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Office of the Crirairtai Sheriff
Parish Of Orleans • State CI LOIdirktnct

Marlin N. Gunman

Sheriff
For

Immediate Release:

May 13, 2005

Canted; Renee Lepeyroleitie
826-7034

SHERIFF GUSMAN REQUESTED INDEPENDENT REVIEW OF MEDICAL
OPERATIONS AT ORLEANS PARISH PRISON
Sherfrlideases Resukt
New Orleans – The Orleana Parish Criminal Sheriff's Office reports the findings of an

independeut review of the: =how operations at the Orleans Parish Prison (OPP).
Rooendyi there have been three deaths at the jail and media inquiries have been made as
to the specifics oft be health care programs at the Orleans Parish Criminal Shetifrs
Mee.
The Orleans Parish Oita/nal Sheriff's Office has a lope oompreherielve Medical
Departs:lee which provides primary care and emergency medicine seri/lees to inmates.
The department is staffed by 125 heath care personnel, includiag 13 fdl-time phyirleians.
The OPP Medical Dvartment is hilly accredited with both the Katie/nil Commission oz
Correctional Health Cart (NCCHC) tad the American come/ince Association (ACA).
In August of 2004, the OPP Medical Depatment was recognized by the Nccac for
outstanding medical care to inmates.
Several weeks ago, an OPP inmate, Mr. John Scott, died as a result of complications from
an active tuberculosis infection. A few weeks Leer, a Deputy Sheriff died from a rapidly
progressive pneumonia. Due to the serious none of these matters and out of extern far
the safety of OPP irdnikteg and raft Sheriff Marlin GM= invited Three independent
medical nroftesionale, unafEliated with the jail, to examine the recent deaths and the

jail's infection control program Tobeiculosis experts from LW Health Sciences Center,
Tulane University Scieteol of Medicine, and the Louisiana Office of Public Health (OPH)
were *eked to provide en impartial evaluation of inmate medical care end to specifically
examine the ease of each person who died.
Mr. Scott was arrested OW02/04. At the time of booking, he usiderweat a routine health
screening which wee nettemarkable. Two days later, he had a full hietory and physical
examination Wok was sou unremarkable. Oa 9/08/05, Mr. Scott was tested for
tuberculosis (part otthe routine screening performed on all new arrestees). The teat was
negattly.

;:0 Crawler Scree; taw Orleans. LA 70119 • irorw.opcsmors

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2+4r, Scott did well until 02/02105 when he submitted a routine request to see the doetot
was seen by an inter)* t on 02/04/05 whore ho reported a "bad cough." The physician

examined Mr. Scott, ordered lab work and a chest x-ray, and preseribed antibiotics fora
possible pneumonia. A follow lip evaluation was scheduled as well. A second
tuberculosis test was also performed to assess for tuberculosis infection. This repeat test

was again nsgativa.

He reported
significant improvement in his symptoms. Likewise, his physical examine
' time had also

Mr. Scott had a follow-up appointment with the physician on 2/12/05.

