An Invisible Health Crisis

Deadly Staph ‘Superbug’ Has a Dangerous Foothold in U.S. jails.

By Silja J.A. Talvi, AlterNet

Like so many other regional and national newspaper and magazine stories about MRSA’s creeping presence in the nation, this feature in the Nov. 26 issue of The Seattle Times was chock-full of useful, preventative information. Among the key, common sense suggestions were for readers to remember that MRSA isn’t limited to the transfer of blood or bodily fluids. While not airborne in the way that tuberculosis is (although MRSA has been known to be transmitted by sneezing), the bacterium spreads with tremendous ease by way of skin-to-germ contact. The article advised people to remember to wash their hands regularly; to avoid unbleached public washing facilities; not to share towels, razors, or any kind of shared drug paraphernalia; and to have the “courage” to be willing to ask medical personnel if they’ve washed their hands before touching you.

The Centers for Disease Control and Prevention has rightfully called MRSA (pronounced mer-sa) the “cockroach of bacteria.” It spreads silently and stealthily, and moves quickly from one location to the next. Once it’s around, it’s also incredibly difficult to get rid of because this virulent mutation of staph is resistant to all but the most rare and expensive antibiotics. Sometimes, even the super drugs don’t work against this superbug, resulting in some 19,000 deaths in 2005, more than one in five of the estimated 94,000 Americans who had been walking around with MRSA lurking on skin surfaces and in nasal cavities.

Media headlines have emphasized the existing or potential presence of MRSA in hospitals and schools: at least three students are known to have died from the bacteria. But it’s remarkable to note how little attention is being paid to the kinds of facilities where the superbug thrives and spreads the fastest: poorly ventilated living and sleeping quarters; overcrowded rooms; shared mattresses, toilets and showers; and a preponderance of people who arrive with poor health, drug problems, and severely compromised immune systems. Homeless shelters and emergency rooms serving indigent populations are among them, but there is no question that the biggest incubators are the nation’s 5,000-plus prisons and jails.

“MRSA is running rampant through prisons and jails in the country,” says Paul Wright, editor of Prison Legal News and co-editor of the newly published book Prison Profiteers: Who Makes Money from Mass Incarceration. “Prisons and jails have historically been the incubators of disease, and that trend continues today. A disproportionate number of people with infectious diseases, including MRSA, will cycle through jails and prisons each year.”

The exact number of people entering the criminal justice system with either the regular or superbug version of staph is unknown, owing to a combination of factors. For one, not all people who harbor the bacterium present symptoms. For another, most jails and prisons do not regularly test for or report it.

It would be easy to dismiss the prevalence of MRSA in jails and prisons as something that happens to people who are so irresponsible that they don’t take the time to clean themselves or their cells. But stereotypes like these don’t hold true once prisoners are actually given the opportunity to explain or demonstrate what their living conditions are like. Yes, many men and women enter the criminal justice system out of unstable, impoverished environments that have already put them at risk. Like most Americans, people who end up behind bars don’t actually know much of anything about how MRSA is spread, what signs of infection to look for — or even, for that matter, that the bacterium exists.

Even those prisoners who understand how MRSA is transmitted and who seek the proper precautions tend to find that they cannot learn all they want. Prisoners with obvious signs of infection are rarely separated from the general population and are commonly told that they are simply dealing with pimples or spider bites when they complain about sores or boils on their body that do not seem to heal.

Such was the case when I traveled to the state women’s prison in Grants, N.M., in 2005. The prison, run since the early 1980s by the Corrections Corporation of America, had a veritable epidemic on its hands, something that even some staff admitted to me under the condition that I not publish their names. Many women called me over to so that I could witness the jarring sight of large, oozing, open sores, usually on their upper legs. None of the women with whom I spoke was receiving medical treatment; all had been told that their sores were the result of insect bites or their own unwillingness to stay clean. The women complained, in hushed tones, that the prison had yet to put an emphasis on providing enough soap and sanitary conditions to stem the spread of the bacteria.

Prisoners across the nation echo these concerns. It is not unusual for me to hear (or notice) that low-quality soap is doled out in very limited amounts; prisoners routinely complain about not having enough to last them through the week. Even having access to soap isn’t a guarantee of being able to wash one’s hands to get rid of surface germs, because the tap water made available to prisoners is often lukewarm or cold. The same is true for the availability of bleach to clean showers or toilets, as well as antiseptic cleanser for shared gym equipment. Antibacterial hand cleansers are so rare in prisons and jails as to be notable when they are available.

In Washington state prisons, prominent signs have been placed to warn correctional employees and visitors alike of the dangers of MRSA infection in the facilities, yet prisoners must grow accustomed to lack of soap, hot water, and unclean showers and other shared areas. Worse yet, the possession of unauthorized, “contraband” antibacterial gel or antiseptic hand wipes is a punishable offense.

In most jails and prisons, topical salves, gauze, and bandages are rarely provided to prisoners with boils or sores that could well indicate MRSA infections. Many jail and prison employees are overworked and delay and deny prisoner requests to be seen and treated for even the most obvious health problems. Medical co-pays of $5 to $10 are yet another common barrier, because many prisoners simply don’t have the means to afford what might seem to be a nominal amount in the “free world.” Add to all of this the endless recycling of prison mattresses and poorly cleaned bedding and clothing, and it’s easy to see why jail and prison environments are ripe for the spread of MRSA.

States known to have particularly serious outbreaks of MRSA in detention facilities include Massachusetts, Michigan, Pennsylvania, Alabama, Mississippi, Ohio, and California.

