Valley fever is widespread in the Southwest, yet Hawaii’s prison officials haven’t paid much attention to it, despite the recent deaths of at least two Hawaii prisoners who had the disease.

by Rui Kaneya, Civil Beat

In the spring of 2014, Melvin Wright was among a crew of prisoners who manned the morning shift in the dining hall at the Saguaro Correctional Center, an Arizona prison where about 1,400 Hawaii prisoners are housed.

Wright, convicted of attempted murder, was a baker, responsible for preparing cookies for fellow prisoners every morning. But, one day, he stopped showing up for work.

Worried, Matthew Murphy, who shared the morning shift, went to check up on him a few days later. He found Wright wrapped up “in a cocoon of four blankets” in his cell, trying to fight off a fever.

Murphy’s instinct was to get away from Wright before he got sick himself. But he soon realized that Wright wasn’t eating at all – he was too weak to make it to the dining hall on his own.

Murphy took pity on Wright and began helping him walk down the hallway, a task that he took upon himself three times a day.

“It became obvious to me, if I did not assist Melvin to and from the chow hall, he was not going to eat,” Murphy said.

Eventually, Murphy found out what was wrong: Wright had long been suffering from valley fever, a disease caused by inhaling microscopic spores of a soil-dwelling fungus that thrives in the desert Southwest – from the Central Valley of California to the vast scrubland of Texas.

For the majority of infected people, valley fever is essentially harmless, presenting no symptoms at all. Most people may never even know they have it. But, in about 40 percent of the cases, it causes lingering flu-like symptoms: fever, cough, exhaustion. And, in a smaller subset of the cases, it can even spread from the lungs to other parts of the body, triggering life-threatening complications, like meningitis.

In Arizona, valley fever is rampant across the Sonoran Desert, which covers a wide swath of the state – including its two biggest cities, Phoenix and Tucson. According to the Centers for Disease Control and Prevention, more than 5,600 Arizona residents got infected in 2014, accounting for more than two-thirds of the reported cases nationwide.

Despite decades of research, there’s no foolproof way to ward off valley fever. A vaccine hasn’t been developed, and no mask can effectively filter out the fungal spores. In areas where the fungus is widespread, getting infected with valley fever can be as easy as gardening in the backyard – or, for Hawaii prisoners, being locked up at Saguaro, a 1,926-bed facility on the outskirts of a dusty small town about 70 miles southeast of Phoenix.

Yet, the Hawaii Department of Public Safety has reported a remarkably small number of infections among Saguaro prisoners: a total of four cases since the facility – owned and operated by Corrections Corporation of America – was opened just for Hawaii in 2007.

According to Toni Schwartz, public safety spokeswoman, one Saguaro prisoner with valley fever died this year, but the department doesn’t know whether valley fever caused – or contributed to – his death. An autopsy is still pending.

But critics say the department’s count is suspiciously low.

For one thing, it doesn’t appear that Wright’s case has been counted. According to the department, all four infections occurred after 2014, but Wright was diagnosed with valley fever in 2013.

In May 2014, when his condition worsened, Wright was flown back to Hawaii, but it was too late: Within days, he was found unresponsive in his cell and rushed to a hospital, where he died three days later.

According to a copy of Wright’s autopsy report released to Civil Beat by the Honolulu Department of the Medical Examiner, the cause of death was a heart attack, but “coccidioidomycosis,” the medical term for valley fever, was also cited as a contributing cause.

And the department’s count, if true, means that Saguaro has an usually high rate of serious valley fever, given that the fatal complications are known to happen in less than 1 percent of the cases.

In response to Civil Beat’s request, Schwartz says the department is going over its records, but that the review will take time.

“It involves the complication of going through medical files and figuring out what we are allowed to release. We expect it to take at least a few days longer as we go over the information,” Schwartz said.

One Prisoner’s Story

Civil Beat pieced together Wright’s last days at Saguaro based on interviews, as well as Murphy and other prisoners’ sworn statements, which had been collected by attorney Nikki Donnelley.

Donnelley, who represented Eric Wilson, another Saguaro prisoner, was gathering evidence of valley fever at Saguaro as part of a case she was considering filing.

Civil Beat reached out to CCA spokesman Jonathan Burns with the details of the prisoners’ accounts, but he did not respond to our request for comment.

In his statement, Murphy said it wasn’t long after he began helping Wright that he learned Wright suffered from vertigo. Murphy said Wright told him: “Everything on earth was spinning around ... like a kaleidoscope.”

To help Wright walk, Murphy stood on the left side, his right shoulder to Wright’s left, because Wright’s body always teetered to the left. “This is the only way that I could keep Melvin from falling ‘over’ and cracking his head open on the concrete sidewalk,” Murphy said.

But that posed problems for both men. Under Saguaro’s rules, they were supposed to walk in a “single file line on the right side of the sidewalk” – and helping Wright meant that Murphy was breaking the rules.

According to Murphy, Saguaro officials didn’t take kindly to the rule-breaking: When an assistant warden saw him helping Wright, he threatened to send him to solitary confinement for “assault.”

So, whenever Saguaro officials were nearby, Murphy held Wright from behind. But Wright still needed to grab onto the fence beside him for stability, prompting more pushback from the guards.

Meanwhile, Saguaro’s medical staff refused to give Wright a wheelchair, insisting that he needed to walk in order to get exercise.

