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Thanks to all those who've taken the time to read and respond to the diary. It's clear that my friend is in the wrong on some details (though I don't doubt the truth of her experiences at all) and has been mislead on reporting requirements, somewhere along the line. Commenters have taken the time to correct those mistakes, and in the interest of not providing inaccurate information, I must point to the additional info offered in the commentary by those with far more knowledge (and know how on where to find it) on the regulations and requirements for reporting of infectious diseases withiin prison. They are required to report it to the state. Part of this also  meshes well with her statement on local tracking, as well as how prisons can get around this. The original diary is below.

"What do you mean they don't have to report it?"

That was my response to my friend, who had just returned from quarantine after treating an outbreak of tuberculosis at a private prison in her home state of Texas. She then proceeded to tell me that they do not, in fact, have to report it at all to the CDC. Or anyone, really, for that matter. Outbreaks of infectious diseases in prisons are common, but unlike their publically run counterparts, have no obligtation or regulations in place to require them to report them, she told me.

     My friend, who I'm going to leave nameless, is a health care professional and trained respiratory therapist. Recently, she vanished from our shared online space  and, when she returned, she informed me she had been called to treat an outbreak of TB at a local, privately owned and operated prison. What she told me left flabbergasted and astounded.  All I can offer is her perspective, here, and hope it's illuminating. I have asked her to state in her own words her experience with the private prison system.

     Tuberculosis, a disease most people see as a third world disease, highly deadly, and difficult to treat.... We put patients in negative pressure rooms where the air is circulated separately because hospitals know how easy it is to transmit. Frequently, they're placed in full droplet isolation as well. Head to toe personal protective equipment (PPE). And prisons aren't required to report it to the CDC, so we have NO idea how much higher than average for a local population center such infectious diseases occur. Noone is tracking it. All I know is that this stuff breeds easy in conditions like that. US prisons are IDEAL breeding grounds for diseases like tuberculosis, in fact. And because they take a hit to their 'reputation' and chance for state money if prisoner health suffers due to poor healthcare... They choose not to report it. Why would they when they don't have to? Successful treatment of this crap can take over a year, for crying out loud, and can leave long term damage. Here's the thing... People have done studies on this... Hell, even the government has.... Numbers suggest the rate of TB is higher by as much as a hundred times in prison than the local population's average. But since prisons aren't required to report it... Local populations? Basically at the mercy of chance.  And do you know why this is especially heinous for prison populations?: AIDs. Tuberculosis is one of the number one killers of HIV infected patients. Consider this also... How EXTREMELY mobile prisoners are. Transfers between facilities, contact with visitors, lawyers, staff, etc.. Any tracking of the disease in correctional facilities is done entirely at the state level.
She then went on to add the following:
You know the number one way they get around reporting rates of Tuberculosis infection in places that require it? They ship them to a fucking hospital instead of testing/diagnosing for it. That way, the patient had TB while he was in the hospital. Not the infirmary. Which screws up TWO sets of numbers. Suddenly, the local population's TB rate suffers a 'spike'. Prison remains clean. But they don't do that just for TB, you see.  The only way they get treated in a prison... Is if there are too many to fucking move. One or two TB patients can be treated. Five, or six? You cohort them. Even ten is usually enough to overwhelm a single well-staffed, well-supplied hospital.
   She also reccomended the following link, though it isn't specific to the US: http://www.ncbi.nlm.nih.gov/...

    I believe my friend and trust her, but this is almost impossible to believe, even though I know it's perfectly believable. They don't have to report infectious diseases? They can just decide not to? I felt it the sort of thing that really ought to go on a DK diary because, well... this matters. A lot. She's right. People need to know this so that something can be done about this.

    Meanwhile, I am left sitting here, bewildered, and saying: What the fuck?

4:40 AM PT: Wow. Er. Recc list. Can't say I was expecting that. I also want to point to Denise Oliver Velez's enlightening comment below about the CDC guidelines.

