From the Editor - Prison Legal News

April 2008
Drug-Resistant Staph Infection (MRSA) Deaths Nationwide
Now Exceed Those From AIDS; Prison Connection Ignored
The Journal of the American
Medical Association (JAMA)
reported that nationwide, more deaths in
the United States are now resulting from
drug resistant invasive MRSA (methicillin
resistant staphylococcus aureus) skin
infections than from AIDS. Overall, an
estimated 90,000 invasive MRSA infections
occur annually nationally — a rate
of 32 per 100,000 people. The October
2007 JAMA report called this rate “astounding.”
While many staph cases are
simply mild skin infections, the invasive
ones studied here are life-threatening,
entering the bloodstream or destroying
flesh.
PLN has reported extensively on
MRSA infections in prisons and jails
(see: PLN, Aug. 2007, p.1). Indeed, the
greatest liability (58.4%) turns out to be
for patients in community care settings, a
category that includes nursing homes and
correctional settings. Infections acquired
in a hospital, often incidental to elective
surgeries, account for 26.6 %. Another
13.7% arise in “community-associated”
functions (this category includes schools
and sports teams), while the remaining
1.3% were unclassified. There was also a
strong correlation with age (3 times more
prevalent in those over 65) and race (2
times more prevalent in blacks), while
gender was not a factor.
The JAMA study surveyed data from
nine urban regions around the country,
and analyzed 5,287 reported invasive
cases. 90% were in the form of bloodstream
infections, while the remaining
10% were flesh-eating disease. Among the
5,287 infections, there were 988 deaths.
Thus, even with hospitalization and the
latest antibiotics, one’s chances of dying
from invasive MRSA approaches a staggering
20%.
As a result, hospitals have taken
drastic preventive steps. Obvious was
the need for yet improved hygiene
procedures by hospital staff, including
improved hand-washing. Many hospitals
have also recognized that many
patients serendipitously harbor the
MRSA organisms already when they
arrive, and to the extent possible, they
isolate them until they are first screened
of MRSA. It is also known that about
by John R. Dannenberg
5% of all U.S. hospital and nursing
home patients suffer from mild MRSA
skin infections, which, if they were to
invade an open wound or enter the
body through invasive medical equipment
(e.g., dialysis shunts, catheters, or
intravenous tubing), could develop into
systemic infections.
The JAMA report concluded that
invasive MRSA infections disproportionately
affect patients in health care
settings, but are no longer confined to
hospital intensive-care units. Since prisons
and jails present many of the same
cross-infection attributes of health care
centers and nursing homes (e.g., common
socialization areas, dining rooms, and air
handling systems), they plainly remain
major sources of potential outbreaks. Dr.
Federal Healthcare Receiver Investigates
Out-of-State Deaths of Transferred California
Prisoners, but Does His Authority Follow Them?
The federal court-appointed Receiver
for California’s prison healthcare
system is investigating the deaths of four
prisoners who were transferred to outof-state
facilities, but stopped short of
declaring the deaths suspicious or negligent.
His concern is heightened because the
California Department of Corrections and
Rehabilitation (CDCR) is presently engaged
in selectively shipping 8,500 foreign national
prisoners to privately-run facilities around
the country in order to meet federal court
demands to reduce the state’s overcrowded
prison system.
Court-appointed Receiver Robert
Sillen, who has since been replaced, spoke
at the Sacramento Press Club in July 2007
and called three of the four out-of-state
prisoner deaths “not quite natural.” He
said his staff was reviewing the prisoners’
medical files to determine if their
deaths were preventable. The prisoners
died in Nevada, Arizona, Tennessee and
an undisclosed location under the federal
witness protection program.
However, it is not clear whether
prisoners transferred out-of-state due to
38
by John E. Dannenberg
Buddy Creech, a Vanderbilt University
infectious disease specialist, called the
spread of drug-resistant MRSA “epidemic”
and hopes the new JAMA report
will spur development of a “holy grail”
MRSA vaccine.
Sadly, this report barely even mentions
the MRSA epidemic sweeping
prisons and jails around the country and
the spread of the disease from these facilities
into the community, as PLN has
extensively reported in the past. Once
again, the public health impact of mass
imprisonment is largely ignored by the
medical establishment.
Sources: Journal of the American Medical
Association, vol. 298, Vol. 15, pp. 1763-
1771 (October 2007).
overcrowding, who are typically housed
at private facilities, are covered under the
protections of the Plata v. Schwarzenegger
prison healthcare receivership. If
they are, that might create a conflicting
two-tier program for healthcare delivery:
the profit-driven substandard care
typical of private prisons and the federal
constitution-dictated standard of care
provided under the Receiver. Recentlyenacted
California Penal Code § 11191(4)
expressly provides that prisoners with
serious physical or mental illnesses may
be excluded from involuntary transfers
if their condition or scheduled medical
treatment qualifies.
But one thing remains certain. The
size of the CDCR’s out-of-state population
will continue to grow as California
attempts to palm off its prison overcrowding
problem on the backs of
foreign-national prisoners. Over 400 of
the planned 8,500 foreign nationals had
already been shipped to other states as of
September 2007.
Sources: Associated Press, www.scpr.org
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