As many as 3,000 prison inmates in central California deemed to be at risk from a potentially lethal lung disease may need to be moved to other regions under an order from a court-appointed federal overseer.
The directive, issued on Monday, marks the latest effort to stem cases of valley fever, or coccidioidomycosis, at two prisons where the disease was found to have contributed to the deaths of nearly three dozen inmates from 2006 to 2011.
But it could complicate court-ordered efforts to reduce overcrowding across California's prison system, the nation's largest.
The pneumonia-like illness, contracted by inhaling fungal spores that grow in the dry soils of the American Southwest, is not contagious. But the spores become airborne when soil is disturbed by wind, construction, farming and other activities.
Problems with the disease at two prisons in San Joaquin Valley, the state's agricultural heartland, were documented on Wednesday in court papers filed by J. Clark Kelso, appointed as a federal receiver for medical issues at the California Department of Corrections and Rehabilitation.
Previous attempts to reduce both the number of infections and the severity of cases were ineffective, Kelso's spokeswoman, Joyce Hayhoe, told Reuters.
After a report last year found that problems continued at Pleasant Valley State Prison and Avenal State Prison, Kelso asked correctional officials to stop transferring some inmates there who were considered to be at high risk, Hayhoe said.
Among those deemed to be at higher risk of contracting or dying from the disease were African-Americans, inmates of Filipino heritage, those with compromised immune systems and those who older than 55.
On Monday, Kelso went a step further, directing the state to cease housing inmates who fell into those categories at the two prisons in question, though he stopped short of explicitly ordering those inmates to be transferred out.
On Wednesday, he added diabetics to the list of high-risk inmates, court papers showed. He called the state's response so far "anemic."
Jeffrey Callison, a spokesman for the Corrections Department, acknowledged that the state has not stopped sending at-risk prisoners to the two facilities, nor have any been moved out. Kelso's directive to stop housing vulnerable prisoners in the region came "out of the blue," he said.
Callison said that immediately complying with the receiver's directive "would be an enormous undertaking."
Dr. John Galgiani, a valley fever expert hired by lawyers representing inmates, agreed with the federal receiver and prison officials that no outbreak of the disease had been declared in the San Joaquin Valley.
But in his own court filing, Galgiani said the persistence of the illness in the two prisons amounted to a "medical emergency."
Noting a recent report by Kelso's office, Galgiani said in a court declaration that the infection rate at Pleasant Valley State Prison was "1,000 times the rate for Californians generally." Valley fever was a contributing cause of death in 34 cases between 2006 and 2011 in the two institutions, he wrote.
Symptoms of valley fever include a cough, fever, chest pains and muscle aches that can last for many weeks or months. But fewer than half of infected individuals become sick, and only a small percentage become severely ill.
The disease can be fatal, but the mortality rate among infected patients is about 0.1 percent, said Galgiani, an infectious disease specialist who directs the University of Arizona Valley Fever Center for Excellence.
A recent study found that Valley fever was identified as an underlying or contributing cause to 3,089 U.S. deaths during an 18-year span, from 1990 to 2008.
Those most at risk for life-threatening complications from the illness include the elderly and people with compromised immune systems, Galgiani said.
An estimated 150,000 infections occur in the Southwest each year, the majority of them in Arizona. California accounts for nearly all the remaining cases.