4:57 AM PT: It's been pointed a few times now that regulations do require them to report it to the stat.. It looks more and more that they are not not required to report it, but gaming the statistics so as to maintain the prison's 'clean' reputation. Next time I talk to my friend, I'll be sure to pass along the reccomendation that she in fact contact the CDC. As I said, I can only go off what she's told me, and I'm feeling a bit less alarmed than I was. Thus, I apologize for the alarmist tone of the diary. Thanks to MaryKK as well.


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Comment Preferences

  •  Also (6+ / 0-)
    Recommended by:
    sb, Matt Z, uciguy30, commonmass, marykk, Smoh

    This is only my second diary ever. Any suggestions for cleanup/improvement are welcome.

  •  That's right. (8+ / 0-)

    Private prison's rely more on government services than state run prisons ever have.

  •  Hep C is a big one that (7+ / 0-)

    inmates get too.  So is PTSD.  Ins or outs, we're not really safe and we're not really free.

  •  And another reason... (4+ / 0-)
    Recommended by:
    uciguy30, commonmass, cuphalffull, kurt

    as I have mentioned in other diary comments, Federal Prison Industries has priority, by law, over people with disabilities for federal contracts.  Yes, it's true - the non-profit agency that I work for can spend months ( or even years) developing an opportunity to manufacture an item that is purchased by the Federal government, and FPI can swoop in at the last minute and take it away from us.  They have better (more money) lobbyists.

    So, they are a danger to our health and our employment.  

    "I'll be more enthusiastic about encouraging thinking outside the box when there's evidence of any thinking going on inside it." Terry Pratchett

    by kiwiheart on Wed Jul 04, 2012 at 04:28:29 AM PDT

  •  Once again, profit rules. (6+ / 0-)

    Business hates cost. ANY cost. EVERY penny spent is a cost. Cost bad.

    Disregard the amoral reduction of people to objects, and remember that they are simply profit centers. They are considered individually, to better recognize cost, when there is any exception to any expectation of minimal cost. Because cost bad.

    The only possible surprise here is that business might have called in outside help to benefit a person. Oops... profit center. No point in investing in capacity, even for a profit center, in advance of a disallowed cost; just recognize possible cost and minimize it as necessary. Excess staff is, obviously, a cost that can only be tolerated until the problem can be shifted to some other payer. Problem solved.

    The furnace of Affliction produces Refinement, in States as well as Individuals. John Adams, 1776.

    by semiAdult on Wed Jul 04, 2012 at 04:28:31 AM PDT

  •  "Out of sight is out of mind" (2+ / 0-)
    Recommended by:
    commonmass, old wobbly

    Let's also recall that American carceral philosophy has taken an informal but real turn from rehabilitation to punishment. If you ask voters why a person goes to prison, the answer will be "punishment."

    Since prison -- a holding cell -- has become the punishment instead of a waiting place, since it has ceased to be justified by the chance of treatment or aid or instruction, the public's representatives believe in making the experience as punitive as possible. Therefore, disease is a thing they will blame on the prisoners (or the "illegal aliens") and embrace as part of the punishment.

    Private prisons make no sense at all, if we thinking of treatment/rehabilitation, except as the old days of genteel little segregated castles. They make sense as punishment and blinding the public to its duty and the prisoners' humanity.

    Every reductio ad absurdum will seem like a good idea to some fool or another.

    by The Geogre on Wed Jul 04, 2012 at 04:34:54 AM PDT

  •  what was helpful in NY to push for better (12+ / 0-)

    healthcare for inmates was the outcry from corrections officers.  They breathe the same air.  They are at risk.

    CDC guidelines

    http://www.cdc.gov/...