improve :4 after the antibiotics, The physician scheduled another follow-up appointment
(in. one week) to antes his progress. On 02/24105, the day prior to his scheduled fellow
up, Mr. Scott became acutely ill, complaining of shortness of breath. Ile was
ittneediately transferred to the Medical Center of Louisiana fur further care.
lhafortuately, despite aggressive iuedi al etants, 	
Scott died in the hospital. (Of
note, Mr. Scott did not report anymedical problems between his appointment on
02/18/05 and 02/24/05 despite the fact that a nurse visited hint de ply.)
The second death involved au OPP Deputy Sheriff The deputy died from a severe
pneumonia that was completely unrelated to tuberculosis. However, given the
seriousness of both events and their temporal proximity, Shetiffeesman felt compelled
to request ail iadepoadent, impartial review of medical. services. The tuberculosis
incperts, were asked to address four specific questions: (1) Did Mr. Scott receive
appropriate medical ft:talent at the jail? (2) Was the Deputy's death related in any way
to the death of Mr. Scott? (3) Did the jail's tuberculosis (`I lit) ecreeniug and prevention.
policies comply oft. nationally accepted guidelines end recommendations set forth by
the Cordes for Diatom Control and Preveexion (CDC)? and (d) Did OPP take
appropriate action to protect inmates and sea once an active case of TB was identified?
After a thorough examination of Medical Department policies and a review of pertinent
medical records, all three investigators reached the same conclusions. First, Mr. Atha
care which met accepted
Scott was provided with appropriate medical cam at the 	
standards of good medical practice. Moreover, the expects commented that Mt Scott
had,, "adequate access to medical tare arid medical complaints were pccmptly triaged and
appropriately attended to by the medical staff." Second, the experts concluded that the
Deputy's death was not related in any way to the death of Mt. Scott calls tabeteulosis
infection, Next„ they commented that, 'TB screening prevention, and control policies
are in acecedance with current CDC and national guidelines," "screening and
prevention policies in place at OPP are completely in accord with the recommendations
of expels in the Sold of tuberculosis corecol." Finally, the =pate universally agreed
that the Medical Depseintect's sesponse to an active, contagious case of TB was
appropriate. Every effort was made to protect inmates and staff and to limit the spread of

infection. In fact, OM commented tat the jail's response, "even exceeded recognized
standards for contact investigation, disease detection, and appmpriateciess of treannent."

Sheriff Outman remains committed to providing inmates with quality health oak care
which ewes commodity standards in tams of quality and timeliness.

	
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Evaluation of the TB
Prevention and Control
Program for Orleans Parish
Criminal Sheriff's Office

March 24, 2005
Juzar Ali, MD*
Shu-Hua Wang, MD**
*Russell C Mtn MD. AiotNEW ?Infuser of Medicine
Vies. Mak CelinieaD Deparonaut of Aletlieine
Ding:ton /...W.Weennes 731 & Chas aim*
Untie@ of Pulmonary & Critinti Care Metliethe
Louisiana Stave University Rae* Sane* Censer

**Osaka! instrnater otModlclale
Tea= University Health Sciences Center
Dept of bRedieine, Section of Idectious Diseases
Assistant Medical Director aiNclitioce TB Clinic

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I. Introduction

On February 2$, 2005, en inmate (IS) was traurforred from Orleans Peri& Criminal
Sheriffs (OPCSO) and later died at &Laical Center of LOuisimus New
Orleans (WINO). Also, around the eame threa, *Deputy ofthe OPCSO (CB) diod at
MCLNO stet she reported with acute respire/my symptorns to the EmereeneY
De/pertinent At the request of the Criminal Sheriff's Office, we have been asked by
the Chancellor's office of the Louisiana State University Health Sciences Center
(LSUFISC) ant the DapettritLIS of Medicine at LSUHSC end Tula= University
Health Sciences Center to review these Glees and to speoificallY address the questions
outlined below in section 2. We present our report based on the methodology outlined
in section
2. Specific quo tiOna to be addressed by this review
L

Based on Vac information available to the Medical Staff of the OPCSO wee
standard of care provided for inmate is? Did inmate IS have adequaee access to

medical cart?

le Is there an adequate -Inberculosis (TB) Surveillance program at OPCSO Medical
Division?
C. Was

there failure of TB sozeening ar OPCS07

d. Is there any correlation between the case of Deputy CB and i=uste JS?

3. Background

TB is au indiviitial medical and a societal medico-social public health problem. In the
United States, TB remains a major hazard in correctional Eteilitior and constbatee a
!ergo reservoir of cases and potential transmission of disease. The transmission of

Mycobacterium tuberculosis in this high tittle, high prevalence *ding is an encaenoos
public health °omens for root only the franares of dose facilities but also far the
employees of these correctional facilities and eventually fur the couratunities to
which, these brumes are released. An effective TB control and prevention program
for correctional facilities requires not only clout eurvoilianee end screening at the
;eery level but: cohesive coordination and collaboration with the Office of Public
Health in the region and the affected commurdty medical =vices.

