The day after a federal receiver ordered two state prisons to exclude inmates especially vulnerable to valley fever, experts hailed the directive as a step toward addressing an alarming public health problem.
Meanwhile, the state grappled with how to digest the directive.
"We still need to evaluate the receiver's authority to make decisions about where people are held," said Jeffrey Callison, spokesman for the California Department of Corrections and Rehabilitation.
"Obviously the receiver has full authority from the court over the provision of health care, and CDCR has provision over custody issues -- in other words, where people are held. This obviously is an issue that might be in between that needs to be resolved."
In his directive, medical receiver J. Clark Kelso ordered that inmates who are at high risk of contracting valley fever and more likely to die from the disease should be expelled from Pleasant Valley State Prison near Coalinga and Avenal State Prison in Kings County. The goal of the policy is to reduce the risks of the disease to a "reasonable level," according to an email detailing the new policy.
The order includes African Americans, Filipinos, inmates older than 55 and inmates with HIV or suppressed immune systems. It applies to about 40 percent of approximately 8,200 inmates at the two prisons, according to Joyce Hayhoe, director of legislation and communications for the receiver's office.
Relocating thousands of prisoners would be a massive endeavor complicated by factors such as inmates' security levels, and medical, mental health and rehabilitation needs, Callison said.
The receiver's office did not give a timeline for moving the inmates out of the two prisons but the order is effective immediately, Hayhoe said.
"We would like to work with the department as closely as we can to get this accomplished, and we are looking forward to their cooperation," she said.
Hayhoe said the receiver has been following the valley fever issue in prisons since 2006. CDCR has tried to mitigate the disease but the situation came to a head last spring when a study showed that the efforts were ineffective, Hayhoe said.
The 2012 study by the receiver's office, which is also known as California Correctional Health Care Services, found that valley fever rates were 1,001 times higher at Pleasant Valley State Prison than the statewide rate. Valley fever rates were 189 times higher at Avenal and 114 times higher at Wasco State Prison.
More than two-thirds of the 27 inmates who died of valley fever between 2006 and 2010 were black.
Since 2006, there have been 40 inmate deaths statewide in which valley fever was the primary or secondary cause, Hayhoe said.
"Because it's a public health issue, we needed to take the additional step now of putting it in our policy and establishing it as a directive," she said.
Donald Specter, executive director of the Prison Law Office in Berkeley, called the receiver's directive a "significant interim measure."
The receiver has also instructed the prison system to request the help of the Centers for Disease Control and Prevention, and the National Institute of Occupational Safety and Health, to conduct an epidemiologic evaluation of the valley fever cases at Avenal and Pleasant Valley, he said. This data could help determine the next steps, Specter said.
"We are interested to hear those results," he said. "They will tell us whether there are any ways the risk can be mitigated and if not, closing the prisons might be the only alternative."
Jason Feldman, a Venice-based lawyer who helped a former Taft Correctional Institution inmate who acquired valley fever reach a settlement with the federal government, said that short of closing the prisons, the health care directive is a move in the right direction.
"We'd like to see this go even further; this focuses on the two prisons that have the largest problem, but there are several other prisons and institutions in the San Joaquin Valley that could use a directive like this, or similar to this," Feldman said.
The risk of contracting serious valley fever may not be as high for the inmates not encompassed in the order, but the threat remains, Specter said. People who have never been exposed to valley fever are more likely to get the disease if they move to an endemic area, said Dr. Michael MacLean, Kings County health officer.
"If I were a prisoner who grew up in Los Angeles and was moved to Pleasant Valley or Avenal, I would be concerned," Specter said.
Whether the prisons are safe for any inmates to live in is "presumably a policy decision," MacLean said.
"If you're sent to prison for car theft, you're suppose to do your time and everything. You're not suppose to die" because of where you are incarcerated, he said.
Even if inmates at high-risk for valley fever are transferred out of Avenal and Pleasant Valley, Callison said the state would continue efforts intended to reduce valley fever in the prisons.
"Anyone, in theory, can get valley fever," he said. "Even if we were to move all of these thousands of inmates out of the prisons immediately, we still would have inmates and staff and visitors in these prisons, where we still have a vested interest in mitigating, and hopefully stamping out, valley fever."
The Reporting on Health Collaborative involves The Californian, the Merced Sun-Star, Radio Bilingue 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 ReportingonHealth.org. It's an initiative of The California Endowment Health Journalism Fellowships at the University of Southern California's Annenberg School for Communica tion and Journalism.