    Case Reporting

    All states require designated health-care professionals to report suspected and confirmed cases of TB to their local or state health department; this reporting is mandatory for all correctional facilities, whether private, federal, state, or local. Correctional facility medical staff should report any suspected or confirmed TB cases among inmates or employees to the appropriate health agency in accordance with state and local laws and regulations, even if the inmate or detainee has already been released or transferred from the facility. Reporting cases to health departments benefits the correctional facility by allowing it to obtain health department resources for case management and contact investigation in both the facility and the community. For each suspected case of TB, the diagnosis or the exclusion of a diagnosis of TB should be entered immediately into 1) the person's medical record, 2) the retrievable aggregate TB-control database at the facility, and 3) the database at a centralized office if the system has multiple facilities. In addition, drug-susceptibility results should be sent to the state or local health department for use in monitoring the rates of drug resistance in the health department's jurisdiction. Drug-susceptibility reports also should be sent to all health departments managing the infectious person's contacts because the choice of medication for LTBI treatment is based on these drug-susceptibility test results (64). Reports to local or state health departments should identify the agency that has custodial responsibility for the inmate (e.g., county corrections agency, state corrections agency, ICE, Federal Bureau of Prisons [FBOP], and U.S. Marshals Service [USMS]) and the corresponding identification number for that agency (e.g., U.S. alien number, FBOP number, or USMS number). Federal law enforcement agencies frequently contract for bed space with local or private detention facilities. Therefore, custodial authority and corresponding custody identification numbers should be verified with the facility's custody staff; detention facility medical staff might not have this information available.

    If it is true that this facility is not reporting - suggest she contacts ACLU re lawsuit and tips CDC.

    "If you're in a coalition and you're comfortable, you know it's not a broad enough coalition" Bernice Johnson Reagon

    by Denise Oliver Velez on Wed Jul 04, 2012 at 04:35:25 AM PDT

  •  Reportable diseases in TX (4+ / 0-)

    If you think you're too small to be effective, you've never been in the dark with a mosquito.

    by marykk on Wed Jul 04, 2012 at 04:46:15 AM PDT

    •  More info, always good. (3+ / 0-)
      Recommended by:
      commonmass, marykk, leonard145b

      Thank you. :)

    •  TB is most certainly reportable in TX (5+ / 0-)
      HEALTH AND SAFETY CODE
      TITLE 2. HEALTH
      SUBTITLE D. PREVENTION, CONTROL, AND REPORTS OF DISEASES
      CHAPTER 89. SCREENING AND TREATMENT FOR TUBERCULOSIS IN JAILS AND OTHER CORRECTIONAL FACILITIES

      SUBCHAPTER A. GENERAL PROVISIONS

      Sec. 89.001.  DEFINITIONS.  In this chapter:
      (1)  "Community corrections facility" means a facility established under Chapter 509, Government Code.
      (2)  "County jail" means a facility operated by or for a county for the confinement of persons accused or convicted of an offense and includes:
      (A)  a facility operated by or for a county for the confinement of persons accused or convicted of an offense;
      (B)  a county jail or a correctional facility authorized by Subchapter F, Chapter 351, Local Government Code;  and
      (C)  a county correctional center authorized by Subchapter H, Chapter 351, Local Government Code.
      (3)  "Governing body" means:
      (A)  the commissioners court of a county, for a county jail;
      (B)  the district judges governing a community corrections facility, for a community corrections facility;
      (C)  the governing body of a municipality, for a jail operated by or under contract to a municipality;  or
      (D)  the community supervision and corrections department, for a jail operated under contract to a community supervision and corrections department.
      (4)  "Health authority" has the meaning assigned by Section 121.021.
      (5)  "Jail" means:
      (A)  a county jail;  or
      (B)  a facility for the confinement of persons accused of an offense that is:
      (i)  operated by a municipality or a vendor under contract with a municipality under Subchapter E, Chapter 351, Local Government Code;   or
      (ii)  operated by a vendor under contract with a community supervision and corrections department under Chapter 76, Government Code.
      (6)  "Local health department" means a health department created under Subchapter D, Chapter 121.
      (7)  "Physician" means a person licensed to practice medicine in a state of the United States.
      (8)  "Public health district" means a health district established under Subchapter E, Chapter 121.
      (9)  "Screening test" means a rapid analytical laboratory or other procedure to determine the need for further diagnostic evaluation.
      (10)  "Tuberculosis" means a disease caused by Mycobacterium tuberculosis or other members of the Mycobacterium tuberculosis complex.
      Added by Acts 1993, 73rd Leg., ch. 786, Sec. 1, eff. Sept. 1, 1993.  Amended by Acts 1995, 74th Leg., ch. 76, Sec. 7.07, eff. Sept. 1, 1995;  Acts 1997, 75th Leg., ch. 348, Sec. 1, eff. Sept. 1, 1997.