Ties Centers for Disease Control and Prevention (CDC) Advisory Council for the
Elimination of Tuberculosis advises that ail eorrectionel facilities have a TB Infection
Control Program tat includes three essential components of TB control ectivider.

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(a) Screanin•idear*ing person who are infected with Mycobacterium tubeeculonia

(Latta TB lannetitra) or who have active TB tsetse; ( b) Containment& Prevernion
of transmission of blycobacteriturt in the 'oorrectional facility by adequately treating
persons with latent infection or active TB disease (C) Amassment- AnceriemMg and
evaluating screening and containment activities.1
Contacts of persons with active tuberculosis am at risk far developing latent TB
infection or active disease. An untreated active TB ease oars spread the disease to 1520 persons per year. A contact itiventigation, therefore, must be initiated promptly
after detection of an active TB case in order to identify end medically evaluate
contacts at risk tor active TS disease or infectioz&
4. Methodology

For the putposos of this evaluation and in preparing the report, we adopted the
following xnethodology
a, Reviewed OPCSO medical record, Mortality Review, and (;heat X-Ray
(OCR) are inmate S.
b. Reviewed MCLNO medical record, C33t, and er scan for imitate IS and
Deputy OB for public health review purposes.

c. Reviewed Prevention end Contra of Inberculosis for the OPCSO Mame

d. Reviewed TB Prevention and Control protocol at OPCSO with Dr. Richard

Inglesn Medical Director of OPCSO, whose ;cope:miens we enknownedp and
, •
ePnint,aittlae
e. Review of current m&cal Moments relating to tabesculosis control guidelines
for correetional fealties.'

5. Sunainehry of review

a. Case 3S.
US is a 24 year old African American male booked at OPCSO on 9/2/04. As
per protocol of the Eseility, an initial health 11366$10210t was conducted by a
nurse, and the inmate reported no medical problems. A Inberculin skin teat
was placed on 9/S/04 and was read as negative on 9/10/04.
ii.On 10/13/04, a "Sick Call" request was placed by the inmate for a rashilives
witnessed by a nurse. 'The inmate was triaged and sent to the medical unit for

