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Ky. jail inmates exposed to 'superbug,' suits say
Flesh-eating bacteria an increasing threat for prisoners — and maybe the rest of us
Lonnie Napier says he was infected with the flesh-eating bacteria at the Laurel County Detention Center, and that his wound grew so gangrenous that a portion of his scrotum had to be removed.
Martel Chapman said she was infected in the Hardin County jail after being forced to share a cell with women who had draining sores and boils. Scott Wooler said he caught it in the Hickman County Detention Center when he helped another inmate change his leaking bandages. All three claim in lawsuits that they were infected with the painful, disfiguring and potentially fatal penicillin-resistant staph infection known as MRSA — or methicillin-resistant Staphylococcus aureus — while incarcerated.
Dubbed the "superbug," MRSA was first identified as a problem in hospitals 40 years ago. It caused more than 94,000 life-threatening infections and 18,650 deaths in the United States in 2005, more than AIDS, according to the most recent statistics from the U.S. Centers for Disease Control and Prevention. Most of those patients were infected in hospitals or nursing homes. But public health officials say a community-acquired strain is an increasing threat in other settings — including in overcrowded jails. And that's a problem beyond the financial expenses incurred by tax-funded institutions being sued, said attorney Greg Belzley, who leads a group that's filed lawsuits against jails in Shelby, Hickman, Laurel and McCracken counties in Kentucky, and Floyd County, Ind. "When inmates are released they go home, they go back to work," Belzley said. "Do you want somebody with MRSA flipping your burgers? Or infecting his child, who sits next to your child in school?"
Kentucky, Indiana jails not required to report it Nobody knows how many MRSA cases there are in Kentucky and Indiana jails because they're not required to report it. But in the Hardin County, Ky., jail alone, 112 inmates have been treated since 2004 for MRSA or MRSA-like symptoms, and 80 infections have been confirmed, according to figures released by the jail in a lawsuit filed on behalf of Chapman and other inmates. The suit is one of five filed by Belzley and a team of lawyers against county jails in Kentucky and Southern Indiana, which are accused of failing to identify, treat and isolate inmates with the infections, which are often initially diagnosed as spider bites. Jefferson County is named in one additional suit.
Jail director Tom Campbell said recently that there were two MRSA cases out of 1,930 inmates there — a low number that Campbell credits to aggressive screening as inmates are processed. The jails named in the lawsuits have denied wrongdoing and said they have taken measures to prevent and treat infections. "Every jailer I know has been extremely vigilant," said Paducah lawyer Stacey Blankenship, who is defending three jails insured by the Kentucky Association of Counties. She argues MRSA is no more widespread in jails than it is in locker rooms or soldiers' quarters — "MRSA is everywhere," she said. Chance of spreading bacteria can be reduced The infection can cause otherwise healthy people to develop deep abscesses and painful boils, as well as toxins that necrotize or consume the flesh. If it reaches the bloodstream, it can be fatal. Chances of spreading MRSA can be reduced by frequent hand washing, regular showers, keeping living spaces and laundry clean and not sharing towels and razors. It can be treated with antibiotics outside the penicillin family, according to the CDC.
In 2004, the state Corrections Department sent every jail in Kentucky a protocol of preventive measures that included isolating any infected inmate whose wound cannot be contained by bandages, and culturing sores to confirm infections and identify the appropriate antibiotic for treating them. Suits claim some jails didn't take proper care But in the lawsuits and in interviews, inmates at some jails say that did not happen. In Hardin County, 26 of 42 people treated for MRSA told their lawyers that they had shared a cell with someone with draining sores, and five of them said they worked in the jail kitchen after they had developed symptoms of MRSA, according to court papers. Hardin County Jailer Louis Lawson declined to let a reporter tour the jail and referred questions to Blankenship, who has noted in court papers that Hardin sprays disinfectant in inmate living quarters monthly, and that for more than 20 years, inmates have been given a spray bottle with which to clean their living area after every meal. She also noted that in response to the lawsuit, the jail has recently adopted policies to ensure that draining wounds are cultured and that inmates are not charged for antibiotics needed to treat MRSA.