      Sec. 89.002.  SCOPE OF CHAPTER.  Except as provided by Subchapter E, this chapter applies only to a jail that:
      (1)  has a capacity of at least 100 beds;  or
      (2)  houses inmates:
      (A)  transferred from a county that has a jail that has a capacity of at least 100 beds;  or
      (B)  from another state.
      Added by Acts 1997, 75th Leg., ch. 348, Sec. 2, eff. Sept. 1, 1997.

      SUBCHAPTER B. SCREENING OF JAIL EMPLOYEES AND VOLUNTEERS

      Sec. 89.011.  SCREENING OF JAIL EMPLOYEES AND VOLUNTEERS.  (a)  The governing body of a jail or community corrections facility, through the community supervision and corrections department, shall require that each employee or volunteer working or providing services in a jail or a community corrections facility, who meets the screening guidelines prescribed by board rule, present to the governing body a certificate signed by a physician that states that:
      (1)  the employee or volunteer has been tested for tuberculosis infection in accordance with board rules;  and
      (2)  the results of the test indicate that the person does not have tuberculosis.
      (b)  In lieu of a screening test, an employee or volunteer with a history of a positive screening test may provide:
      (1)  documentation of that positive test result and of any diagnostic and therapeutic follow-up;  and
      (2)  a certificate signed by a physician that states that the person does not have tuberculosis.
      (c)  The health authority may require an employee or volunteer to have an additional screening test or medical examination if the department determines that an additional test or examination is necessary and appropriate to protect the public health.
      (d)  An employee or volunteer is exempt from the screening test required by this section if:
      (1)  the screening test conflicts with the tenets of an organized religion to which the individual belongs;  or
      (2)  the screening test is medically contraindicated based on an examination by a physician.
      Added by Acts 1993, 73rd Leg., ch. 786, Sec. 1, eff. Sept. 1, 1993.  Amended by Acts 1997, 75th Leg., ch. 348, Sec. 3, eff. Sept. 1, 1997.

      Sec. 89.012.  FOLLOW-UP EVALUATIONS AND TREATMENT.  (a)  An employee or a volunteer with a positive screening test result must obtain a diagnostic evaluation from the person's own physician to determine if the person has tuberculosis.
      (b)  If the employee or volunteer has tuberculosis, the governing body may not permit the person to begin or continue the person's employment duties or volunteer services unless the person is under treatment for the disease by a physician and the person provides to the governing body a certificate signed by the attending physician stating that the patient is noninfectious.
      Added by Acts 1993, 73rd Leg., ch. 786, Sec. 1, eff. Sept. 1, 1993.  Amended by Acts 1997, 75th Leg., ch. 348, Sec. 4, eff. Sept. 1, 1997.

      Sec. 89.013.  CERTIFICATE REQUIRED.  (a)  The governing body or a designee of the governing body shall confirm that each employee or volunteer required to be screened under this subchapter has the required certificate.
      (b)  The governing body may not permit an employee or volunteer to carry out the person's duties if the person does not have the required certificate.
      Added by Acts 1993, 73rd Leg., ch. 786, Sec. 1, eff. Sept. 1, 1993.  Amended by Acts 1997, 75th Leg., ch. 348, Sec. 5, eff. Sept. 1, 1997.

      Sec. 89.014.  COST OF TESTS, FOLLOW-UP, AND TREATMENT.  The employee or volunteer shall pay the expense of a screening test, diagnostic evaluation, or other professional medical service required under this subchapter unless the commissioners court, the governing body of a municipality, or a local health department or public health district elects to provide the service.
      Added by Acts 1993, 73rd Leg., ch. 786, Sec. 1, eff. Sept. 1, 1993.  Amended by Acts 1997, 75th Leg., ch. 348, Sec. 5, eff. Sept. 1, 1997.

