Treat the Epidemic Behind Bars Before It Hits the Streets

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http://www.nytimes.com/2004/06/22/opinion/22TUE4.html?th

 

June 22, 2004EDITORIAL OBSERVER Treat the Epidemic Behind Bars Before It Hits

the StreetsBy BRENT STAPLES

 

The murder of 20-year-old Raul Tinajero at the Los Angeles County Jail in April

focused national attention on the violence that dominates much of the American

correctional system. Mr. Tinajero had testified for the prosecution at a murder

trial and had been guaranteed special protection that never materialized. The

inmate against whom he testified roamed the jail for hours on a forged pass, the

authorities say, until he entered Mr. Tinajero's cell and strangled him in front

of his cellmates.

 

This marked the fifth murder of an inmate at the Los Angeles County Jail in

seven months. Battered by public criticism, the jail opened its doors to

reporters, who could see right away that violence was far from the only hazard

associated with life behind bars. The Times's Charlie LeDuff reported that the

jail commonly housed as many as six prisoners in a single cell, which meant two

slept on floors wet with toilet seepage.

 

A staph infection was raging through the cellblocks, and inmates crowded at the

bars to show their lesions. These infections are especially dangerous to people

with compromised immune systems, a category that includes many prisoners. The

Centers for Disease Control and Prevention has cited the Los Angeles County Jail

for an outbreak of drug-resistant strains of staph, which are especially

aggressive and difficult to treat.

 

Staph can be partly contained by giving inmates access to soap and hot water and

making sure that the laundry is thoroughly washed and dried. But jails that

cannot organize themselves well enough to provide clean sheets stand little

chance of success against the heavyweight infectious diseases that have become

endemic behind bars today. Among them are H.I.V., tuberculosis and hepatitis C.

Complications from hepatitis kill 25,000 people each year.

 

The diseases that incubate behind bars don't just stay there. They come rushing

back to the general population — and to the overburdened public health system —

with the nearly 12 million inmates who are released each year.

 

Some states have responded to the danger of prison epidemics by gearing up to

test, treat and counsel inmates. But most of the system is not so forward

looking. Faced with tight budgets, many jails and prisons have backed away from

testing inmates for fear that they will be required to pay for treatment.

 

This approach was shown to be penny wise but pound foolish when the country

experienced an epidemic of drug-resistant tuberculosis — driven mainly by former

prison inmates — during the 1990's. Though expensive, testing and treatment for

TB cases behind bars are more efficient and cost-effective than mounting a

full-scale assault on the disease once it hits the streets. A similar pattern

has emerged with AIDS as infected inmates leave prison and infect people

outside, who then turn to the public health system.

 

The prison health problem registered in Congress, which in 1997 held hearings

and instructed the Justice Department to perform the country's first nationwide

study of the health environment of jails and prisons. The study, a

groundbreaking work entitled " The Health Status of Soon-to-Be-Released Inmates, "

was completed in 2000.

 

Critics of the government say that the report was shelved for two years before

being made public — without the imprimatur of the Justice Department, which had

worked on the project. Once released, the study sank so swiftly from view that

even members of Congress seemed unaware that it existed.

 

" The Health Status of Soon-to-Be-Released Inmates " is available on the Web site

of the National Commission on Correctional Health Care, which worked with the

government on the project. It offers a sobering view of the corrections system,

which has clearly become a major conduit for infectious disease. The rate of

transmission for sexually transmittable disease behind bars is roughly 10 times

that in the world outside. In any given year, 17 percent of people with AIDS, 35

percent of people with tuberculosis and nearly a third of those with hepatitis C

pass through the corrections system.

 

This system represents a gaping hole in the public health network, thanks in

part to the fact that prisoners become ineligible for Medicaid assistance while

they're behind bars. Inmates who have the misfortune of being housed in jails

and prisons without serious medical programs often have no choice but to cease

treatment, which means that they get sicker and continue to pose an infection

risk to others. Once released, these same inmates spend months trying to

re-enroll in the Medicaid program and get care.

 

The United States would experience less infectious disease — which means fewer

deaths and less strain on the health system — if the public health apparatus

were fully extended into the jails and prisons. The health status report argues

convincingly for a rigorous program of testing, treating and counseling that

would slow the spread of disease and alert inmates to illnesses before they

reached the crisis stage and became prohibitively expensive to handle.

 

These ideas are perfectly consistent with what we know about the importance of

preventive medicine. But applying them to prison inmates will be difficult until

we begin to see them not as outcasts who deserve to be cut off from the public

largess, but as fellow citizens with whom we will eventually share a common

fate.

 

Copyright 2004 The New York Times Company