TB and MRSA and Ronald Reagan

I will always think of Ronald Reagan as the president who brought back tuberculosis.  I think of all the evil he did, corruption at home and abroad, his legacy should most appropriately linked to inflicting disease on America.

I thought I had remembered Reagan cutting of the tuberculosis funds in the eighties, but I could find so little reference to this political crime, I began to doubt my memory.  Ironically, when you run a search of "Ronald Reagan and tuberculosis" you mainly get an outbreak among the sailors on the USS Ronald Reagan in 2006.  

My memory in this case was correct.  These are from a publication of the Johns Hopkins University Press in 2004 (click the title):

        Unlike the outbreaks of “emerging” diseases like Ebola, Hanta Virus or AIDS, when New York City faced an epidemic of resurgent tuberculosis in 1990-91 the famous disease detectives of the CDC  faced the challenge, not of identifying a new pathogen, but of developing policies to correct a breakdown in institutional disease control that had been more than a decade in the making. The few remaining tuberculosis specialists in the United States had warned for years that a TB resurgence was likely due to the dismantling of the city’s public health surveillance and treatment programs since the 1960s. One of those critics was Dr. Lee Reichman, Executive Director of the National Tuberculosis Center in Newark, N.J., who in 1992 described the upsurge in TB cases as “horrendous” to a New York Times reporter, remarking that, “This was a 100% preventable and curable disease.”

And,

   The rightwing political climate had generated an atmosphere of retrenchment in the public health community. Every year from 1981-87 the Reagan Administration called for repeal of the federal tuberculosis program (Ryan 1992).  Ironically, in 1986, the year when New York City’s TB case rates suddenly rose by 20% over the previous year, the federal-supported TB surveillance program for drug resistance was discontinued (Berkelman 1994). 

Of course, in the early eighties, tuberculosis was not much of a problem, but Reagan guaranteed it would become one.  I first started seeing tuberculosis during about the same time in Brownsville in the jail when the jailers were getting sick and calling about workers' compensation claims.  Of course, we could then still blame the problem on sick people coming across from Mexico.  Not anymore.

Now we are hearing about MRSA or the antibiotic resistant strains of staph.  These have been around for a while.  I had a case involving an infection in a local hospital about 15 years ago.  My client had gone into the hospital for a knee replacement.  The radiologist had burned him and then the burn was infected with an drug resistant staph infection.

The expert witnesses gave information about the disease, but the facts that struck me were the origin of the disease and why it sticks around.  As I recall from the expert testimony, MRSA arose in Detroit among drug users who were passing needles around and treating themselves with antibiotics, but not allowing a long enough course of treatment to cure the disease.  Soon, though, it was in hospitals all over the country.  The problem is that modern hospitals don't have windows that will open.  The bug is killed with fresh air and sunlight.

Now, the bug sits in wait in almost every hospital, jail, military base and school.  About a third of us would show positive for some staph infection if we all got our noses swabbed.  Many people don't get sick, but some are more susceptible than others.  Especially those with open wounds or compromised immune systems.

What does this have to do with government?  First, this is not even a disease that requires reporting to the CDC, so we don't know how many have it or how many have died.  However, it is generally believed as infectious diseases go, to be the biggest killer in the country.  Second, it is a disease perpetuated by a large poor, sick, incarcerated population.  

Twenty eight years of Reaganism has taken a toll.  I hope it ends this year.

Cameron County Can't Afford Death Penalty Prosecutions

How much does it cost to kill a man? How much should it cost?

North Carolina estimated that that an execution costs $2.6 million more than a non-death murder case. Florida says $3.2 million per prosecution, but the average cost of those executed has averaged out at $24 million. Californians have paid more than a quarter of a billion for each of the state's eleven executions.

The Dallas Morning News estimates that each Texas death penalty case costs an average of $2.3 million.

The trial alone involves a hefty increased fee. The State of Kansas estimated $508,000 per capital case more than plain vanilla murder. The State of Washington said it was $470,000 on top of the costs for another type of murder. Washington also estimated as much as an additional $70,000 for court personnel and $100,000 for appeal.

