This is the latest in an ongoing series of articles on the valley fever epidemic. Please click here for previous articles in the series.

Kevin Walker arrived at Taft Correctional Institution, a federal prison in western Kern County, in December 1999 to serve a 14-year sentence for attempted possession of cocaine.

But another kind of sentence awaited him, one far more painful than confinement alone.

In July 2001, fluid-leaking boils broke out across Walker’s face and body. Once he was diagnosed with valley fever, doctors administered an antifungal drug — amphotericin B — but the drug was so powerful that it caused his kidneys and liver to begin failing.

He was switched to another antifungal drug — fluconazole — and transferred to a prison in Ft. Worth, Tex. But the disease continued to spread throughout his body, even into his bone marrow. Boils, then holes, developed on his spinal column and clavicle.

“That 14-year sentence turned into a life sentence,” said Walker, who was released from prison in 2010, “because I have this disease for life, and no one has accepted responsibility for putting me in that situation.”

Taxpayers are also paying a price. Californians spend about $23.4 million a year to treat state inmates with valley fever (cocci). And the federal prison system, while admitting no fault, recently agreed to pay $425,000 to another inmate who contracted the disease at Taft Prison.

The California prison system estimates about 200 inmates are hospitalized every year because of valley fever. Most of them are diagnosed with the disease while serving sentences in eight institutions in the San Joaquin Valley, where the airborne fungus that causes valley fever is rampant. That doesn’t include federal inmates at prisons like Taft, which was described in one lawsuit as a “petri dish for valley fever.”

A study by the state prison health system found that the rate of valley fever at Pleasant Valley State Prison in Coalinga was 600 times the rate found outside the prison in Fresno County.

When you add up all the time state inmates spend in the hospital for valley fever, it amounts to an average of 5,000 days, or about 25 days for every inmate. The gruesome details of inmates’ experiences with the fungal disease and its long-term impact on their lives remain largely hidden from the public’s view.

But stories like Walker’s and those of other inmates point to a larger question: Is it fair to incarcerate inmates in an area where they are hundreds of times more likely to contract valley fever?

Because most inmates are trucked in from outside the valley, they have no built-in immunity to the disease, which is the best defense for most valley residents.

“It’s mind-bogglingly egregious,” said Brad Brockmann, executive director of the Center for Prison Health and Human Rights in Providence, R.I. “It’s a human and civil rights outrage that people’s lives could be compromised because by the luck of the draw they end up at Pleasant Valley State Prison. That’s outrageous.”

On top of that, research studies have shown that blacks are far more likely to develop the most serious form of the disease. The prison population has a higher proportion of blacks than whites, and prisoner advocates criticize state and federal agencies for putting black inmates in harm’s way.

More Vulnerable on the Inside

The rates of valley fever in the communities surrounding the prisons in Central California already are high. Someone in Bakersfield, Fresno, Stockton or Merced has a much higher chance of contracting the disease compared with someone in Los Angeles, according to the California Department of Public Health.

But the rates inside the prisons are worse. An April 2012 study found that at Pleasant Valley State Prison, the rate of valley fever was 7,011 cases for every 100,000 people. Most years, fewer than 20 people out of every 100,000 are diagnosed with the disease in states that report cases.

There are several reasons for inmates in the prison system experiencing high rates of valley fever. In addition to the fact that most are brought into the valley from the outside, they also spend lots of time outside in the dusty prison yard, where they could inhale the spores. Many inmates already have weakened immune systems because of AIDS or hepatitis.

“I don’t think I’ll ever be back 100 percent,” said Gregory Edison, who is serving time at Taft for manufacturing drugs. Valley fever, he said, left him with chills; migraine headaches; dry, alligator-like skin; exhaustion; weight loss; and an uncomfortable tightness in his lungs.

“I think that if they are going to give you all this time, they are supposed to take care of you so you can go back to your family,” he said. “You’re not sentenced to death in prison.”

Black Inmates Particularly Vulnerable

Experts also question whether it’s fair to house black inmates like 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 nonblack inmates.

“Although we did not systematically examine risk factors for severe disease and death due to cocci, we did find that African-American inmate men died with cocci as a cause at higher rates than the general inmate population and much higher rates than African-American men in California,” the report concluded.

Kings County health officer Dr. Michael MacLean raised this issue in October during a valley fever town hall meeting in Bakersfield hosted by state Sen. Michael Rubio (D-Shafter).

“African-Americans are disproportionately imprisoned, and African-Americans clearly have a much higher risk of having a complicated, disseminated disease,” MacLean said.

Blacks constitute 29 percent of the state prison population, according to 2012 data from the Public Policy Institute of California, but 6.6 percent of the overall state population, according to 2011 census data.

“I think one of the challenges for California is that we probably should have concern that there is a very significant racial disparity going on with respect to inmates in California and valley fever,” MacLean said.

