Officers say risks merits more pay
An incorrect report of an extensive outbreak of TB at a New York state prison last month points to the role TB and other infectious diseases are playing in a simmering dispute over wages and working conditions for correctional officers.
In fact, rates of TB, hepatitis C, and HIV have all been falling inside state prisons for the past several years, says Lester Wright, MD, chief medical officer of the New York Department of Corrections.
At the same time, the threat of the three diseases has become an important talking-point in arguments union officials are using to try to win more sympathy as they prepare to renegotiate contracts next year. In conversations with correctional officers, it seems clear that many who make their living guarding the state’s prisoners are genuinely fearful of contracting TB, HIV, and hepatitis C.
"You’ve got 70 inmates and one officer in a dorm, and you’re sitting there just breathing all that stuff," says Richard Harcrowe, the newly elected president of the 24,000-member New York State Correction Officers and Police Benevolent Association. Harcrowe adds he worries that getting skin-tested for TB once a year may not be enough. "When I took my kid to the doctor the other day, she told me I should be wearing one of those moon suits to go to work," he says.
The New York state correctional officer who contracted the multidrug-resistant TB and infected his young son seems to have been incorporated into a sort of institutional memory, and several union officials referred to the 10-year-old episode as if it happened only a few weeks ago.
Mandatory prophylaxis — well, almost
Union officials also say inmates with hepatitis C or HIV use their own bodily fluids as assault weapons. "It’s not just a question of getting attacked or stabbed or pushed down the stairs anymore," says Tom Butler, a media spokesman for the union. "Inmates throw their urine and feces at officers. They’ll bite down on their lip until it bleeds, and then spit a spray of blood into an officer’s mouth or eyes."
Others in the union cite the case of the officer who contracted hepatitis C on the job, and is currently on a waiting list for a liver transplant. "He’s 46 years old, with three kids," reports Anthony Farda, the union’s central region vice president. Many officers’ biggest fear, he adds, is "the worry that after you leave the work environment, you could go home and infect the ones you love."
Ironically, rates of TB and other infectious disease have dropped dramatically inside the system. TB is down from 225/100,000 10 years ago to 24/100,000 last year, Wright says. Less than half of last year’s case rate reflects cases diagnosed inside the system; considering only that smaller number, the case rate last year was only 11-12/100,000. "Our new case rate was lower than that of the borough of Manhattan, which is where I live," Wright adds.
One important tool in the fight against TB has been the state’s aggressive approach to prophylaxis, Wright says. "Our inmates come into the system with a skin-test positivity rate of about 25%," he points out. "In my system, it isn’t mandatory that they all get prophylaxis — but it’s pretty darn close to it." That means either isoniazid or short-course treatment, which often translates to rifampin alone, instead of the sometimes-troublesome combination of rifampin plus pyrazinamide, he adds.
Just two cases, not 18
Last month’s incorrect report — that there were eighteen active TB cases at Marcy Correctional System — may reflect some of the evident disconnect at the union between perception and reality. Although results of several cultures still are pending, there are only two cases at Marcy so far, both pan-sensitive — one index case, and one secondary case, says Wright. (Cultures still were pending for several more subjects.)
The investigation has also uncovered 50 tuberculin skin-test (TST) conversions, including 47 in inmates and three in staff members. The index case was hospitalized within two weeks after first complaining of symptoms; hence, the large number of conversions simply reflects that "this was a hot’ case," adds Wright. "Why some cases are more infectious than others, we have no way of knowing."
Because there were so many conversions, Wright says he decided to err on the side of caution, collecting sputum samples from anyone with impaired immunity or a TST conversion; and from anyone in the circle of contacts with any symptoms, regardless of skin-test status.
HIV seroprevalence rates inside the prisons have also been falling, at the rate of about 1% a year for the past dozen years. There still are about 5,000-5,500 prisoners in the system who are HIV-positive, he adds; that amounts to a prevalence of 5% to 6% among males, and about 14% among females. All HIV-infected inmates are treated with "everything in the books," he adds. "Since the advent of [Highly Active Antiretroviral Therapy], our death rate has fallen over 90%."
Hepatitis C rates are higher — about 14% in males, and about twice that in females. Those infected with the virus, which tends to establish a chronic infection the sequellae of which include cirrhosis and liver cancer, all are treated with combination therapy, a costly step not many state systems have taken.
Part of the union’s argument clearly has to do with money, not just infectious disease. Officers working for the state start in "the low $20,000s," and must work for 20 years before they’re making $50,000. By comparison, a New York City correctional officer typically makes $50,000 within five years, Farda adds. The low salary makes it especially hard on officers stationed in the southern part of the state, where costs of living are higher, Butler adds. "Try living anywhere but your Mom’s basement on $20,000 a year in the New York City area," he says. Farda says that to make ends meet, some officers must resort to food stamps; and that those stationed far from their families make do by cramming in eight or more to an apartment during their work week.
"I’m no medical expert," Farda says. "But working in those places isn’t pretty. And to fear that I’ve infected someone in my family with a terrible disease — that’s as bad as it gets." That, he and others in the union say, ought at least to be worth some more money.
An incorrect report of an extensive outbreak of TB at a New York state prison last month points to the role TB and other infectious diseases are playing in a simmering dispute over wages and working conditions for correctional officers.
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