Leper mingled with other state prisoners

A prisoner with a history of leprosy who had visible lesions was allowed to circulate among hundreds of other inmates at two Minnesota prisons for nearly two months this spring after prison medical staff failed to properly assess and quarantine him for treatment, the Star Tribune has learned.

Dr. David Paulson, medical director for the state Department of Corrections, admitted in an interview that prison medical staff in St. Cloud failed a legal requirement to inform the Minnesota Department of Health that they suspected the offender had a communicable disease.

Paulson said he was at a loss to explain why a nurse and doctor initially responsible for the inmate's care did not take proper precautions. "I can't answer that. We needed to be notified right away. I've told them," he said.

The case provides a rare inside look at the confusion that can beset prison health officials who are not well versed in infectious diseases but care for thousands of inmates with vague medical histories.

Aung Moe, 31, was one of them. From mid-March to early May, he was held in the general population in prisons at St. Cloud and Rush City before a doctor reviewed his case and immediately ordered him transferred to the prison at Oak Park Heights, which has quarantine facilities.

As of Friday, state corrections officials still had not informed inmates in St. Cloud and Rush City about possible exposure to Moe's condition. But to alleviate fears among scores of staff at both prisons, they assured them by e-mail in early May that medical precautions had been taken and the risk of infection was slight.

"We're assuming he has the paucibacillary leprosy," Paulson said of Moe. While a biopsy taken from Moe last month from an extremely small skin sample did not show "active" lesions, Paulson said a larger sample might have.

Once greatly feared, leprosy is a slow-developing bacterial infection of the skin, nerves, bones and eyes. Most people are immune, and most who contract the disease can be cured with antibiotics.

"It's unlikely anyone was harmed by the two-month delay," said Dr. Priya Sampathkumar, a specialist in infectious diseases at the Mayo Clinic in Rochester, Minn. But prison officials should have evaluated Moe, taken photos and a skin biopsy and sought expert advice, she said.

"Leprosy raises alarms and there's a lot of hysteria associated with it," she said. "If I had my choice between undiagnosed tuberculosis and undiagnosed leprosy, leprosy is definitely much safer."

After Moe was transferred from St. Cloud, he was examined on May 3 by a prison doctor in Rush City. She saw two active lesions on his body and immediately raised doubts about whether he had been properly treated.

But by then, Moe had been in daily contact with prisoners since mid-March, according to a source with direct knowledge of the case and documents reviewed by the newspaper.

Paulson said that when he learned of the case from the doctor in Rush City, he ordered Moe placed in quarantine and put on antibiotics as a precaution. A day later, Moe was transferred by ambulance to Oak Park Heights. After nearly a month in quarantine, he was released last week from the isolation unit.

Leprosy can be spread by coughing and sneezing. Untreated, it can cause permanent damage. But antibiotics typically control the disease within weeks.

Indecision and delay

From the outset, Moe's case was characterized by confusion, indecision and a lengthy delay of treatment for what could have been a much more serious case of leprosy. Not reporting Moe's case violated a state law that suspicion or confirmation of infectious disease be reported immediately to the Department of Health.

The leprosy case, believed the first of its kind to face the Department of Corrections (DOC), at times was veiled in secrecy. Medical staff at Oak Park Heights were ordered for several days not to tell corrections officers about Moe's condition, the source said.

Moe, a non-English-speaking refugee from Burma (Myanmar), arrived at the St. Cloud prison in mid-March on a three-year sentence for a knife assault against his wife in Ramsey County. Through an interpreter, he told a prison nurse after an examination that he needed help for his skin condition. He said he was diagnosed with leprosy during his 20-year stay at a refugee camp in Thailand and had taken pills there for the disease from 2007 to 2010.

The nurse consulted with the prison doctor, checked Moe's account against medical drug tables and concluded he had received adequate treatment, even though he had scaly, raised lesions on his neck, chest and back, and could not identify the drugs he had received in Thailand. Moe also complained of numbness in his fingers and a forearm -- a condition associated with leprosy, documents show.

The prison doctor who consulted with the nurse is an employee of Corizon Inc., the for-profit medical provider that has come under fire in other states for poor medical care. Corizon provides health care to the state's 9,400 inmates.

The nurse is a state employee named in a federal court suit brought by a then-inmate in St. Cloud who suffered severe cornea damage and a loss of skin from his entire body from an adverse reaction to prescribed drugs given to him in prison in 2007. The DOC settled out of court last December with the man for $275,000; he is suing Corizon for damages. The nurse and doctor who treated Moe still work at the prison.

For prison officials, "the red flag was that he [Moe] told the admitting nurse in St. Cloud that he was diagnosed with leprosy," said a state health employee with direct knowledge of Moe's case. "Steps should have been taken by them to place him in isolation until they verified whether he'd been properly treated and what kinds of medication he'd received" in Thailand.

Soon after that exam, Moe was transferred to Rush City, where a doctor concluded that he had not been treated adequately in the refugee camp.

The doctor was so concerned about the active lesions and Moe's sketchy medical history that she consulted the National Hansen's Disease Program in Baton Rouge, La. A doctor at that federal agency told her to perform a biopsy immediately and send a sample to his agency. Hansen's Disease is another name for leprosy.

The following night, Moe was taken by ambulance to the prison in Oak Park Heights, which has a negative air-flow room used to treat inmates with contagious illnesses.

'Safety is our first priority'

Three days later, after reviewing Moe's chart, Paulson and Margaret Gemmell, assistant director of nursing, sent an e-mail to prison staff in St. Cloud, Rush City and Oak Park Heights "to minimize fear" and reassure everyone that proper steps had been taken.

"Because leprosy is a disease causing fright in most people, mostly based on misinformation, we want to provide you with accurate information to support you," they wrote. "Leprosy is one of the least-infectious known diseases. ... Please be assured that the health and safety of our staff is our first priority."

Moe is expected to be transferred soon to a yet-to-be-named state prison. He likely will be placed in the department's supervised release program in August 2013.

Paul McEnroe • 612-673-1745