Just One Breath: Will California Take Valley Fever as Seriously as Tobacco?

The subject line from the top editor was succinct:

Big.

I knew it had to be news related to valley fever, a story that the Reporting on Health Collaborative – our joint reporting effort by seven California news outlets -- has been reporting for months. Our stories have been breaking news and spurring action from policymakers at the CDC, in Washington and California political circles and now in a new realm: California’s prisons. Re gulators, it turned out, had ordered prison authorities to stop sending vulnerable prisoners to Central California to face a possible unintended second sentence – debilitating disease or even death from the disease.

As Joe Moore – a member of the Reporting on Health Collaborative – wrote for KVPR:

The federal receiver in charge of health care in California’s prisons is ordering the state to remove inmates from two Central Valley prisons who are especially at risk of contracting the fungal disease known as valley fever. The move affects about 40 percent of the inmate population at Avenal and Pleasant Valley State Prisons. Those affected include African Americans, Filipinos, inmates who are HIV positive, have compromised immune systems, or are pregnant or elderly.

The collaborative broke the story about the problems in the prisons last year. After pressing state officials for numbers, Rebecca Plevin and Yesenia Amaro documented the trends in cases of valley fever in the prisons and the costs to taxpayers. They were able to show that an estimated 200 inmates develop valley fever every year at a steep price.

California Correctional Health Care Services foots an annual bill of about $23 million for sending inmates with valley fever to hospitals outside the prison, guarding these patients, and for their antifungal treatments. That’s about what it costs to build a new school in Fresno County. Not included in that sum are the costs the state prison system racks up treating valley fever within the prison walls and the costs attributed to expensive, long-term care for patients with complications of valley fever, such as meningitis.

Plevin then returned to the topic to show the human costs of valley fever in prisons. In writing about prisoners you go in knowing that most of the public will have little sympathy for them. Trying to secure an interview with a prisoner through the state corrections system proved to be difficult, too.

With persistence, Plevin was able to capture the central question of whether an added punishment for a crime should be a chronic and sometimes painfully fatal disease. She wrote Valley Fever Turns Short Prison Terms Into Lifelong Penalties and focused on two inmates in particular, Kevin Walker and Gregory Edison. Both inmates were sent to prison for nonviolent drug crimes. Both now have valley fever that they will have to struggle with rest of their lives.

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.

So far, civil rights lawsuits over valley fever have gone nowhere. Now, with valley fever being treated as an imminent threat by the federal receiver for California prisons that might change. As Dr. Michael MacLean, Kings County’s health officer, explained to Plevin and Rachel Cook:

“If you’re sent to prison for car theft, you’re suppose to do your time and everything. You’re not suppose to die” because of where you are incarcerated.

In addition, Gov. Jerry Brown is supposed to present a plan soon to reduce prison overcrowding to a panel of federal judges. If he has no plan, he could be forced to stand trial. Taking an estimated 8,200 prisoners out of the San Joaquin Valley and finding new spots for them will only add to the pressure.

So, yes. This is big.

Because this means that one of the biggest, richest and most politically powerful states is going to have to take valley fever seriously. And, as we have seen with air pollution, tobacco use, and other public health concerns, when California starts setting policy on a topic, it can have a powerful effect nationally.

Image by Charlie Kaijo via Flickr