evaluation. He was observed overnight and nested with pee/time 40mg
daily for three days in addition to Benadryl and Ulnae and released on
10/14/04. A follow-up visit on 10/25/04 showed no, additional lesions. On
11/15/04, a paned "Sick Call" request was made by the innate for a
toothache and be was Sara by the dentist on 11121/04,
12/29/04„ inmate IS asked for a "Sick Call" request for a cold with a
nonproductive cough. He was triaged by a nurse and a medical appointment
was scheduled for 1/4/05. He was seen by a physician and diagnosed with
viral upper respiratoey infection and prescribed medications for symptomatic
relief,
iv.0,a 2/2/0:5, another "Sick Call" mast was placed for cough, decreased
appetite, end weight loss. He VIM triaged by a nurse and scheduled for clinic
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on 2/4/05. His vitals sips wets: temperate* of 98.6, pulse of 88, and weiett
of 120lbs. 'Physical elatiMilUttiOn MIS significant for demrased breath sounda
diffuse, rhonchi and wheezes bilatetal4 r, end creckles at the right base.
Inmate JS Ins preacribed Doxycycliae 100neg twice day for a 10 day come.
hi addition, the physician also ordered a OCRarad laboratoty evaluatke:
consisting of a complete blood most, complete metabolic panel, and thyroid
Amain studies. Re was scheduled fort follow-op appointment on 2/10/05,
er,A CXII, was taken on 2/5/05. A taxed repast Otte CCR. lading was sent to
Infection Como/ on 2/7/05 with the "Abnormal" box checked or and written
;totems= of "fatten/ upper lobe pateochynna disease. Right Wester tetee
left ?obronic versus acute . Upon review of the OCR repoet, the Infection
Control physician ordered a repeat tuberculin skin test (PPD) and a HIV test.
A rapid, my test was performed on 2/12/05 which was %resolve and a repeat
ND vet placed on 2/12/05 and fined on 2/15105 as negative.
vi3Ou 2/113/05, inmate 38 was frau in the clinic fur his two we* fallow-up by
the same physicist: who had seen hire earlier. The clinic note stated inmate's
"dry cough persist but "...feels bake, The physician was =ware, of the
CXR :Teat. Physician noted the ihnorteal laboratory results hem 2/11/05;
wac of 11.9, Semoglobin 92, Platelet 518. Sodium of 129 and Albumin of
2.6. , The physician ordered iron eupplement, dietary and fluid supplements,
an anemia work up, routine bacterial sputum culture, sad additional labs
including an FIN test, Bleed was drawn on 2122/05 bee the complete
metabolic panel was unable to be performed by referee= lab due to improper '
labelber, (no name am the epecimen)
vit,On 2r24105', inmate IS coraplained of shorten of breath, worsening over 2
weeks, with bloody sputum noted by nurse. Ile was tinged by the physician
on-call end was noted to be in distress and unable to complete 11111 Sadetteeti.
Vital Signs at Medical Unit were temperature of 102.1, pulse of 153, blood
press= of 94/611, respiratory rate of 24, and pulse ox of 91%, The inmate
was then trimeporind via ambulance to MCLNO.
MCLNO, the admitting C.Xit was alivereneal with evidence of multi-fowl
pnevenouia ("Patchy sir-spates disease in upper and middle thug zones,
Fedoras:eat on the right...but also noted firs left superior Inns zone. Cermot
exclude right perstracheal widening from lymphadenopathy. Tho Misr
regions are not well visualized") He wee initially pieced on broad :feet=
antibiotics and admitted to the medical service, Los, he required intutertion
and tend= to the medical interutive ceira unit ibr respiratory failure. Mita/mem/lose; teatmenit was alerted and the sputnm =oar sent on 2t25/05
later reported positive for acid fast bacilli. ivied "coded" on 2/28/05
WS; prerammeed deed it 2/205 8:59 A.M.
InAt the time of this report, the thud autopsy report of 3S Is still pending.

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by Case CB,

I. Dainty CB is a 42 year old African America female aeon at the MMNO on
3/9105 Nvith complaints of shortness of hmatbk inability to speak, and lethargy
ger admitting CXR. was abnormal and sigoiScant ibr patchy opacities noted
in the right beznitinmor more
tin
the mid and lower lunglones with
air-bremptuagratos. She was ink/14W in the emergency depart:moat due to
respiratory failure and placed on broad spectrum, antlietica. Sputum and
blood Datum were positive tar methicillin resistant naphytegvecia aurezt.s

(MRSA). No acid fast bacilli wore identified to date. Patient "coded" twice
during the hospitalization and sal,sequently died on 3/11/05.
ii At the time of this report, the final autopsy report of CB is still pending.

6. Answers to npeciik queattous

a, Based on the infoonation available to the Medical Staff of the OPCSO was
standard of care provided for inmate IS? Did inmate IS have adequate access to
medial care?
Yet. Standard of care was provided ter innate IS by thc Medical Staff at OPCSO
based on the Wormed= available to there at various visits. In addition, Inmate
TS did have adequate access to, medical care end hie medical complaints were
promptly triaged and'appropriately intended to by the medical staff.
b. Is there an a &Taste Tuberculosis (TB) Surveillance prop= at MSC) Medical
Division?
Yes. The Contact Investigation at OPCSO tetbeequeet to the detection of the
active case of TB VS) wee adequate and has been conducted appropriately`

