March 3- 9, 2005

city beat

Skin Deep Trouble

A national outbreak could spawn a local emergency.

by Mike Newall

It usually first appears in a warm, moist section of the body, like an armpit or the crotch. Initially, it is a small, red bump, similar to a spider bite. Within days, it develops into a boil the size of a grapefruit with the potential to spread fatal poisons into the bloodstream. In other strains, it gradually eats away at a victim's flesh. Methicillin-resistant staphylococcus aureus (MRSA) is a highly contagious skin infection that is resistant to the most commonly used antibiotics. It is often ignored by patients or mistreated by doctors, allowing the infection time to grow and become more dangerous.

In the past, MRSA was most often restricted to hospitals and jailhouses, environments filled with people with compromised immune systems, doctors say. In recent years, MRSA has mutated into a potentially more dangerous infection that's attacking the average population more frequently, infecting athletic centers, gymnasiums and health clubs. In 2003, a senior wide receiver from Lycoming College in Williamsport complained of MRSA symptoms on a Tuesday. He died the following Saturday.

Last spring, the Children's Hospital of Philadelphia presented a study that found a sharp increase of MRSA in otherwise healthy local children. There have been roughly 100 children treated for MRSA there in the last four years. "The cause is unknown," says study co-author Susan Coffin of the increase. "It's a phenomenon appearing all across the country."

"We don't have the national data yet, but there definitely has been an increase of MRSA cases in the general community," says Jennifer Morcone of the Centers for Disease Control and Prevention.

While a Feb. 28 Sports Illustrated article detailed how MRSA has begun to appear more frequently in school and professional athletic locker rooms, Vincent Thompson, a spokesperson for the School District of Philadelphia, said no one has ever thought to track MRSA in local students.

"We are just learning about MRSA," says Thompson, "but we will begin a process of informing parents, especially those of athletes, about the prevention, symptoms and treatment of it."

As health and school officials across the nation move to prevent the spread of MRSA, Pennsylvania prisons continue to pay the consequences for allowing the infection to spread under their watch.

In January, a federal judge ordered the Bucks County prison system to pay a combined $1.2 million to two former inmates who battled MRSA behind bars. Kevin Keller, 27, was repeatedly turned away by prison health officials, his attorneys claim, even after he had developed a large MRSA boil on his scrotum. After finally seeing Keller, officials had him isolated in a solitary confinement cell — the prison has no infirmary — where he lay in pain for 36 hours on a mattress stained with urine, blood and vomit before being seen by a doctor. Benjamin Martin, 23, nearly had to have one of his legs amputated by the time prison officials properly treated him. Bucks County still faces five other MRSA-related lawsuits as well as a class-action suit, aiming to improve prison medical facilities and treatment.

"People might not have the most sympathy for prisoners," says Angus Love, a lawyer for the Philadelphia Institutional Law Project, which provides free legal services to prisoners. "But this is a public-health issue. These county guys are circulated very quickly through the system. These folks bring whatever they get back into their communities."

Counsel for four of the 12 Philadelphia County inmates claiming to have been improperly treated after their MRSA diagnoses, Love argues overcrowded local prisons are rife with poor sanitary conditions and inadequate medical services that foster the spread of MRSA.

The city solicitor's office has been mediating negotiations between the inmates attorneys and Prison Health Services (PHS), the private contracting company that oversees medical treatment in Philly jails. Both sides charactize the talks as amicable and say a financial settlement will be agreed upon without having to go to court.

"The city Law Department, the Health Department and the managing director's office are taking a collective and aggressive approach on MRSA," says Carlton Johnson, the chief deputy solicitor overseeing the negotiations. "There is a complete review of our prison medical protocals underway to ensure that we are meeting the standards annunciated by the Centers for Disease Control and Prevention."

PHS, one of the nation's largest for-profit providers of prison medical treatment, has repeatedly come under fire for practicing shoddy medicine, including here, as a federal court in the 1990s found dangerous shortfalls in treatment. Philadelphia County Prison spokesman Bob Eskind says that while there have been problems with PHS medical service in the past, they're doing everything possible to prevent MRSA's spread.

"There has been increased training for prevention, diagnosis and treatment among all the medical staff, officers and inmates," says Eskind, who described the number of inmates diagnosed with MRSA as a "tiny portion."

Love is not convinced. "This thing spreads like wildfire," he says. "Where there's smoke, there's fire."