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A highly contagious and antibiotic-resistant strain of staph infection has contaminated a Miami-Dade County jail, causing open, seeping sores in some inmates that could potentially spread to anyone they come into contact with including corrections officers, visitors, lawyers, and judges. Corrections medical officials have misdiagnosed the ailment, been slow to treat specific inmates, and not alerted the public. The outbreak went untreated for months, until one inmate's repeated requests for care finally resulted in a Miami-Dade County Health Department inspection in April.
Twenty-one-year-old inmate Jason Mancas, at Metro West Detention Center since October 2002 awaiting resolution to armed robbery charges, says he first became infected in February. During an interview at the jail where he shows scars on his belly, he recounts being misdiagnosed several times, until the infection became "as big around as a baseball, oozing pus and blood," and he couldn't move.
Mancas says as many as five other inmates in the open dorm unit where he was housed also showed symptoms months ago. But corrections officials say they've treated only two cases of staph. One corrections officer, who asked not to be identified, corroborated Mancas's account, saying that he had seen similar symptoms in at least four inmates and adding that the jail's clinic was continuously labeling the infections as boils or insect bites. "They're not taking this seriously," the officer says. "They're putting inmates at risk and the officers at risk." The infection is known as methicillin-resistant Staphylococcus aureus, or MRSA, and is spread through physical contact. People with cuts are especially susceptible.
In Mancas's case, the clinic's mistakes had consequences. He has a blood disorder, chronic purpura, that causes his blood-platelet count to drop and weakens his immune system. In early February, when he first saw a sore on his stomach and started feeling weak, he asked to go see a doctor and was denied. After repeated requests, he eventually saw a nurse, who gave him an antibiotic. The sore went away but came back a few weeks later, in much worse form. "I noticed this huge ulcerated wound," Mancas's mother, Virginia, says. She called the shift commander and eventually her son was taken to the clinic, where he was once again given antibiotics. "I asked the nurse, 'What is this, a boil?'" Mancas recalls. "She said, 'Yes, that's exactly what it is.'" The treatment once again failed to kill the infection, and when it resurfaced in mid-April, Mancas's health deteriorated sharply.
"He couldn't get out of bed," his mother says. "That's when I say 'Forget this!' and I call the health department infectious diseases unit." Health department officials immediately visited the jail, prompting corrections officials to send Mancas back to the clinic to see a doctor. "He told me it was staph and that it was bad," Mancas says. He was put in an isolated unit; given stronger antibiotics, including shots; and doused in special baths.
Health department officials, meanwhile, issued an April 14 memo to corrections medical chief Dr. Robert Gonzalez warning about the outbreak and listing seventeen preventive measures to stop the spread of MRSA. They included performing cultures on all inmate lesions, replacing all torn mattresses, enforcing inmate hygiene and officer hand-washing, and scrupulously cleaning all surfaces with disinfectants.
But, say Mancas and the corrections officer, nothing has changed. The health department memo was posted in the officers' mess hall, but no one has systematically informed officers about the spread of the disease and warned them how to protect themselves. And not enough cleaning supplies have been issued. "I'd say about 80 percent of the officers don't even know about the infections," the officer says.
"We had two cases of staph infections and they've been treated with the appropriate antibiotics," says Janelle Hall, the corrections department's spokeswoman. "They were isolated and are both considered to be noncontagious at this time." But both Mancas and the officer recount seeing sores on several inmates. "I see more every day," the officer says. "The nurses are just telling them it's spider bites."
An official with the Public Health Trust, which runs the jail's medical facilities, said that by April 16, all recommended steps were taken: Sixty-five inmates were briefed on hygiene, five inmates were examined, and only two had MRSA. There are 3000 inmates at Metro West.
By contrast, when Broward County Sheriff's officials discovered an outbreak of MRSA in six inmates in their jail system on May 12, the Broward Sheriff's Office immediately moved the men to another jail to isolate and treat them. Then the office sent out a press release to warn people who may have had contact with infected prisoners. "We decided we had to get the word out to the criminal justice world to make sure the judges, the attorneys, and the law enforcement personnel were informed," says Jim Leljedal, BSO spokesman. Newspapers and TV reported the outbreak.
In the press release, the BSO announced it would distribute training bulletins to all Department of Detention employees, and that medical staff would visit every roll call to educate and answer questions: "BSO DOD staff has adopted a 'zero tolerance for MRSA' policy and intend [sic] to go above and beyond the CDC [federal Centers for Disease Control and Prevention] guidelines to control the disease." Despite that quick response, by May 19, a total of 21 inmates had been infected.