Further deltas of this contact investigation am on record with the medical staff at
OPCSO.	
reported conversion rate a/approximately 35% (29 tuberculin shin
test C011V0£310:33 E110114 83 Vi40 previously had negative eldu tests) is to be expected
in this epidemiolegicel setting,
c. Was there a failure of TB screening at OPCSO?
This can best be answered in two parte:
* The cturam TB screening protocol at OPCSO Wm** adequate screening of
its employees and human. The Prevention and Contml of Inherculosis for
the OPCSO Manual from jammer, 20033 00km outlines or the protocol *r
OPCSO; the protocol is in accordance vita the current recommendations of

MCP ad national guidelines,
• As stated above, we would like to re-emphasize that the current TB acrecning.
prevention end control procedures adopted by the OPCSO ere in accordance
with muted CDC and =loud. guidelines for correctional facilities. However,

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we eve: noted that there are acme aspects of coordination and coromunieatipti
at verious efinicalttnedical/tadiologicel levels in the mute at OPCSO that
can be farther improved.
d. Ys them any correlation between the case of Deputy CB and in

	 JS?

No. At this time, es far as we know, VA based on the dam available, theme is no
evidence to suggest any MOW= between the deaths of inmate JS and Deputy
CB. The final autopsy reports of both oases are petalkg and we are not aware of
the findings, It can be reasonably assumed that Deputy CB's death may be due to
post vireVinfluense pneumonia infection, However, the fluil attoPeY Mort of
the case is roil' pending.
7. Recoonnendittions
Our revs:roma:ad= are based on the above findings and sitppotte4 b y refereneed
evidence based data. The recoremendations focus oo three components enticed and
specified below.
a. bnpICAMMUlt in TB Prevention Program
b. Improvement in Inmate/Patent Girt
c. Update of TB Prevention and Control Manual

a. Improvement in TB Prevention Prolate
1. Follow-up Screening of inmates and employees of correctional flat?.
a. Data regarding skin test conversions of inmates and employees of
correctional face iry should be analyzed petiodicaily to estimate the
risk ibr acquiring taw TB hifection in the correctional facility.
b. Additortally more faccsent testing rem 6 months in this high
prevalence high risk populations, rosy be needed, If this requires VIM
Health Care Worker manpower, it is worthwhile to consider expending
such a progmat at OPCSO
2. Routine analysis of status of inmates with active and latent infection to evaluate
,
completion rates for Latent end Active TB treatment.. 	
a. CDC Advisory Committee on TB Minton advisee that at least
95% of immues who begin active or latent TB treatment should
complete the prescribed regimen?. In case of treatment of salve cases
post release, the Office of Public Health (OPR) has the infiastruttam
for follow up to ensure compliance and adhere:nee to treatment,
However, they must be plugged into this In a seamless consistent
=timer. The use of specific case managers at the OPCSO level will
alliance this coordination and ensure continuity of care,
b, In case of treatment of latent TB infection (which is nou.ntsastoty
from the public been point of view)0 as long as the inmate is
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incarcerated, Direetly Observed Preventive Tres/roost (DOPT) die
prescribed and ensued by the OPCSO, lire tentinustion of this
therapy once the imam ie :closed is not inundated and lacks a
consistent approach. It relies upon the fbilownwp by the ex-inmate and
hirilacc contact with the public had% system. As a general trend, these
Mairitiatia approach the public health system Dully when they require
medic'sl intention for other purposes, or emeenine and or Cliaarataa for
homeless shelter and trausaional stay Also, they may not
come into public health preview u►ta they ant either seen in siteltees or
CD= trough the OPCSO systems again. This exposes this "kaVOIViLt$
door format to wide gaps in public health enforcement and follow-11P,
enefore, it sem be justified that such oases that come through this
smoking door" mechanism or axe in the OPCSO system 6or a short
period should here a CXR. as a screening tool rather than on just
re13►33g on reports of a PPD Ws test Tins approach has been
described and proposed in the medicel literature especially fin inmates
who stay In the OPCSO line system far less than 10 dila, Again, ease
managers at the OPCSO level may play an important role in this
=gated in catkilittztlaa with the Louisiana Office of Public Health.
c. We hater suss that the issues mentioued in this subsection are the
weakest link in the ovemU control of TB in Orleans Parish and the
Gress* New Clime metopolitse eree via a vie TB in the inmates and
it the soh pOup ortransiertrimobile populations.
Improve follow up of inmates to referral TB or couneunitY clinics of
intones who are released by specifically
L Update referral information to Region 1 Weterene TB Clinic
with new location address and through appointed contact
/denigrated persolmel...
ii. For lactates with active TB: Provide TB-9 forms with TB
medication regimen to the Region I, Office of Public Health.
Upon release of 'waste from tortectionel facility provide
updated seedieel informatire repeading their T$ treatment to
Offroe of Public Health through desigeated contact personnel
Provide names of inmates who were on latent TB treatment to
Office of Public Health Regional Clinic such as Wetmore TB
Clinic upon Itleir release in order for Clinic to contact and
' facilitate follow-up appoittravrat
Adopting ienovslive measures to dimmer released inmates to
oomplete treatment fat TB .6
a. Tunapravanateat la Patient Care