      SUBCHAPTER C. INMATE SCREENING AND TREATMENT

      Sec. 89.051.  INMATE SCREENING REQUIRED.  (a)  Each inmate in a jail or community corrections facility shall undergo a screening test for tuberculosis infection approved by the board if:
      (1)  the inmate will probably be confined in jail or a community corrections facility for more than seven days;  and
      (2)  the inmate meets the screening guidelines prescribed by board rules.
      (b)  The inmate must be tested on or before the seventh day after the day the inmate is first confined.
      (c)  An inmate listed by Subsection (a) is not required to be retested at each rebooking if the inmate is booked into a jail or a community corrections facility more than once during a 12-month period unless the inmate shows symptoms of tuberculosis or is known to have been exposed to tuberculosis.
      (d)  An inmate is exempt from the screening test required by this section if:
      (1)  the screening test conflicts with the tenets of an organized religion to which the individual belongs;  or
      (2)  the screening test is medically contraindicated based on an examination by a physician.
      Added by Acts 1993, 73rd Leg., ch. 786, Sec. 1, eff. Sept. 1, 1993.  Amended by Acts 1997, 75th Leg., ch. 348, Sec. 6, eff. Sept. 1, 1997.

      Sec. 89.052.  RESCREENING;  DIAGNOSTIC EVALUATIONS.  The department or a health authority may require a governing body to provide an additional screening test or a diagnostic evaluation if the department or health authority determines that an additional screening test or a diagnostic evaluation is necessary and appropriate to protect the health of the jail inmates, employees, volunteers, or the public.
      Added by Acts 1993, 73rd Leg., ch. 786, Sec. 1, eff. Sept. 1, 1993.  Amended by Acts 1997, 75th Leg., ch. 348, Sec. 7, eff. Sept. 1, 1997.

      Sec. 89.053.  FOLLOW-UP EVALUATIONS.  (a)  If an inmate has a confirmed positive screening test result, the governing body shall provide a diagnostic evaluation to determine whether the inmate has tuberculosis.
      (b)  The sheriff, jail administrator, or director of the community corrections facility shall provide appropriate accommodations to an inmate who has tuberculosis or is suspected of having tuberculosis, including respiratory isolation, if necessary, and adequate medical care and treatment that meet the accepted standards of medical practice.
      (c)  The jail or community corrections facility shall provide preventive therapy to an infected inmate if the preventive therapy is prescribed by the attending physician and the inmate consents to the treatment.
      Added by Acts 1993, 73rd Leg., ch. 786, Sec. 1, eff. Sept. 1, 1993.  Amended by Acts 1997, 75th Leg., ch. 348, Sec. 8, eff. Sept. 1, 1997.

      Sec. 89.054.  INMATE TRANSFER AND RELEASE.  A copy of an inmate's medical records or documentation of screenings or treatment received during confinement must accompany an inmate transferred from one jail or community corrections facility to another or the Texas Department of Criminal Justice and be available for medical review on arrival of the inmate.
      Added by Acts 1993, 73rd Leg., ch. 786, Sec. 1, eff. Sept. 1, 1993.

      SUBCHAPTER D. REPORTING;  RULEMAKING;  MINIMUM STANDARDS

      Sec. 89.071.  REPORTING.  (a)  A case of tuberculosis shall be reported to the appropriate health authority or to the department not later than the third day after the day on which the diagnosis is suspected.
      (b)  The results of a screening test shall be reported to the department monthly in a manner approved by the department.
      Added by Acts 1993, 73rd Leg., ch. 786, Sec. 1, eff. Sept. 1, 1993.

      Sec. 89.072.  RULEMAKING.  The department shall recommend to the Commission on Jail Standards and the Texas Department of Criminal Justice rules to carry out this chapter, including rules describing:
      (1)  the types of screening tests and diagnostic evaluations and the scope of the professional examinations that may be used to meet the requirements of this chapter;
      (2)  the categories of employees, volunteers, or inmates who must have a screening test under this chapter;
      (3)  the form and content of the certificate required under Subchapter B  for employees and volunteers;
      (4)  the deadlines for filing a certificate;
      (5)  the transfer of employee or volunteer certificates and inmate records between facilities;
      (6)  the frequency of screening tests for employees, volunteers, and inmates;
      (7)  the criteria for requiring an additional screening test or a diagnostic evaluation or examination;  and
      (8)  the reporting of a screening test or an evaluation or examination result to the appropriate health authority or to the department.
      Added by Acts 1993, 73rd Leg., ch. 786, Sec. 1, eff. Sept. 1, 1993.  Amended by Acts 1997, 75th Leg., ch. 348, Sec. 9, eff. Sept. 1, 1997.

