Contagious MRSA

Jail’s contagious dispute

As MRSA infections spread, so does legal mess.

By Jan Hefler

Inquirer Staff Writer

At the Gloucester County Jail, Michael DiFelice requested a cell that would keep him away from more hardened criminals. The real estate appraiser, who was serving time for driving with his license suspended, got his wish. The price was a mattress on the floor, in a cell shared with two other inmates.
From the beginning of his 40-day stay in 2005, parts of the chronically overcrowded jail seemed unusually dirty, DiFelice said. The bathrooms were often so filthy that he tried to time his showers to their cleanings. “I’d watch and wait because I was afraid of getting something,” he said.

What DiFelice did not know was that his cell block also housed sick inmates. One was his cell mate, who had a “big, nasty boil” on his back. The relevance of this would not be known for five months, when DiFelice was back on the street and his armpit swelled to the size of a softball. At the hospital that day, the emergency-room doctor said the septic cyst would “explode unless we operate.”

DiFelice suffered from methicillin resistant staphylococcus aureus – MRSA – a strain of a common bacterium that causes staph infections, spreads by casual contact, and sometimes goes undetected until it shows up as a boil or a swollen area.

Unlike most staph infections, MRSA is difficult to treat and potentially lethal if it spreads to vital organs or the blood. A recent nationwide scare over staph was driven by a federal study that estimated the number of MRSA deaths at 19,000, and by an infected 17-year-old student’s death in Virginia.

At the Gloucester County Jail, MRSA spread among inmates to corrections officers and beyond: Several spouses of inmates and corrections officers were infected. No one has died, but the infections have left many of the victims with lifelong medical complications, produced 18 lawsuits, and raised questions about the jail’s response.

The federal lawsuits have already cost tens of thousands of dollars to defend, and there is a local precedent for substantial jury awards and payments to plaintiffs. The Bucks County Jail was the subject of 19 MRSA-related lawsuits. Two years ago a jury awarded $800,000 and $400,000 to two inmates, and $150,000 settlements were reached with others. A lawsuit to improve conditions at the jail, filed on behalf of 36 other inmates, is pending.

Corrections facilities are especially vulnerable to MRSA because the germ spreads in close quarters and thrives in unsanitary settings. Aside from the cases in Bucks County, MRSA outbreaks have taken place in other county jails in the region and in Philadelphia. The Pennsylvania Institutional Law Project, a rights advocate for inmates, estimates that as many as 30 people infected with MRSA in city prisons have received undisclosed settlements.

The Gloucester County Jail, home to about 300 men awaiting trial or serving sentences of less than one year, became a kind of incubator for MRSA in 2003, according to the lawsuits and interviews with inmates, corrections officers and others.

The lawsuits allege that county officials withheld or “fraudulently concealed” information about the spread of MRSA and failed to “put procedures or policies in place to eliminate or minimize the risk of exposure.” County officials deny the allegations and say they responded aggressively as soon as they learned MRSA was spreading.

For the victims, the shock of learning they are infected is followed by the rigors of treatment, which in some cases will continue for years.

Sgt. Ken Warfield, a corrections officer, broke out with boils in August 2003, six months after MRSA first struck the jail. Despite aggressive treatment, the boils reoccur. Two years after he became infected, Warfield required 14 days of intravenous applications of Vancomycin, a powerful antibiotic. Last month, he was hospitalized with pneumonia, and doctors aren’t sure whether his continuing battle with MRSA caused it.

Now 60 and still working when able, Warfield retreats to his upstairs bedroom in his Franklinville home whenever the boils return because he fears infecting his wife or their six grandchildren. His clothes are laundered separately – in hot water and bleach. And he is constantly washing his hands.

The infection, he said, “really ruined my life.”

Mysterious lesions
Officials at the Gloucester County Jail were mystified. It was February 2003, and 14 inmates had developed oozing lesions. The initial theory? Spider bites.

Chad Bruner, the jail’s former health director, told The Inquirer in 2004 that it had taken the jail “a long time to figure out” what caused the lesions. But once MRSA was identified, jail and county officials said, they acted.