atepertable CXR ("RED FLAG X-RAY")
i, ht 00140124:40Th with the Oard405113 so be adopted by the OPCSO
clinicians and contracted radiologists while keeping in mind the
logistics and limintions of the system, we senctumend that a list
of "Reportable'"
findings be created which mandato/ the

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radiologists to :testify the pbysicians of such Wings
telephonic or pager system bromediately. For exempla: CXR
suggestive of TB, multi-lobar pneumonia, or obvious malignancy
shoed be notified to the clinician promptly end riot left up to fie
tthantel of written notes through the infootket control tine .
ii. Improve filing of CXR results into' medical veoord end establish
a back- up method, of remains a OCR result in case of delayed or
run:Ming of results at follow-up appoint:wits.
itilosure that abnormal =Xs au reviewed by the physician
caring for the innate in order to enable them to correlate their
chiral impression/ status with CXR findinp.
iv.For symptom scristaain,g, inmates CXR, intexpretation should be
available within 24 bouts!'
b. improve conscarcieations between medical staff.
a, Medical Chant*
Although in this setting, the clinical symptoms, history
and physical sips data. playa seccsidary role, the
importance of the doetrunanfortion of such findings u
elaborate as possible cannot be overemphasized. Some
of the physician findings were excellent in our taview.
However at certain other ,points, some findings were
. missing ,aitd may have helped in &Meting closer
clinical scrutiny.
Tests end labeling
Spurt= should * submitted for AFB smears sod
culture ammination front persons who are diagnosed
with initially with other respiratory disease but whose
symptoms do not improve atter initiation of metre
For inmates with document weight loss, chronic cough
for greater than 3 weeks and at risk for tuberculosis
should have sputum smear and cultrut evaluation for
TB. Proper labeling of specimens for laboratory
analysis trill ensims timely retrieval of Meting results,

b.Laboiatory

Li this connection, a suggested mom, of chertfog Is the
development of a single standardized form Ina check rut so that
findings said labs ( be they be ordered, awaited or missing) by
treating tvlDs, arc all clearly available.

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4, Update ern Prievoition and Control Manual for °PCS°
4We recommend periodic rfrview and updatins of the TS Psevantion and
Control Manual for OPCSO, This would scrva a dual putpose of better
dicing! and public baelth collaboration ,between the two ass of TA
control in this population but Lc, Inmates while at OPCSO and when '
=hued to the coranutaity at the WIT loyal,
00.

