Taft Correctional Institution in Kern County, in the San Joaquin Valley, when he contracted valley fever in 2005. His lawsuit alleged that BOP officials knew about the fungus and its potential for serious infection yet took no measures – such as planting grass around the prison buildings, paving roads near the prison or issuing filter masks to prisoners – to prevent infection. See: Panah v. United States, U.S.D.C. (C.D. Cal.), Case No. 2:09-cv-06535-GAF-PLA.

PLN has reported extensively on valley fever at California prisons. [See: PLN, July 2013, p.28; July 2010, p.22; June 2008, p.22; Aug. 2007, p.1].

Sources: www.cdc.gov, www.washingtonpost.com, www.sbsun.com, Associated Press, www.dailyjournal.com, www.bakersfieldcalifornian.com, www.motherjones.com, Valley Public Radio, The Californian, www.correctionalnews.com, www.feldmanwallach.com, www.cdcr.ca.gov, Sacramento Bee

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