There are many factors that play into where an inmate is housed, said Terry Thornton, deputy press secretary for the California Department of Corrections and Rehabilitation.

As a policy, she said, “we only move inmates from endemic areas when medical staff identify an inmate is susceptible to valley fever, regardless of ethnicity.”

Are Inmates Doubly Punished?

Experts and inmates alike question whether it’s fair to doubly punish people, once for a crime and again with a disease whose symptoms and related costs could linger long after the prison sentence.

That’s a concern lawyers Ian Wallach and Jason Feldman hear on an almost daily basis. Since they took the case of a former Taft inmate who contracted valley fever and this summer helped him obtain a $425,000 federal settlement, the Venice-based lawyers have received hundreds of letters, phone messages and emails from inmates with valley fever seeking help.

Most of the letters come from prisons in Central California. Some letters are handwritten, a few are typed. Some include medical records as proof, others include newspaper clippings.

All the correspondence contains essentially the same message, Wallach said.

“They’re all scared about future medical expenses and who is going to pay for this when they get out,” he said. “Whether they got it in Avenal, whether they got it in Pleasant Valley, wherever they got it they want money for pain and suffering because they have been hurting.”

He read from one of the letters splayed across a dark wood table: “It’s one thing to pay back society for my crime, but to send me to a prison which could kill me is another thing.”

Messages like that underscore the need for humane imprisonment and compensation for inmates’ future medical costs, Wallach said.

“We took control over their lives; we took control over their liberty,” Wallach said. “We put them there, and if as a result of us doing that they acquire an illness they have to pay for for the rest of their lives, why should that be their burden?”

Some inmates have asked the state to shoulder some of the burden. Between 2008 and 2010, 11 inmates filed claims related to valley fever with the state Victim Compensation and Government Claim Board. The largest claim was for $10 million for general and punitive damages related to valley fever.

They all were rejected.

In general, anyone who wishes to file a lawsuit against the state or its employees for damages must first pursue a remedy through the government claims program, said Anne Gordon, public information officer for the board. The valley fever-related claims were mostly rejected due to their complexity, she said.

“The Government Claims Program rejects many cases as the issues raised are complex and outside the scope of analysis and interpretation typically undertaken by the Board,” she wrote in an email.

“Our three-person Board is not set up like a courtroom where we can hear testimonies, hear from witnesses and examine other evidence,” she wrote. “The courts are the appropriate venue to resolve such claims, and rejection preserves the claimants’ right to pursue these matters in court.”

A Life Sentence

Arjang Panah is one of the many inmates whose health and productivity have been destroyed by his stint in a valley prison.

He contracted valley fever in 2006 while serving a seven-year sentence at Taft for distribution of methamphetamines. Years later, the fungus remains in his body. When he catches a cold, he said, it turns into bronchitis or pneumonia, and “my recovery period is five times as long as anyone else’s.”

“On a daily basis, I have to take into consideration my disease, whether it’s prevention of catching a cold or getting sick or whether it is to deal with the symptoms of the illness, once I have caught a cold,” he said.

That affects his ability to work. Panah earned a master’s degree in business administration while in prison, earned his Ph.D. in business administration after his release and now works as an account executive selling jet fuel. But he’s often too sick to work.

“The disease causes me not to be my best about 50 percent of the time,” he said. A lingering cough racked his body as he spoke over the telephone.

California taxpayers contribute about $23.4 million annually to the state prison system’s bill for treating valley fever in state prisons. But the costs of supporting inmates sickened by valley fever after they are released from prison are less evident.

With the help of Wallach and Feldman, Panah received a settlement from the federal government to cover the lifelong costs of treatment for his disease.

“If they offered me three times that amount — if they said, ‘You can have three times that amount or not have this disease’ — I’d choose not having the disease,” Panah said. “It is an extremely unfortunate thing that happened to me.”

Walker can afford his medicine and medical care only because of government aid. The disease has left him debilitated and unable to work. He has qualified for federal supplemental security income and in-home supportive services since he was released from prison in 2010.

Even with that support, some days are rough. The fungus has overtaken his joints, causing him pain when it’s cold or rainy. Sometimes the disease and the powerful medicines sap his energy.

Others would have succumbed to the disease by now, he said, but “fighting is just part of my blood stream, so giving up isn’t an option.”

This project results from a new venture — the Reporting on Health Collaborative — which involves the Bakersfield Californian, the Merced Sun-Star, Radio Bilingüe in Fresno, The Record in Stockton, Valley Public Radio in Fresno and Bakersfield, Vida en el Valle in Fresno, the Voice of OC in Santa Ana, and The collaborative is an initiative of The California Endowment Health Journalism Fellowships at the University of Southern California’s Annenberg School for Communication and Journalism.

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