When I traveled in early 2007 to research the women’s jail in Los Angeles County, I entered the Lynwood facility with full knowledge of the reoccurring problem of large-scale MRSA infections in what has become the nation’s largest jail system. One of the primary reasons for the frequency of outbreaks of MRSA in the Los Angeles County jail system has unquestionably had to do with severe overcrowding.

I walked into the area containing what are known as “in-transit” holding cells, where inmates are placed when they are en route to, or returning from, court hearings in various parts of the county. These women had already been booked into the jail and could have been promptly returned to their housing units, but staffing constraints mandated a “holding” period. I was especially alarmed to see that more than 20 women were constrained in one small cell. Although at least a half-dozen adjacent cells sat empty, these women had been crammed into a space that had probably designed to hold six to eight inmates, at most. There were no bars, only something that looked like a plexiglas window with a small vent on the bottom half. Several women crammed around it, trying to get gulps of fresh air — or the closest thing approximating it inside this jail. These utterly miserable-looking women had squeezed themselves into every nook and cranny of the cell, which held one toilet in the back and a single pay phone. There were no towels, linens, mattresses, or antibacterial gel in this cell.

If even one of those women entered that cell harboring tuberculosis or MRSA, it would be more than likely that at least one other person would acquire an infection, something that almost never makes the news until a full-blown epidemic is under way or a major lawsuit threatens to cost a government agency a pretty penny.

The notable exception where media exposure is concerned has been the spread of MRSA to guards and healthcare workers. Among many other similar situations in local jails and state prisons, prison employees have sued over unchecked and unaddressed MRSA infections that spread to spouses, children, and acquaintances. Lawsuits across the country have emphasized that the top-level brass have shown disregard for educating frontline prison staff about MRSA, including information about symptom identification or simple prevention strategies—even in the midst of what were later disclosed to be outbreaks in the captive population.

There have been many outrageous cases along these lines, including that of prison employees hospitalized for long periods of time because of resulting disabilities. One of those cases included a nurse in the Calhoun County Jail in Michigan who acquired MRSA from two prisoners who both died within the space of 13 hours. One of those prisoners had sneezed on the nurse in March 2005, and she developed such severe complications from the ensuing infection that part of her foot was amputated. In West Palm Beach, Fla., an assistant public defender almost lost an arm to MRSA when he contracted the disease from a client in a severely overcrowded, unsanitary jail in which 200 prisoners contracted the superbug within just a three-month span in early 2004. More recently, the California Department of Corrections and Rehabilitation was fined $21,000 for failing to take appropriate measures to prevent employees at the massive Folsom State Prison from acquiring MRSA infections. Many guards were hospitalized before the prison administration admitted that they had an outbreak on their hands.

A 2006 report by the nonpartisan Commission on Safety and Abuse in America’s Prisons looked at the prevalence of untreated infectious diseases. It strongly recommended that prison and jail systems should join public health providers in “the common project of delivering high-quality health care that protects prisoners and the public.”

The commission went further to insist that every detention facility in the U.S. should “screen, test, and treat for infectious diseases under the oversight of public health authorities... and ensure continuity of care upon release.”

There have been a few moves toward that end that deserve recognition, including the Broward County jail system in Florida, which developed a program in 2004 to identify and treat each infection in order to stave off a larger outbreak. Each housing unit has information about MRSA, including color photos of common symptoms related to the infection.

As noteworthy as it is, the Broward County model is exceptionally rare in our prison-crazed nation, which already bears a crown of shame for the incarceration of more people per capita than any other country in the world. Mass incarceration is a foolish and primitive approach to “public safety,” and fails to address the most common underlying factors in prisoners’ lives: mental illness, poverty, drug addiction, histories of trauma, unemployment, unstable housing or homelessness, and other damaging variables. Unfortunately for all of us, the overpopulation of jails and prisons is widely predicted to worsen over the next several years, at great, multitudinous cost to our society.

While genuine prison depopulation and meaningful criminal justice reform will take untold years or decades to accomplish, we have the opportunity to reconceptualize at least this one aspect of incarceration. Jails and prisons should be viewed as an opportune setting in which trained professionals could address high-risk behavior, intervention, and the effective treatment of health and medical problems (most notably in the prevalence of drug addiction, mental illness and infectious disease).

Considering that at least 95 percent of American prisoners will eventually be released — at over 650,000 people per year — local governments and jail/prison administrations should be setting their sights on the value of educating prisoners so as to prevent dangerous epidemics from raging behind prison walls and beyond. Moreover, improving and sanitizing living conditions in jails and prisons should be seen an absolute imperative for the sake of public health and human dignity.

The way in which the MRSA superbug in prisons continues to be treated (or untreated, as is usually the case) is a direct and ugly consequence of the dehumanization of men, women, and youth locked away from our collective consciousness. Indeed, a “Don’t ask, don’t tell” approach toward the deadly MRSA infection among our captive populations is ignorant and baffling at best, callous and sadistic at worst.

Silja J.A. Talvi is an investigative journalist and the author of "Women Behind Bars: The Crisis of Women in the U.S. Prison System" (Seal Press, 2007). Her work has already appeared in many book anthologies, including "It’s So You" (Seal Press, 2007), "Prison Nation" (Routledge, 2005), "Prison Profiteers" (The New Press, 2008) and "Body Outlaws" (Seal Press, 2004). She is a member of the Advisory Board of Real Change and senior editor at In These Times. Talvi appeared Feb. 14 with former Seattle police chief Norm Stamper for a Real Change reading and discussion on the criminal justice system.