The jail also created four new isolation cells, in which inmates will have the same privileges as other prisoners, and signs have been posted in all cells describing MRSA and steps to prevent it. Still, she said some inmates are likely to become infected regardless of preventive measures, and that some hide their wounds — and don't get treated — because they don't want to be placed in isolation. Laurel County Jailer Jack Sizemore didn't return phone calls. The county's lawyer, Leslie Vose, of Lexington, said she couldn't comment on the cases of inmates who've filed suit there. She said, however, that Laurel County meets and exceeds the state protocol for preventing and treating MRSA by requiring that a board certified internist diagnose and treat all such infections. Like Blankenship, she argues that "infections occur in even the most careful of settings." Judge denies motion for class-action status Laurel County won the first round in the lawsuit filed on behalf of Napier when U.S. District Judge Danny Reeves in February denied the plaintiffs' motion to make the case into a class action. Though Belzley and other lawyers claim that as many as 50 inmates have been treated in Laurel for MRSA or MRSA-like symptoms, Reeves said there was definitive proof of only two infections. The plaintiffs have appealed the ruling. Plaintiffs must prove infection came at jail Lawyers for the jails say it will be impossible for any plaintiff to prove he was infected with MRSA in the jail, rather than before he was incarcerated, because about one in every 100 people carry the bacteria harmlessly in their noses or under their fingernails and can go months before it is transferred into an open wound and infects them. But lawyers who have successfully litigated MRSA cases elsewhere said that if an inmate is infected after six or seven months in jail — and can show they were exposed to another infected prisoner — juries will conclude they got the staph infection while locked up.
In Bucks County, Pa., for example, the local government has spent $2.5 million defending claims after 32 inmates, guards and family members were infected in a 2002 staph outbreak at the jail, according to court records and interviews. In late March, a federal judge approved a class-action settlement that requires the county to hire additional nurses and infectious disease specialists to monitor the jail. And a jury awarded $1.2 million in 2005 to two inmates who said they begged for weeks for medical help as MRSA infections spread through their bodies. "The defense that inmates can't prove they got it in jail isn't true," said Anita Alberts, one of their lawyers. Reporter Andrew Wolfson can be reached at (502) 582-7189. What is MRSA? Methicillin-resistant Staphylococcus aureus, or MRSA, is a type of staph that is resistant to common antibiotics like methicillin, oxacillin, penicillin and amoxicillin.
Who gets MRSA? It is contracted mostly by people in hospitals and nursing homes who have weakened immune systems. The health- care variety infects surgical wounds, the urinary tract and the bloodstream, and can cause pneumonia. But people can become infected in locker rooms, schools, jails, military barracks and other settings. So-called community-associated MRSA usually appears as skin infections, such as pimples and boils, and occurs in otherwise healthy people. How common is community-associated MRSA? The majority of MRSA infections occur in health-care settings, but it is becoming more common in the community. Data from a 2003 study suggests that 12 percent of clinical MRSA infections are community-associated.
What causes the spread of MRSA? MRSA is almost always spread by physical contact and not through the air. It can occur by touching contaminated objects such as towels, sheets, wound dressings, clothes, workout areas or sports equipment.
How can I prevent staph or MRSA skin infections? Keep your hands clean by washing thoroughly with soap and water or using an alcohol-based hand sanitizer. Keep cuts and scrapes clean and covered with a bandage until healed. Avoid contact with other people's wounds or bandages. Avoid sharing personal items such as towels or razors.
What should I do if I think I have an infection? See a doctor.
Are the infections treatable? Yes. Most are treatable with antibiotics and some may be treated by draining the abscess or boil and may not require antibiotics. Infections are usually mild, limited to the surface of the skin. In rare cases, if left untreated or not recognized early, infections can progress to life-threatening blood or bone infections.
If I have MRSA skin infection, what can I do to prevent others from getting infected? Cover your wound and keep wounds that are draining or have pus covered with clean, dry bandages. You, your family, and others in close contact should wash their hands frequently, especially after changing the bandage or touching the infected wound. Don't share towels or washcloths, and wash sheets, towels and soiled clothes with water and laundry detergent. U.S. Centers for Disease Control and Prevention
Story written by Andrew Wolfson
Printed in the Louisville Courier-Journal, May 4, 2008

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