In a February 4, 2008 article in the New Yorker Magazine called Death In Georgia: The high price of trying to save an infamous killer’s life by Jeffrey Toobin, the author describes a trial in which the entire indigent defense budget of the county of $1.2 million was exhausted before the first juror was picked. The case had to be put on hold until more money could be found.

Cameron County has charged about 100 people with capital murder according to an i-docket count. These cases appear to go back about ten years.

I recently requested a count of the number of pending capital prosecutions in Cameron County. The number is an extraordinary 18 cases with two on death row.

With even a conservative price of, say, $2 million per execution and Cameron County proposes to execute all twenty of these people, the price will be about $40 million. I am not accountant, but this looks to me like it is impossible with Cameron County's budget.

Nor am I very good at reading budgets, but it appears that the Cameron County's 2008 is $111 million. The indigent defense budget is located in two places. One is for personnel in the amount of $199,000, down from $223,000 in 2007 and the other from a General Fund in the amount of less than $900,000. My guess is the second number represents the approximately $6,000 per month per court for contract attorneys and appointments and the first number is court personnel who run the system, but I welcome correction and explanation from the numbers crunchers among you, Readers True.

Assume that no new capital indictments are issued and the costs of the 20 now targeted for death is spread out over five years, that is still $8 million per year. The entire cost of the jail for 2008 is only about $4 million. The district courts are $2.4 million a year. The County Courts at Law run $1.5 million.

In other words, to truly prosecute and defend this many capital cases, the expense would be greater than the entire criminal and civil justice system in Cameron County. We would need to shut down the jail and all the courts to be able to fund the prosecutions, but of course then we would have no place to put or try the capital inmates. Either that or cut into indigent health care, burials and road crews.

So if the numbers are impossible, how is it that Cameron County is pretending to prosecute 18 pending capital cases with two on death row. I have a couple of guesses. One is that many of these 18 shouldn't be capital cases at all and will be reduced, but only after small fortunes are spent to pretend they are capital cases for a while. Another is that the judges will try to defend these cases without spending this much money.

Every old-time criminal lawyer has a story about how he was made to take a capital case, worked on it for months or years and then either not paid or paid a pittance. Other horror stories abound of expert witnesses who were stiffed. Differently put, the county pretended to pay for the defense of capital cases, but did not. So the quality of justice was low, which means in in a capital case that the risk of executing the innocent was high.

The law has changed in the last few years so that if the lawyer falls asleep in the course of the trial of a capital case or the trial judges refuse to pay for needed expert witnesses, the cases will be reversed and sent back to be tried again. For a defense to be constitutional, every defendant must have a mitigation specialist thoroughly investigate the background of the defendant and present that information at trial to support life rather than death. He must have a psychologist on the trial team. He must be able to investigate the facts and have experts who can analyze the physical evidence. He must have parity with the state in resources.

As far as I can tell, these minimum requirements have not been met in the past. Under these conditions, if things are not done better now than they were before, Cameron County may produce some death penalty convictions, but they won't be legal.

We will enter into an endless cycle of cheap, illegal trials that have to be redone because no one has the political will to require that indigent capital defendants receive a defense that meets minimum requirements of the constitution. Because of lawyer errors, we will likely get some executions, but we won't really know if the people being executed are guilty.

We pay a high price for cheap justice.

If this is the way Queen Victoria treats her prisoners, she doesn't deserve to have any.

Today I received a letter signed by 21 women who are inmates in the Cameron County Jail. I won't include their names because I don't know the status of their cases or whether there is a risk of retaliation.

Please remember these women have usually not been convicted of the crimes they are accused of committing. If they are convicted, they will be moved to a prison. Some may have never committed any crime at all. The following are excerpts with spelling and grammar as I received it:

"To start here in this Jail all the guards are nice persons. I think is not there fault about what's going on in this Jail is the fault of the County the one that is responsable for it. The food is so bad, sometimes it comes with hairs, with nats the water too. About the toilet paper we still having hard time with it one day thay had us with two brown paper napkins for each inmate. Now that Mrs. Gail Hanson has been banned out from this jail like we don't have nobody that we can tell about what we are passing through all weekend and other day we havent no toilet paper if we need they just give us a piece but in the cell we don't have none.

