As Suspects Wait, the Fear of Tuberculosis Rises
In the basement of the New York City Criminal Courts Building in Brooklyn recently, so many men were crammed into four small holding pens that most had only enough room to stand.
It would be at least one or two days before they were arraigned on charges as disparate as loitering and murder. And prisoners’ rights advocates and health experts worry that while they waited, some of them could have become infected with tuberculosis.
Crowded spaces. Poor ventilation. A large population infected with the AIDS virus. Few places have under one roof so many factors associated with the spread of tuberculosis as jails and prisons, health officials say. And although health experts say infection usually occurs through prolonged exposure to someone with active tuberculosis, they stress that even the court pens, with their short-term incarceration, can be breeding grounds for infections. ‘Like a Polluted Stream’
“There are certain people who are extremely infectious and we usually don’t know which people those are, so it’s possible to get infected with relatively low contact,” said Dr. Tom Frieden, a medical epidemiologist with the Federal Centers for Disease Control and member of a multi-agency task force looking at the TB problem in the city’s correctional system.
But New York City’s court pens and jails, from which 70 percent of New York state’s prison inmates come, are ill-equipped to combat a public health threat that once seemed near elimination and is now found at five times the national average.
“You can’t breathe,” said Julius Trowell, a 35-year-old who spoke through the bars of one of the 8 1/2-by-14-foot windowless cells in Brooklyn that held 19 men.
The situation, many agree, heightens the risk for the general community and for those who work in the criminal-justice system. Several pregnant legal aid lawyers, for example, have taken disability leaves rather than risk possible infection with the germ, and court interpreters have begun to worry whether their proximity to inmates during trials puts them at risk.
Of the 213,000 to 247,000 people a year charged with a crime in New York City, 120,000 to 140,000 go to jail, and half of those are back out in two weeks or less, according to the New York City Health Department.
“The criminal justice system is like a polluted stream that can spread its poison to the larger body of water,” said Robert Gangi, executive director of the Correctional Association of New York, a nonprofit watchdog group. “The system is not only not preventing but it’s contributing to the problem.”
The Centers for Disease Control says cases of tuberculosis in correctional centers arise at rates at least three times higher than in the general population. Last year, a drug-resistant strain killed 13 inmates and a guard in New York state prisons, and four inmates in New York City jails.
The problem in New York City is all the more urgent because a substantially high proportion of the city’s inmate population — an estimated 26 percent of the women and 16 percent of men — are at higher risk of developing active tuberculosis once infected with the germ because they carry H.I.V., the virus that causes AIDS, health officials say. It is not yet known whether those who are infected with H.I.V. are also at a higher risk of catching the germ, health experts say.
While only 1 in 10 healthy people who become infected with the TB germ will ever develop the disease, people with the human immunodeficiency virus have impaired immune systems and are more likely to develop active TB. It is those with active TB, a chronic wasting illness characterized by coughing, fevers and weight loss, who can infect others, experts say. ‘Right From the Streets’
Many wonder about the cumulative hazard posed by their routine contact with inmates. Corrections officers, usually more concerned with the threat of a violent attack from their charges, now worry more about catching a deadly disease.
“At least in an institution they go to a clinic and they are de-liced and they get a full medical exam, but here they’re right from the streets,” said Denise Strother, 34, a Correction Department officer.
The growing tuberculosis problem in the city — new cases rose 38 percent from 1989 to 1990 — prompted the creation of a task force late last year to recommend ways to control the disease in jails and holding pens. The increase has also emphasized the need for coordination and joint efforts among city agencies that deal with the same high-risk populations, city health officials say. Thirty percent of the city’s inmates, for instance, are homeless and pass through the shelter system.
But measuring the extent of the problem has proved difficult. Transfers Stall Readings
Dr. Steven Safyer, a doctor at Montefiore Medical Center in the Bronx who also directs health services at Rikers Island, said that although all inmates are examined when admitted to jail, checking them for TB is hampered because they are often moved around the jail system.
The standard TB test entails injecting a harmless tuberculosis protein under the skin, and waiting 48 to 72 hours to see if a small lump forms indicating infection. But many inmates are either released or transferred to another jail within that time. As a result, Dr. Safyer said, it can take weeks rather than days to get a reading.
In addition, a high number of inmates test negative for tuberculosis even when they are positive because the test can be unreliable when done on people with abnormal immune functions, like those infected with H.I.V. Drug-Resistant Strain
Health officials say that 15 to 25 percent of the city’s inmates test positive for the TB germ, compared with less than 3 percent for the general community. At Rikers Island, 125 to 150 inmates are on anti-tuberculosis medication at any given time, compared with 35 three years ago.
Twelve inmates died from TB in city jails last year, up from 7 in 1990, 10 in 1989 and 2 in 1988. Four of the 1991 deaths were caused by a drug-resistant strain, which develops in people who do not take their medication consistently and in those they infect.
But the court pens may be the best breeding ground for the disease because the physical conditions are poorer and there is no medical screening for detainees.
During a tour of court pens in Brooklyn and Manhattan this month, the air exchange units in Brooklyn that were supposed to compensate for the lack of windows were shut off, and in Manhattan a fan provided the only air movement for as many as four pens. Although detainees are supposed to appear before a judge within 24 hours of their arrest, some said they had waited for two days.
In Brooklyn, one detainee said he had TB and complained that he had not been able to take his medication since his arrest the day before. But officers said his complaint that day was the first they had heard of.
Raul Jardines, 32, a correction officer for seven years who works in the Manhattan courthouse, tested positive for TB two years ago and is convinced that he caught the germ on the job. Preventative Measures
“You can’t avoid the contact,” he said. “If I treated you like you’re a germ it would cause undue hostility.”
Members of the TB task force say some prevention steps are easy.
“If you open a window you’re going to cut down on TB transmission,” said June S. Binney, assistant commissioner for correctional health services in the New York City Health Department.
But the task force, which is headed by the city Health Commissioner, Dr. Margaret A. Hamburg, and includes representatives from the Department of Correction, the Centers for Disease Control and the Mayor’s office, is also looking into more substantive steps, including keeping inmates in the same place for at least 72 hours until the TB tests are read.
City health officials have already noted that the jails are in dire need of at least 100 isolation beds — they have none now — and the Correction Department has been ordered by the court to provide 42 of those by May. Detection and Treatment
Advocates for prisoners’ rights say on-site medical evaluations should be instituted in the court pens to spot those with symptoms and determine health and medication needs.
City health officials say that part of the urgency of tackling TB in the criminal-justice system stems from the fact that jails could be the best place to identify cases early and treat them effectively.
But some say most of the measures under consideration should have been in place long ago.
“It was always inhumane to keep people like that,” said Michael Z. Letwin, president of the Association of Legal Aid Attorneys, which is pushing for TB testing of its members every six months, rather than once a year.
“But now it poses a threat to the entire city,” he said.
Photo: Crowded spaces like the holding cell above at Centre Street in Manhattan prove to be perfect for the spread of tuberculosis. While health experts say that infection usually occurs through prolonged exposure, some people are extremely infectious. (Dith Pran/The New York Times)
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