Prison nets two cases, plenty of bad press
Prison nets two cases, plenty of bad press
Union, TB experts say problem is solved now
A recent hullabaloo at a Pennsylvania prison shows why facilities that contract to take detainees picked up by immigration authorities need to stay on their toes, labor leaders and TB experts say. The episode at York County State Prison started last spring. A Russian picked up by the the Immigration and Naturalization Service (INS) was taken to an INS processing center in New York City, says Bill Barry, MD, state TB controller for Pennsylvania.
There, the man told health care workers he had no history or symptoms of TB. He was shipped out to York County Prison, where he showed up without any medical records, Barry says. At the prison, he was placed with some 30 other prisoners in a "pre-classification" cell, a room that measures about 40 by 80 feet and has a new ventilation system, says Kevin Cicak, president of the local teamsters’ union, which represents prison guards.
In between rounds of coughing, the Russian began telling everyone around him that he’d been treated in the past for TB, says Barry. Within 24 hours, he’d been placed in respiratory isolation on four-drug therapy.
Concern builds
The news spread among the guards that the detainee might have multidrug-resistant TB. Barry and prison authorities say they must protect the detainee’s confidentiality, and won’t talk about his culture results. The union "red flagged" the episode, says Cicak, and started asking about prison medical procedures. They were told "there was no problem," Cicak adds.
A second INS detainee, this one from Mexico, arrived at the prison in August, again without medical records, Cicak says. This time, INS officials say, a radiologist at the INS processing center misread the man’s chest X-ray, saying it was normal.
Although prison health care authorities say the man was smear-negative when he arrived, they found his chest X-ray to be suspicious. He, too, turned out to have TB. Again, guards began hearing that the man’s isolate was drug-resistant.
By this time, the union had taken its case to the local newspapers, says Cicak. Banner headlines began appearing. Barry remembers one in particular that screamed, "Guards, prisoners will carry incurable TB into the community!"
In an attempt to calm things down, Barry says he held three informational sessions at the prison, but only a handful of guards showed up. Of the 300 guards who work at the prison, 160 had tuberculin skin tests placed and read, and 16 reacted positively, says Cicak.
Because there were no baseline skin tests available, it was hard to know what to make of the reactions, says Barry. In any event, four guards have decided to take preventive therapy, Cicak says.
Meanwhile, the local papers kept up the pressure and continued the volley of inaccurate information, says Barry. Finally, prison and TB controllers both stopped talking to the local papers.
As Cicak sees it, the trouble at York was that the INS detainees, who sometimes arrive two and three bus loads at a time, probably showed up many times without proper medical paperwork. After the decision was made to let them in, "it was out of sight, out of mind," he adds.
Barry disagrees. The slip-ups were probably isolated instances, the kind that are bound to occur when so many inmates come from high-prevalence countries. "Occasionally, you’re going to get someone with TB," he says, but if the problem were as bad as Cicak fears, it would show up in morbidity rates for the county, Barry adds.
Yet last year there were only five TB cases in the county, including the prison, he adds. That equals a case rate of 1.3 per 100,000, about a third lower than the Healthy People 2000 objective.
Making sure there’s no repeat
Still, Barry says he’s working to make sure there are no repeats of such episodes. "We’re talking with the INS to make sure that people who come here arrive with the proper paperwork," he says. "If they’re suspected of having TB, they ought to be isolated and started on treatment instead of being shipped somewhere else."
Cicak says he’s content that, for now, the problem of prisoners being admitted without proper medical paperwork has been resolved.
"We’ve got written procedures in place now that everyone understands, rather than having everything compartmentalized," he says. "If there’s a problem at the front end coming in the door, paperwork is generated, so other people have to check to make sure there’s the right follow-up."
The guards have agreed to get regular PPD testing, too, both men say.
One thing worries Cicak, he adds — whether the four negative airflow cells the prison maintains are enough.
"For this size facility and the number of at-risk inmates we handle, I’m just not sure that’s sufficient," he says. But when he asks about guidelines, it seems there are none, at least none that fit a prison system stuffed with foreign-born detainees, he says.
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