To Murphy, all this seemed clearly calculated. Saguaro officials “were believing that Melvin’s health would turn around, justifying their decision to not pay for the additional medical care that Melvin so desperately needed,” he said.

But Murphy persisted, eventually managing to prod the medical staff to provide Wright with a walker.

Then, one day, when Murphy was accompanying Wright to the medical unit for an appointment, they ran into a group of outside visitors. Murphy didn’t know who the visitors were – “corporate or auditors?” – but that was when the guards surrounded them, “asking Melvin how he was feeling?”

Murphy said he told them: “How come you didn’t give a shit about the way he felt yesterday or the day before that? This man needs a fuckin’ wheelchair.”

A wheelchair was delivered to Wright later that day.

But Wright kept developing more problems, including an infection caused after he’d had a lung biopsied months before. Finally, Murphy was told to help pack up Wright’s belongings, so he could be flown back to Hawaii.

But Wright’s homecoming didn’t last for long: According to his autopsy report, he died of a heart attack on May 24, 2014.

Valley Fever on the Rise

Since the late 1990s, the cases of valley fever have increased dramatically nationwide. According to the CDC, the number of reported cases jumped tenfold, from about 2,200 cases in 1998 to 22,000 cases in 2011.

What triggered the increase – or why the number of cases has declined in the past few years – is little understood. But experts believe the amount of rainfall has a lot to do with it.

“We think that rain stimulates the growth of fungus in the soil,” said Dr. John Galgiani, a valley fever expert who directs the University of Arizona’s Valley Fever Center for Excellence. “So, when things do dry out, there’s more spores in the air, which increased the infection rate.”

Statistically speaking, it’s far more probable to get infected with valley fever than most other communicable diseases. According to the CDC, valley fever is estimated to cause up to 30 percent of pneumonia cases in places like the Phoenix and Tucson metropolitan areas.

And the risk of contracting life-threatening bouts of valley fever is much higher among certain populations – African-Americans and Filipinos, as well as those who suffer from diabetes, take steroid medications or have compromised immune systems.

One study has shown that black patients are 14 times more likely than white counterparts to suffer complications from valley fever, while Filipinos – who make up about 11 percent of Saguaro prisoners – are 175 times more likely to get infected and 192 times more likely to die from it.

In California, the state’s prison officials have a policy prohibiting at-risk populations from being housed at two Pleasant Valley prisons, where valley fever is endemic. It was instituted after a string of lawsuits alleging that the California Department of Corrections and Rehabilitation failed to protect vulnerable prisoners there.

“Defendants knowingly imposed on plaintiffs a lifelong, crippling and sometimes fatal disease in addition to their lawfully determined sentences,” according to one lawsuit filed in 2013 on behalf of more than 160 prisoners.

Another lawsuit is seeking monetary damages to pay for the medical costs – $1,000 a year for testing, $5,000 for antifungal medication and $25,000 in hospitalization expenses for prisoners with severe infections.

Donald Specter, executive director of the Prison Law Office in Berkeley, California, says the Eighth Amendment prohibition against cruel and unusual punishment is the basis for all the lawsuits.

“Knowing that somebody has a high risk of contracting a very serious illness and sending that person into that toxic environment presents a grave risk of harm. In California, we believe that’s a constitutional violation – and it certainly applies in Hawaii,” Specter said.

Kat Brady, coordinator of the Community Alliance on Prisons, argues that being housed at Saguaro amounts to capital punishment for some Hawaii prisoners.

“Hawaii doesn’t have the death penalty, but we’re sending our inmates to a place where they could end up dying from the disease. What are we doing?” Brady said.

Fighting to be Heard

Wilson, who was released from Saguaro earlier this year and now lives in a halfway house in Pearl City, Hawaii, says Wright’s death was preventable – had it not been for Saguaro officials’ indifference to his suffering.

Wilson, who knew Wright at Saguaro, saw how quickly his health deteriorated. After hearing that Wright was suffering from valley fever, Wilson tried to learn as much as he could about it and educate other prisoners.

“The problem is that it only takes one spore,” Wilson said. “Saguaro is so dusty that these guys come back from the rec yard, pounding their shoes, releasing the dust in the air.”

Wilson also began corresponding with Brady, alerting her about Wright’s condition – and, in the process, putting himself on a collision course with Saguaro officials.

Wilson says he was soon sent to solitary confinement for five months – ostensibly for minor infractions of Saguaro’s rules. But he maintains that it was in retaliation for looking into Wright’s case.

Donnelley said she couldn’t get in touch with Wilson during that time. Saguaro officials told her that Wilson refused to take her calls – something that he maintains wasn’t true.

“I don’t know if they were necessarily trying to hide something as much as trying to get back at him for making a nuisance of himself to find out about valley fever,” Donnelley said.

Wilson says he’s still troubled that Saguaro prisoners remain oblivious to the dangers of valley fever.

“Hawaii inmates who are being housed there aren’t being informed of the dangers and they’re always being misdiagnosed,” Wilson said. “They aren’t even aware that they’re at risk.”

Brady says that should be changed immediately.

“By not educating, they’re perhaps putting more inmates at risk,” Brady said. “That is irresponsible.”

This article was originally published by the Honolulu Civil Beat on June 27, 2016; it is reprinted with permission, with minor edits.