By ESTEBAN PARRA
and LEE WILLIAMS 10/09/2005
Mark Stewart is afraid of infecting his fiancee and friends in southern Delaware's network of small, quiet communities.
A 45-year-old convicted drug user, Stewart is a likely carrier of a virulent bacteria called methicillin-resistant staphylococcus aureus, or MRSA, which can lead to infection by flesh-eating bacteria. He believes he contracted MRSA inside prison in Delaware, where he spent six months recently on a probation violation. In that stay behind bars, Stewart was exposed to bacteria by a cellmate who burst his own untreated boils. Soon after, a spot on Stewart's scalp swelled into a bump.
In a letter dated last month, Stewart's doctor warned prison officials about the condition and the potential for its spread to other probationers during Stewart's weekly visits to the Sussex Violation of Probation Center in Georgetown.
"Mark did have an MRSA infection," Dr. Stephen D. Carey wrote in a letter Stewart said he delivered to Robert I. George, the Sussex Community Corrections Center's warden. "He is likely now to be a carrier of that bacteria. The implications of this to your organization are to be determined by yourselves, however, he is again a carrier of the methicillin-resistant staphylococcus aureus infection."
"Mark did have an MRSA infection," Dr. Stephen D. Carey wrote in a letter Stewart said he delivered to Robert I. George, the Sussex Community Corrections Center's warden. "He is likely now to be a carrier of that bacteria. The implications of this to your organization are to be determined by yourselves, however, he is again a carrier of the methicillin-resistant staphylococcus aureus infection."
"I don't want to endanger anyone," said Stewart, who was diagnosed in May with the antibiotic-resistant condition. The Blades resident had more than 2 inches of skin removed from the back of his scalp. "Now I have a life sentence of MRSA."
Stewart is one of a handful of inmates and their family members interviewed by The News Journal who claim Delaware inmates are picking up varieties of infections that can cause necrotizing wounds, which, like gangrene, spread and kill the surrounding soft tissues. Untreated, or misdiagnosed, the infections can lead to pneumonia, meningitis, toxic shock and death.
According to a 1996 report by the U.S. Centers for Disease Control and Prevention, an average of 500 to 1,500 cases of MRSA are reported each year in the United States. Around 20 percent end in death.
The spider myth
Many Delaware inmates initially complain about spider bites and claim they have been told by doctors and nurses working in Delaware's prisons that brown recluse spiders are behind a host of welts, boils and oozing wounds.
But brown recluse spiders aren't common in Delaware and a senior vice president of Correctional Medical Services, or CMS, the state prison's health provider, believes spider bites are often wrongly diagnosed.
Beth Welch, spokeswoman for Correction Commissioner Stan Taylor, said in an e-mail that the prison has "not had a confirmed brown recluse spider bite case. No, we do not have a spider problem."
In prison "there has been significant amount of misinformation on the 'inmate grapevine' that attributes these otherwise unremarkable lesions to, most often, arachnid bites," Dr. Louis C. Tripoli of CMS wrote in an article last year for an American Correctional Health Services Association newsletter.
Taylor said three cases of flesh-eating bacteria have been confirmed in Delaware prisons over the past three years, but eight inmates or their family members told The News Journal that they have been treated over the same period for necrotizing wounds.
Necrotizing fasciitis, the medical term for infection by flesh-eating bacteria, is caused by the bacterium streptococcus pyrogenes. That disease can infect the skin through lesions caused by MRSA infection.
MRSA bacteria enter the body through a cut or scrape. The infection is usually treated with a massive infusion of antibiotics delivered through an IV and removal of the affected tissue. Amputations and skin grafts are common, and most survivors end up scarred when treatment is delayed.
Physical contact is enough to pass on the bacteria. It also can be spread by touching surfaces or laundry that have been contaminated with tainted body fluids.
"The use of alcohol-containing antiseptic scrubs is common in the noncorrectional setting, but because of security concerns, these particular disinfectants are not as available in the correctional setting as outside," wrote Tripoli, who recommends that an adequate hand-washing should take 15-30 seconds. He also urges that surfaces used by multiple people be decontaminated.
"An important aspect of correctional officer training is to facilitate inmate reporting of even minor-appearing skin infections so that there can be measures taken to make sure that this does not represent a methicillin-resistant staphylococcus outbreak," Tripoli wrote.
Stewart said this is not the practice in Delaware's prisons. Welch said she would check on how Delaware prisons deal with MRSA, but didn't immediately provide details.