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Reforences:
IVEAWR Prtyrynion arid Control of re in Coneedmil Paraties. Escortrandations oo Advt40rY
Could tin Elimination of TD. hoe 7, 1996, V,o145/1410.
21410111.1165oraial araponents of TobotendoldS Proven:ion sod Controi Promo, fieremiss "Ittbensulosii •
sad Tolseroulosis Infection, in High Rid; P094111ktOSES. Septembsr 1995/Vol 44/ No. MI I
Ineeen, R. Prevent= tot4 Control of Irtibereslosis for the Orions Wei Criirdnal
February 2003

ertra MCC

20fW14. Prevention and Control of TB Cortoolms/ Penalties. Reciotramodations oftite Adrisoty
Cameo for Etroination of TE. Arne 7.1996. Vol WM. Idt4. pat 13.
MMWR Provention tat4 Control of '112 in! helm. laccortinnedittions of tios Advisory
Council for Iiitonnalion of. hoe 7, 1996. VW 4.44,10.0„4 p22,
4 WaVtgAt Prevention and Connol ofThix coneettonig halide& motions Oftbe
Couneg for Elimination Ta AUte 7. 1996. Vol 45N0.10.-2 pay 19.

duIviargir

Prevent= arid Coatral oft) n Cometiong PIol1ITI AteelniZeasdatinso *Me Advisory
Council for Eliiminstam WM. 7 7, 3)6. Vol45/NO. P.P.4 Per 7.

trIAM

8 114301t. Prevention aid Control of TB in Corseetional harks. Itocommtudations ow Advisory
Conrail kens:minstrel *fn. Amt 7, 1900. Vol 4511■10. *PA pap 15 .
HMO.

Treatment oiratxtscolosts. Awed= Morsel"
20,2003. Vol 52/P.It-11

snellattotions
Dimas Society
C

Aliserient. I	

44 2.12arltIntsoten Inbereulto Testing fair Tressmait of Latent 'rebeggulosir 1ofsetion. Ante 9, 2000.
Vol 49/1M4.

Stgrsed:

hay AN MA 14t6
Sbu-11(tta Wan KM
Marra

24, 2005

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MAY-23-2005 MON 03:47 PM AL TV NEWS 2
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DEPARTMENT OT EXALTS ANOZOSMALS	

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CICOOMICA

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UCOCUMX

April 20, 2005
Orleans Perish-hued Shot:Ors Ms
Ain: Waned D. Inslise.
"
Maned Admireistration
2800 Grater Street

New Orleans, Loriiidene 70119
Dear Dr. Inglese:
?lease enolosed t eopy plat welt, Wei& I wrote Ihnowitli our mei**
Plow feel free to ebart this mon with mono you *C1 amy be interested to ito and thank We
for the opportunity you pet me to meet with you about these tatter&
Siommtiy,

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FAX NO. 504 529 6472

MAY-23-2005 MON 03:48 PM WWL TV NEWS 2

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On Wednesday, April 6, 2005 I met with Dr. Richard D. Ingleie, medical dtecter at
Orleans Parish Criminal Sheriff's °Moo (OPCSO) and discussed at %IA the
l'uteradosis Control Program at Orleans Parish Prison (OPP),
. . balding
, „ the following
,
=dor points;
(1) The screellal. Ig program
(2) The medicel disposition of incarcerated persons with disease, both active and
latert
(3) The sorvallance program, including contact tracing
(4) The details rd•die medical comae of inness of tbe pidient 14-0 a Pcreou
incarcerated recently at OM who died of tuberculosis
In OW discussion, Dr. been showed meths Tnberouloais Control Marnal used at
OPP, which he wrote in 2003, and which contains all unite latest recommended
procedures published by recognized experts in the control of tuberoubsis in the
United States, in general, as well as in correctional factities, in particular.
Additionally, Dr. Iniglese abated whit me the detailed patient record off.S. from the
medical clinic at OPP and the files kept at OPP regarding follow sup of those persons
who had =tact with IL and were exposed or were even possibly exposed to LS.'s
active tuberculous disease. I was also provided with %report addinenting many of
these same points written by Dr, Ma AB of Louisiana Stare Univelsky Medical
School and D. Sins-Hue Wang of TolaneUniversity Medical School
Atter ow discussion and review, Dr. Wiese posed the folkywing questions to me;
(1) At the Orleans Parish Criminal Sheriff's Office (OPCSO) correctional hectlitif,
also known as Orleans Perish Prison (OPP), are =caning anal prevention policies
irsplace?
(2) Was the can of .LS. at OPCSO (OPP) thimoustrative of adequate access to
oompetent medical care as wall as danonstretive ofacceptable medical care by
the physician(*) at OPCSO (OPP)?
(3) Was the response of the medical and allied health staff at OPCSO (OPP) to the
' appropriate?
presence eat active case atutoccuiork at the facility
lit response to these quations, i have the following comments: •
(1) The screening and prevention policies 'apiece at OPCSO (OPP) are completely in
accord with the recommendation ofapetts ta the field of tuberculosis contralto
published by the United States Public Health Service,. Centers for Disease Control
and Prevail= (CDC) — gacallatgatasaUsegRala, 46 edition, 2000, and
IltrazitimmigilIMIS011bosiisiiiiiiCogaigaibtatim /999.
(2) In my opinion, the medical care ofJ.S. at OPCSO (011) was acceptable by all
medical standards regarding access and apreepelattescn,
(3) In ray opinion, the response of the medical and allied health staff at OPCSO
(OPP) to the presence of an active case of tuberculosis (I.s.) at the ihaity was