"...About the medical ...other girls they wait they cry of pain or about their physical problems. And the stuff take their time, while the inmate is hurting.

"I was like...bleeding of my surgery and they would give me hydrocarbonate water to clean the cut that was infected. They didn't took me to the doctor until the Consul of Mexico call them.

"Some of the inmates have the mattess torn and the blankets are torn.

"Commisary takes advantage of all the Inmates by selling the items on a very very high price. Somthings comes expire. They do it because they know we don't have other choice.

"The indigent package is toothpaste, a bar of soap and a toothbrush. When they should provide at least one stamp, envelope, one piece of paper and one pen so can the families be notify not everybondy takes collect calls and they should start selling phone cards.

"Recreation should be at least 3 times a week and not always they do that we could one week without getting rec. and that's unfair."

Is this true? In my experience, inmates tend to be more straight forward than people in the free world, just because there are few pretensions left. I think inmates tend to suffer silently. As our founding document says, it is a self-evident truth that 'mankind is more disposed to suffer while evils are sufferable than to right themselves by abolishing the forms to which they are accustomed.' Since these women don't have much chance to abolish the jail, they will be even more disposed to suffer according the self-evident truth of the Declaration of Independence.

Inmates often become stoics, perhaps not in philosophy, but certainly in practice. I have seen inmates suffering from swollen jaws, bad insect bites and dislocated shoulders not even mention the problem. Until I ask about it.

When inmates begin to risk complaints, the conditions have often pushed the boiling point--something else Cameron County has seen.

I have been listening to inmate complaints for over 30 years and I know that there are explanations for mistreatment. I had a client who ate light bulbs. Another who set her mattress on fire. And others who made a regular habit of stuffing up toilets and causing floods.

I don't know if Cameron County jailers were faced with these types of problems, but I know that jailers reach decisions to deprive the inmates based on violations of jail rules. Sometimes jails run out of supplies, which may be the case with toilet paper here.

Part of the problem is sometimes everyone gets punished if the jail administrators can't figure out who is causing the problem. This creates moral and ethical problems. There is a specific provision in the Geneva Conventions that prohibits group punishment.

If it is true that the inmates go a week without recreation, that is a violation of the Jail Standards Commission:

Each facility shall have and implement a written plan, approved by the Commission, for inmate physical exercise and physical recreation. Documentation of physical exercise and physical recreation shall be maintained for Commission review. Each inmate shall be allowed one hour of supervised physical exercise or physical recreation at least three days per week. (Click on the title for reference to the Texas Jail Standards).

Part of the problem is sometimes neither inmates nor jailers know what conditions should be expected under the jail standards. The inmates don't know to ask for them and the jailers don't know what they should be providing.

The commissary is a different type of problem. One of the Democratic candidates for sheriff attempted to make an issue of giving a private contract on the commissary. I was glad he raised the issue, but doubted it would help him much in the campaign.

A private, profit motive for a captive market is not free enterprise. I don't know what the prices are, but there is no reason prices won't be extortionate because there is no competition. Why not give this contract to the Big Brothers, Sierra Club or the Kiwanians or the Hanna High band? Any nonprofit is better than a private, profit making group. Contracting out the courthouse restaurant is different from the jail commissary, because in the courthouse, if prices are too high or the food is old, people can go somewhere else.

Security is also often a problem. The women's jail does not report complaints of being controlled by prison gangs, but I have heard these complaints from Carrizales-Rucker.

The most disturbing thing about the letter remains the complaint that a jail minister is being excluded for fielding complaints. This creates problems both for the Free Exercise of Religion and for shining a light on the nature of the problem. If no one can report on what goes on in a jail, it becomes a dungeon.