Starting in December, Stewart spent six months in the Sussex Work Release Center in Georgetown after violating his probation for possession of drugs and drug paraphernalia. Two of those months, Stewart said, he shared a cell with an inmate prescribed Benadryl by doctors to treat a large boil on his leg.
"It got so bad that he eventually cut it open to drain it himself," Stewart said. "I know because I watched him do it."
In April, Stewart felt a small bump on the back of his head. The bump grew over the next few weeks, but since he had less then a month before he was released, Stewart decided to wait until he left the prison to see a doctor.
"All they gave my roommate was Benadryl," Stewart said. "I wanted to see a real doctor."
When he was released in May, Stewart visited a physician, who immediately scheduled him for surgery. Within 24 hours, Stewart said the doctor removed an area from his scalp about the size of a half-dollar.
"I was in the hospital for four days while they treated me with IV antibiotics to stop the infection from spreading to the rest of my body," he said. "On Sept. 16, I was again operated on to perform a skin graft in order to cover [several more] inches of removed tissue."
Stewart needed 17 staples to hold the graft in place, he said.
On Monday, Stewart hand-delivered a letter to correction officers explaining his condition and the risk he poses. "I'm carrying in germs," he said. "I could be passing this on to other people on the inside."
The DOC would not respond to questions about Stewart's condition, citing federal privacy laws.
'More dangerous'
Until a few years ago, these drug-resistant infections were unheard of except in hospital patients, prison inmates and the chronically ill, said Dr. John Bartlett, who chairs the committee on antibiotic resistance at the Infectious Diseases Society of America. Now, resistant strains are infecting healthy children, athletes and others with no connection to a hospital.
"This is a new bug," said Bartlett. "It's a different strain than in the hospital ... more dangerous than other staph."
Bartlett, a professor at Johns Hopkins University School of Medicine, treated three young Baltimore-area women this year who got pneumonia from antibiotic-resistant staph.
Because staph is so contagious, the Federal Bureau of Prisons considered the detection of two or more cases of MRSA, when caused by the same strain in the same place, to be an outbreak.
MRSA and necrotizing wounds are contributing to a series of complex problems plaguing Delaware prisons.In a series of articles published last month, The News Journal examined high rates of AIDS-related inmate deaths and suicides over the past four years and allegations by inmates of poor medical treatment for cancer, meningitis and staph infections.
In response to the series and other complaints, the Civil Rights Division of the U.S. Department of Justice last week launched a formal inquiry into prison conditions in Delaware.
Near death
Michael Surtees is a Gander Hill inmate who suffered from MRSA.
Surtees, who pleaded guilty in 2003 to first-degree attempted robbery, became infected with MRSA last October after a wisdom tooth was removed, according to a lawsuit filed in New Castle County Superior Court.
Even though he was experiencing pain, neck swelling and shortness of breath, Surtees went five days without treatment, the lawsuit claims. On Oct. 11, 2004, he was taken to Christiana Hospital, where he underwent several surgeries on his neck and throat and was placed on a ventilator.
Nearly a month later, Surtees regained full consciousness.
"I just woke up at Christiana Hospital," he said. "I was shocked. I still thought I was in the infirmary."
Surtees almost died, his family contends. He remained in the hospital until Dec. 19.
In addition to scars created by tubes in his stomach and chest, the 24-year-old's vocal cords were damaged. His now-soft voice has earned him the nickname Whispers around the prison.
"I got to laugh it off," he said.
Staph infections are costing thousands of dollars for the treatment of Delaware inmates like Surtees and Japhis Lampkins, who is serving a life sentence for the 1980 robbery-murder of a 59-year-old Wilmington woman.
Lampkins, 57, thought he was bitten by a spider. Within weeks, a boil appeared on his testicles. He complained about the pain to a nurse at the Delaware Correctional Center near Smyrna.
She told him to hold a hot compress on the wound and return to his cell, his family claims.
In August, with the skin sloughing off his scrotum, Lampkins threatened to cut his arm and write the nurse's name in blood on a wall if the nurse didn't refer him to a doctor at a hospital, his family said.
Lampkins was sent to Kent General Hospital last month, with two correctional officers guarding him 24 hours a day.
A surgeon sliced into Lampkins' scrotum, removing the skin around his testicles. Doctors cut a piece of skin from his left leg and performed plastic surgery to repair a gaping wound.
"If the infection continues, they will have to remove his testicles," said Lisha Meades, Lampkins' niece.
Contact Esteban Parra at 324-2299 or eparra@delawareonline.com. Contact investigative reporter Lee Williams at 324-2362 or lwilliams@delawareonline.com. The Associated Press contributed to this article.