      Sec. 89.073.  ADOPTION OF LOCAL STANDARDS.  (a)  The standards prescribed by this chapter and the rules adopted by the board relating to screening tests or examinations for tuberculosis required for certain employees and volunteers are minimum standards.
      (b)  With the prior approval of the department:
      (1)  a governing body may adopt and enforce standards for carrying out this chapter if the standards are compatible with and equal to or more stringent than the standards prescribed by this chapter and the board's rules;  and
      (2)  a private facility may adopt and enforce standards for carrying out this chapter if the standards are compatible with and equal to or more stringent than the standards prescribed by this chapter and the board's rules.
      (c)  The board shall adopt substantive and procedural rules to govern the submission of standards adopted under Subsection (b).  At a minimum these rules must contain:
      (1)  a procedure for the submission of standards for departmental review;  and
      (2)  an internal departmental appeal process by which a governing body or private entity may seek a review of the department's decision to reject proposed standards.
      Added by Acts 1993, 73rd Leg., ch. 786, Sec. 1, eff. Sept. 1, 1993.  Amended by Acts 1997, 75th Leg., ch. 348, Sec. 10, eff. Sept. 1, 1997.

      SUBCHAPTER E. CONTINUITY OF CARE

      Sec. 89.101.  DEFINITIONS.  In this subchapter:
      (1)  "Corrections facility" means:
      (A)  a jail or community corrections facility, without regard to whether the jail or facility satisfies the requirements of Section 89.002;
      (B)  any correctional facility operated by or under contract with a division of the Texas Department of Criminal Justice;  or
      (C)  a detention facility operated by the Texas Youth Commission.
      (2)  "Offender" means a juvenile or adult who is arrested or charged with a criminal offense.
      Added by Acts 1997, 75th Leg., ch. 348, Sec. 11, eff. Sept. 1, 1997.

      Sec. 89.102.  REPORT OF RELEASE.  A corrections facility shall report to the department the release of an offender who is receiving treatment for tuberculosis.  The department shall arrange for continuity of care for the offender.
      Added by Acts 1997, 75th Leg., ch. 348, Sec. 11, eff. Sept. 1, 1997.

      If you think you're too small to be effective, you've never been in the dark with a mosquito.

      by marykk on Wed Jul 04, 2012 at 04:53:09 AM PDT

      [ Parent ]

  •  This makes me think about the way people (7+ / 0-)

    used to come back from exile in Siberia or from the Gulag. Full of diseases like TB, malnourished, physically and psychologically broken. Except here in the US, we treat people like that for fun and profit.

    Thanks for bringing this to our attention.

    Santorum: Man on Dog; Romney: Dog on Car. Mrs. Romney: Fraud on Horse. equalitymaine.org

    by commonmass on Wed Jul 04, 2012 at 04:50:19 AM PDT

  •  This Should Be Reported to (4+ / 0-)

    the CDC regardless of what you or anyone is hearing from the people running the prison.

    I'm not clear as to what the law is, but don't assume the prison managers are telling the truth regarding what they are required to report.

    They may be LYING to protect their dumb asses. if they are breaking the law, I'm guessing there will be a fine involved-- and of course that impacts profit.

    "A civilization which does not provide young people with a way to earn a living is pretty poor". Eleanor Roosevelt

    by Superpole on Wed Jul 04, 2012 at 04:54:20 AM PDT

  •  Here are the rules (3+ / 0-)

    If you think you're too small to be effective, you've never been in the dark with a mosquito.

    by marykk on Wed Jul 04, 2012 at 05:01:22 AM PDT

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