Contagion in the Jail

Inmates, their families, and even elected officials wonder if the county health department is taking the presence of flesh-eating disease seriously enough.

County jail and health officials insist their aging 1,700-bed downtown King County Correctional Facility is safe, and they're doing their best to keep it disease-free. But two superbugs have been discovered at the jail in the past 23 months, one of them continuously sweeping the population—and both combining to cause an inmate's death. That's led anxious inmates, family members, and county and city council members to suspect the jail's health safeguards are insufficient. King County Council member David Irons considers the situation serious enough to call it "a new public health threat" for those inside and outside the facility.

The diseases are necrotizing fasciitis, better known as flesh-eating disease, and methicillin-resistant Staphylococcus aureus, a bacterial infection commonly called MRSA. They led to the 2004 death of a drug user serving a short sentence for theft. (See "A Jail Shakedown," Nov. 2.) The deceased inmate's family blames his death in part on the jail's negligence. It turns out that a girlfriend of that inmate, who was serving a similar sentence at the same time at the jail, died from flesh-eating disease a month later, shortly after her release. Their similar causes of death have not been previously reported. Jail officials do not see a link between the jail and the two deaths, but they never substantially investigated either case.

The spread of MRSA, in particular, has some officials alarmed. "An untreated infection of MRSA can cause swelling, boils, blisters, fever, pneumonia, bloodstream infections, and eventually loss of limbs and even death," says Irons, a six-year member of the county Board of Health. Because MRSA has quietly plagued the jail for several years, he says, he also worries that over time it "is disproportionately affecting low- income and minority members of our community" who are jailed and might later carry the bug outside.

Like flesh-eating disease, MRSA is a superbug, resistant to traditional antibiotics, that can cause severe reactions, usually after a strain of bacteria enters the body though an opening or break in the skin. MRSA is a virulent staph infection that thrives in close populations such as jails, prisons, and medical facilities. To varying degrees, it has sickened hundreds of King County jail staff and inmates in recent years, officials say. In the Allegheny County Jail in Pittsburgh, Pa., this year, two female inmates died from MRSA after catching the flu, authorities there said. As was the case in the death of the male King County inmate, MRSA and flesh-eating disease also work together. According to a study reported in the New England Journal of Medicine this year, 14 recent Los Angeles cases of necrotizing fasciitis were traced to MRSA bacteria, indicating a troubling pairing of the two superbugs.

Flesh-eating disease is not itself considered contagious, although the bacteria that cause it can be transferred by casual contact, experts say. The danger comes when it enters the body through a wound or needle puncture, for example. If not detected early, the disease can rapidly lead to toxic shock, amputations, and death, as it did in the case of the two King County inmates.

Seattle City Council member Tom Rasmussen says he's trying to learn more about jail health conditions and is awaiting a report from Public Health– Seattle & King County, which provides jail health services. Rasmussen recently met privately with a jail staffer who expressed "significant concerns" about the facility's medical services, Rasmussen says. Nurses and corrections officers say the jail is understaffed, lacks an efficient medical record-keeping system, and puts inmates at risk unnecessarily. County Council member Irons has also asked the health department for more information on jail conditions. In particular, he "immediately" wants a written update on what response the department is taking to combat MRSA. He says he worries about the likelihood of the general public being infected and, in a letter to health officials Nov. 16, warned, "This disregard for the health and safety of our own [jail] staff as well as the citizens in our custody could become a serious liability for King County." Several inmates have already filed lawsuits.

KING-TV recently reported that MRSA has been a growing concern, but the jail and the health department have been slow to control bacterial spread and impose stricter sanitary precautions. KING cited a 2003 jail supervisor's memo that stated he was "extremely concerned about our lack of policies and procedures" in handling MRSA. Last year, a jail-health doctor cited a "lack of consistency in our management of MRSA."

The health department says MRSA is under control in the jail and thinks the flesh-eating deaths were rarities and not necessarily caused or abetted by incarceration or lack of treatment. "Necrotizing fasciitis is not a reportable condition, and we do not specifically track the condition in the jail," says health department spokesperson James Apa. "However, we believe it to be exceedingly rare in the community, and we are not immediately aware of any additional cases in the jail with either staff or inmates within the past two years."

According to police, jail, court, and medical examiner records, the two county jail inmates died of diseases in January and February 2004. Patrick A. Harrington Jr., 40, a SeaTac mechanic who was arrested for shoplifting meat from a West Seattle Safeway, complained of shortness of breath on Jan. 24, a few days after his 20-day jailing for theft. Harrington had an infected left arm and died the next day at Harborview Medical Center. An autopsy determined the cause was flesh-eating disease and MRSA, linked to chronic injection drug abuse. His family questions in part those findings and the jail's actions, claiming officials negligently ignored Harrington's request for medical attention. They claim he had not used a needle in 10 days and had no open wound when jailed. According to jail and hospital documents, his wound spread to 10 inches and was leaking for two days before he was aided, the family says.

Then Harrington's girlfriend died. Laura J. Serrano, 41, of Seattle, who also was arrested for the shoplifting, was released from jail for a day on Feb. 2 to attend Harrington's funeral. Mourners were told they couldn't touch the body, a family member says, for fear of picking up the bacteria. Serrano returned to her cell and completed her sentence on Feb. 12. Within a week, she was ailing and wound up at Harborview, where she died early Feb. 24. Besides the disease, needle-use was also a factor in her death, says the medical examiner. It is unclear if jail officials, who were aware of Harrington's death, knew a second inmate had died of the same disease. A jail spokesperson referred questions to the health department.

"We are vigilant for necrotizing fasciitis at King County Jail, given the high number of injection drug users booked into the facility," says the health department's Dr. Benjamin Sanders, the jail's health director. But, "Merely being in the same cell with an inmate patient who is later diagnosed with necrotizing fasciitis is not a risk factor for the condition." If two people share a needle, they obviously increase their risks, he notes. And for the disease to take hold, "there is nearly always some direct insertion of the bacteria deep into body tissues," Sanders says.

The National Necrotizing Fasciitis Foundation, however, emphasizes that chances for infection are more general— it takes only a pinprick. The disease is also known to be spontaneous. In medical literature, the foundation says, "We can personally tell you about people who developed NF after a C-section, after abdominal surgery, after scratching a rash, after giving birth vaginally, from a tiny scratch, after bumping a leg with a golf bag, after a friendly punch in the arm from a buddy, after a little cut on the finger, after a cut on the foot, after a rug burn, after having a routine blood draw in a physical exam, after a broken arm, and after a broken leg, and from no known trauma at all." Adds the foundation: "Let it be said that there is no sure prevention."

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