More Jail Musings

"When is my death row job available?"

Archer Daniel Midland could do executions cheaper

All rise!

Finally some real judicial economy.

Cameron County does not have the worst jail in the world. In fact it is not even the worst jail in the Valley. On a scale of bad, worse, horrible, the standings would be Cameron County, Willacy Detention Center, with La Villa coming in last. These are all places where federal prisoners are kept, but the last two are privately owned facilities.

My impression has been that La Villa is by far the worst of the three and lately there seem to be fewer Brownsville prisoners housed there. Maybe the U.S. Marshal's office finally gave up on them. I had one client in La Villa who tells me he screamed for twelve hours trying to get attention during an appendicitis attack. The other guys in the jail were screaming with him. He didn't die and after his surgery, he cleaned up pretty well, but it could have been bad. He was in jail on a charge of entering the country illegally.

There are certain things that privatization may make cheaper, but depending on the goals involved, it sure doesn't make things better. Private jails may make a profit, but they don't do much for the quality of justice.

Why not sell the courthouses to Walmart and allow them to use Walmart greeters as judges? This would be cheap. The same for executions. Executions could be contracted out to Archer-Daniels-Midland. They could use the same employees used in the slaughterhouses. This would be cheap.

Cameron County Jail Needs Gail Hanson

(None of us are perfect. --- Sometimes you need a little help from a friend)

First may I confess to the Seven Deadly Sins: Pride, Covetousness, Lust, Anger, Envy, Gluttony, Sloth. Especially Gluttony and Sloth, because aging has stolen the energy I once had for the others.

That having been said, the Cameron County Jail, and for that matter, the Cameron County Criminal Justice System, and for that matter, jails, prisons and criminal justice systems in the United States could use some improvement.

Sheriffs (including this Sheriff) become defensive when "their" jail is discussed. The recent election cycle showed the weird spectacle of a jail preacher talking about how nice the jail is and the good doctor discussing how good the care is, in defense of the sheriff who, no doubt, is practically perfect in every way.

So before we move to specifics, let me pontificate in general that the tensions between sheriffs, county commissioners, police agencies, and Texas State Government guarantee that all the jails in the State are substandard. Not that all would fail a gumming test by the toothless Texas Commission on Jail Standards, but none do what they are intended to do: that is, hold people who are presumed innocent in a humane manner until they can be tried and convicted or acquitted.

The best sheriff would probably not be a policeman at all, but have some management experience in running a hotel or a restaurant or a hospital or a school or a monastery. Unfortunately, for reasons mired in other social defects, the only candidates who present themselves for the august position tend to be cops. More on this after some reflection during the wee hours of the morning: "Why don't other folks, besides police officers, want to be sheriff?"

In the meantime, sheriffs cannot run a good jail, because commissioners won't give them the money to do so. Commissioners won't give them the money to do so, because they would rather hire someone for the road crew so they can get the patronage rather than giving it to the sheriff. Also, Commissioners won't give the money because felons and illegal immigrants who fill the jails can't vote. Also, Commissioners won't give the money because they are afraid some genius will start talking about criminals not needing to be in country clubs and sheriffs need to be tough guys to go with the police image rather than the motel manager image I think is more appropriate for the job.

Most folks don't worries too much about jail conditions unless they have a kid in jail. Did I ever tell you about my Republican Christian lawyer friend who ridiculed me for a couple of decades for talking about jail conditions until his son grew up, went bonkers, and spent months in and out of jail on minor offenses? All of a sudden he became interested in the 8th Amendment and prohibitions against cruel and unusual punishment. I felt I was being strong and kind by resisting saying,"I told you so," in the midst of his pain.

Does anyone remember when Cameron County Jailers were contracting tuberculosis from the inmates? Jails become a petri dish for disease and jailers (who mostly are there because they need a job and have families to support) catch those diseases.

This all leads up to the question on my mind: Isn't a shame, a scandal even, if Gail Hanson, private school administrator and jail pastor is excluded from the women's section of the jail because she advocates for the prisoners?