FAX NO, 604 529 6472

MM-23-2005 MOM 03:48 FM WWL TV NEWS 2
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appropriage ad even exceeded, regogniweil ataudattle for contact investipdo;
disease detection and appropriatiness oftmetment ofthose pasons needitgiiiiuch

treetmotts

(4) Rampart-t og that thus cages system in Plana at OPCSO (OPP) tbllows thc
recontraranied guidelines of CDC auntioned hi (1) alms, ceetteio additions end*
=Danced= to the SYsteci in 'place a OPCSO (OPP) are mocesecianda. These
ere:
(a) Ted eotvireumental condidens of tba oottectional facility *ma be
*seated now assaci deficiencies, iif hued, should be torrected By
environmental conditions, I rens specifically to the heating, ventilation
and• air conditioning *yams, which, ifnet kept nectionlously clew and
good working order, can taws speed ofinfitotions dim*, ant
totorcolosis, from one infecupd pus= toWu= wi thins shod time.
,
(b) Incarcactedperieve at OPCSO (OPP) diagnosed wit pnanzunis. tieing
at high risk flit having active tobacalosik Should have eputace samples
examined for causative inkieroorpciuns oftchaculoale, tbs acidAst
bacilli of ttibetronloaK a the earliest possible apportunity. 'Ma Lordeinne
Wk. *MUD Health (Mt) througais
bean laboratory in New
Orleans would be sable to wept sod esesdne the *put= simples
sated fro= OPCSO (OPP) tor the onuastive raimo-orgemisnal of

tuberculosis.
(c) The radiologist's interpretatiou of any abnourad Amity loll* spray area
taken at OPCSO (OPP) obouldba caninunicated inuttediate0 by
telephone to a member of the nualicid muff t 0PgiO (OPP);

(d) Upon release from OPCSO (OPP) the aeaanae end addresses of(formerly)
incinerated pesos tetra:nag for %hemlock should be made known
to tlie Louisimia OPWs regionel office intim Odom, wberti die' ease
invertigatiou rpeolallats oat tbilow•tip with the formerly incarcerated
pastes to =aka we they have appropriate nudes' follow* am and
roodirives at either the public clink hr gels in New Orleans
(Wetmore Clinic) or trough /civet medical care.
(e) A pnatenent
stalfpereon at OPCSO (OPP) aa4 a4 pannarent
aniffpason at 01111 regional office in New Odium should both
be named to mot vegulsey, ikg. once weekly, en diaCgaa MOM of watual

cancan related to the control eftabereulosio. OPl would tie able to DI=
such a person at this time.
(f) lhe possibility of istablhhing a respitatozy battles it* at OPCSO
(OPP) shou/d be =adore•

I appreciate the oppoitunity to have nut with Dr, Ingest ahaut these
matter& I
would also welcome toy questions, the reader nay lave about tbla doverreet.

R 18
16/16