Within three months, county freeholders replaced the sheriff who oversaw the jail and brought in a professional administrator to make improvements. Health experts say education and hygiene are key to controlling the spread of MRSA, particularly in group settings, and officials said plans had been put in place at the jail.

“Every employee and corrections officer went through a program with the health department on avoidance and how to spot” MRSA, Freeholder Director Stephen M. Sweeney said in a recent interview. “We never ignored the problem.”

By 2004, hand-sanitizer dispensers were installed around the jail. Daily logs of confirmed and suspected MRSA cases were kept, starting that September. Over the next two years, according to the jail, MRSA cases decreased by half, from 20 to 10.

But soon after the logs were started, the warden was suspended for misrepresenting the numbers, and corrections officers demanded his ouster and pushed for stronger action to protect them from MRSA.

In January 2005, the warden was replaced and a new jail director, Robert Balicki, was named. A policy to isolate infected inmates was adopted, but persistent overcrowding defined how well it was applied.

Unsanitary conditions
DiFelice landed in the jail in April 2005. For 40 days, his home was a three-story brick building attached to the courthouse in Woodbury. Built 20 years ago, the jail often exceeds its capacity of 225. In 2005 and 2006, for example, the average was 313.
Although the MRSA outbreak had taken place two years earlier, DiFelice said, no one told him about the infection or instructed him in how to protect himself. He said he quickly had noticed the boil on his cell mate.

“What is that thing?” DiFelice said he had asked. The cell mate said that he had a cream to treat it, and that he sometimes got gauze from the nurse to try to keep it covered.

MRSA spreads through skin-to-skin contact, contaminated items and surfaces. A general lack of cleanliness contributes, according to the Centers for Disease Control and Prevention. At the jail, the conditions for contagion were often ideal.

DiFelice said he draped his towel across the rail of his cell mate’s bunk because the cell lacked hooks. When he was assigned to clean the showers, he said, there was often a shortage of bleach.

“Slimy and nasty,” he said of the showers. “Sometimes we were told to just give them a few squirts to clean them, or to just use dish soap when there was no bleach.”

The New Jersey Department of Corrections noted several lapses during annual inspections in 2005 and 2006. One inspection, in December 2005, noted that inmates did not receive the required allotment of clean bedding and towels.

Inmates also were not given a rules handbook, which informs them how to get medical services, according to the inspectors. DiFelice was asked to sign a document stating he had received the handbook when he arrived, he said, even though officers had not provided him one because none were available. In 2006, inspectors cited the jail for failing to have records showing that indigent inmates received hygienic supplies, such as soap and toothpaste, as required.

Under New Jersey law, corrections facilities have 60 days to respond to citations and are reinspected within six months. When inspectors returned each of the last two years, the jail was in compliance except for the continued overcrowding, a common problem in jails.

Balicki, the director at the jail, said the deficiencies noted by state inspectors had been a result of the jail’s not having the proper documentation. “We don’t have these documents in our back pocket when the inspector arrives,” he said.

Officers were unaware
Warfield’s precautions have kept MRSA from spreading to his family. Other corrections officers have been less fortunate. Three have infected their spouses.

Robert A. Greenberg, a lawyer in Cherry Hill who represents those three corrections officers and two others, said the impact of MRSA went beyond the medical. “They’re ashamed, and in many cases they’re shunned,” he said of the officers.

Greenberg faulted the county for failing to inform the officers of the problem and not addressing it promptly. Corrections officers, he said, were unaware of the signs of MRSA or its consequences.

“They didn’t know,” Greenberg said. “They thought it was just a pimple or a boil � and passed it on to their spouses by direct contact.”

Even after the jail identified MRSA as a threat in 2003, the infection persisted. Michael A. Collins was infected in 2004 while serving six months for violating parole. He said jail officials had ignored his complaints about a painful sore for three days.

“My leg blew up like a hot-air balloon, and it turned blue, yellow, orange and green,” said Collins, 36, of Franklin, a plaintiff in the lawsuits. He underwent three operations to excise an infection that bored deep into his muscle. He now walks with a cane.

The persistence of MRSA at the jail has pitted the union representing the corrections officers against jail administrators. Union officials accuse the jail of not doing enough and contend that MRSA remains a threat, while jail officials say their monitoring has significantly reduced the rate of infection. The antagonism is rooted in part in the early confusion of MRSA and the fact that the infection spread to officers and their spouses.

Sgt. Joseph Hetzel, who was vice president of Lodge 97 of the Fraternal Order of Police during the 2003 outbreak, said jail officials refused to admit there was a problem. When officers became infected and learned the truth from their doctors, they informed jail officials but were ignored, Hetzel said.

“Some people were just given a cream for their boils and were told they’d be OK,” said Joseph Marano, a Westmont lawyer who represents several former inmates and one corrections officer.

The union said measures implemented by the jail after the 2003 outbreak were insufficient. Only when sued did jail officials begin isolating inmates with MRSA, but quarantine is often difficult because of overcrowding and inconsistent practices, Hetzel said.

Sgt. Eugene Caldwell, president of the Gloucester County Corrections Sergeants Association, said the county could still be a lot more aggressive. “Our biggest fear is getting the disease and bringing it home to our families,” he said. “They need to take the problem more seriously.”

His union, which represents 16 officers at the jail, is advocating for procedures established at federal and state corrections facilities, including immediate medical attention for inmates who exhibit a boil and a routine examination of their cell mates.

Union officials also said that the jail had reduced the number of cultures that are taken – such tests are the only way to confirm MRSA – and that inmates with boils were treated with the antibiotic Bactrim and tested only if the boils persisted.

Balicki, the jail’s director, said measures had reduced MRSA cases. “There’s hysteria about MRSA,” he said. “We’re not the breeding ground people think we are.”

Though cell mates of infected inmates are not checked, their cells are immediately disinfected, Balicki said. Sick inmates are seen within 72 hours, and inmates with a boil can get prompt attention by notifying an officer, he said.

Balicki said cultures cost $87 apiece – too prohibitive, he said, to order routinely. They are ordered only if inmates have a sore that is draining or won’t respond to antibiotics, he said, adding that inmates sometimes served short sentences and were released before results come back.

Health experts, however, say cultures are critical to verify infection, identify the bacterial strain, and choose the proper medication. In federal prisons, if two or more inmates have the same strain, it is deemed an outbreak and the facility is disinfected and other inmates are examined.

Preparing for trial
The current lawsuits, filed in U.S. District Court in Camden, have been consolidated for discovery purposes. They could go to trial next year.
The complaints name as defendants Gloucester County, the Board of Chosen Freeholders, the Department of Correctional Services, the county Sheriff’s Office, Prison Health Services Inc., and individual jail directors and wardens, among others.

Lawyers for the inmates said current conditions at the jail were providing them with a steady stream of potential clients. Derek J. Layser, another attorney in the litigation, said he had 10 cases under review. “We’re getting calls from inmates who say it takes five days to see a doctor,” Layser said.

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More About MRSA
Methicillin-resistant staphylococcus aureus, or MRSA, is caused by a bacterium that is spread by skin-to-skin contact; through the sharing of personal items, such as towels, clothes and sheets; or by certain high-risk behaviors, including drug use. It is found most often in hospitals, jails or prisons, gyms, and military training facilities.

The infection often starts as a boil that appears to be a hardened pimple or as an abscess. Early detection is critical, and treatment includes antibiotics. Health experts say the risks of acquiring or spreading the disease can be reduced by washing hands frequently and by showering, especially after close contact with others.

For more information, contact the New Jersey’s Communicable Disease Service at 609-588-7500, or visit http://go.philly.com/mrsajail.

To view a video on MRSA in jails and prisons, go to http://go.philly.com/mrsavideos.

SOURCES: Centers for Disease Control and Prevention; New Jersey Department of Health and Senior Services

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Contact staff writer Jan Hefler
at 856-779-3224 or jhefler@phillynews.com.