FRESNO — Kevin Walker arrived at Taft Correctional Institution, a federal prison in western Kern County, in December 1999 to serve a 14-year sentence for attempted possession of cocaine.
But another kind of sentence awaited him, one far more painful than confinement alone.
In July 2001, fluid-leaking boils broke out across Walker's face and body. Once he was diagnosed with valley fever, doctors put him on an antifungal drug -- amphotericin B -- but the drug was so powerful that it caused his kidneys and liver to begin failing.
He was switched to another antifungal drug -- fluconazole -- and transferred to a prison in Fort Worth, Texas. But the disease continued to spread throughout his body, even into his bone marrow. Boils, then holes, developed on his spinal column and clavicle.
"That 14-year sentence turned into a life sentence," said Walker, who was released from prison in 2010. "Because I have this disease for life, and no one has accepted responsibility for putting me in that situation."
Taxpayers are also paying a price. Californians spend about $23.4 million a year to treat state inmates with valley fever.
The California prison system estimates about 200 inmates are hospitalized every year due to valley fever. Most of them are diagnosed with the disease while serving sentences in eight institutions in the San Joaquin Valley, where the airborne fungus that causes valley fever is rampant.
That doesn't include federal inmates at prisons like Taft, which was described in one lawsuit as a "petri dish for valley fever."
A study by the state prison health system found that the rate of valley fever in Pleasant Valley State Prison in Coalinga was 600 times the rate found outside the prison walls in Fresno County.
When you add up all the time state inmates spend in the hospital for valley fever, it amounts to an average of 5,000 days, or about 25 days for every inmate. The gruesome details of inmates' experiences with the fungal disease, and the disease's long-term impact on their lives, remain largely hidden from the public's view.
Because most inmates are brought in from outside the valley, they have no built-in immunity to the disease, which is the best defense for most valley residents.
On top of that, research studies have shown that blacks are far more likely to develop the most serious form of the disease. The prison population has a higher proportion of blacks than whites, and prisoner advocates criticize state and federal agencies for putting black inmates in harm's way.
The rates of valley fever in the communities surrounding the prisons in Central California already are high. But the rates inside the prisons are worse.
An April 2012 study found that at Pleasant Valley State Prison, the rate of valley fever was 7,011 cases for every 100,000 people. In states that report cases, fewer than 20 people out of every 100,000 are diagnosed with the disease.
There are several reasons inmates in the prison system experience high rates of valley fever.
In addition to most of them being brought into the valley from elsewhere, they also spend lots of time outdoors in the dusty prison yard, where they could inhale the spores. Also, many inmates already have weakened immune systems because of AIDS or hepatitis.
"I don't think I'll ever be back 100 percent," said Gregory Edison, who is serving time at Taft for manufacturing drugs. Valley fever, he said, left him with chills, migraine headaches, dry, scaly skin, exhaustion, weight loss and an uncomfortable tightness in his lungs.
Blacks at higher risk
Experts also question whether it's fair to house black inmates -- such as Walker and Edison -- in valley prisons, when medical studies have repeatedly found blacks are at increased risk for the serious, disseminated form of the disease.
A 2012 study in the journal Emerging Infectious Diseases found the rate of hospitalization from disseminated cocci among blacks in California was 8.8 times higher than for whites.
A report from the state prison system does not provide details about cases of disseminated disease, like Walker's, but it does acknowledge that black inmates died of the disease at disproportionate rates.
Of the 27 state inmates who died of valley fever between 2006 and 2010, 18 -- or 68 percent -- were black, according to the report. The rate of death due to valley fever among blacks was twice that among nonblack inmates.
"I think one of the challenges for California is that we probably should have concern that there is a very significant racial disparity going on with respect to inmates in California and valley fever," Kings County health officer Dr. Michael MacLean said.
There are many factors that play into where an inmate is housed, said Terry Thornton, deputy press secretary for the California Department of Corrections and Rehabilitation.
As a policy, she said, "we only move inmates from endemic areas when medical staff identify an inmate is susceptible to valley fever, regardless of ethnicity."
The problem might be exacerbated by the Central Valley prison-building boom that started in the 1990s. There are a disproportionate number of state prison beds in the valley.
The largest percentage of prisoners come from Los Angeles County, but the Central Valley and the Inland Empire house the most prisoners, according to an analysis by public radio station KQED.
Experts and inmates alike question whether it's fair to doubly punish people -- once for a crime, and again with a horrible disease whose symptoms and related costs could linger long after the prison sentence.
That's a concern lawyers Ian Wallach and Jason Feldman hear on an almost daily basis. Since they took the case of a former Taft inmate who contracted valley fever -- and this summer helped him earn a $425,000 federal settlement -- the Venice-based lawyers have received hundreds of letters, phone messages and e-mails from inmates with valley fever seeking help.
All the correspondence contains essentially the same message, Wallach said.
"They're all scared about future medical expenses, and who is going to pay for this when they get out," he said. "Whether they got it in Avenal, whether they got it in Pleasant Valley, wherever they got it -- they want money for pain and suffering because they have been hurting."
The inmates may have been convicted of a crime, Wallach said, but they weren't sentenced to a punishment that included a debilitating and, in some cases, lifelong illness.
Some inmates have asked the state to shoulder some of the burden.
From 2008 to 2010, 11 inmates filed claims related to valley fever with the state Victim Compensation & Government Claim Board. The largest claim was for $10 million for general and punitive damages related to valley fever.
They were all rejected.
A life sentence
Arjang Panah is one of the many inmates whose health and productivity have been destroyed by his stint in a valley prison.
He contracted valley fever in 2006, while serving a seven-year sentence at Taft for distribution of methamphetamines. Years later, the fungus remains in his body. When he catches a cold, he said, it turns into bronchitis or pneumonia, and "my recovery period is five times as long as anyone else's."
That impacts his ability to work. Panah earned a master's degree in business administration while in prison, earned his doctorate in business administration upon his release, and now works as an account executive selling jet fuel. But he's often too sick to work.
California taxpayers contribute to the state prison system's bill -- about $23.4 million annually -- for treating valley fever in state prisons. But the costs of supporting inmates sickened by valley fever, once they are released from prison, are more hidden.
With the help of Wallach and Feldman, Panah received a settlement from the federal government to cover the lifelong costs of treatment for his disease.
"If they offered me three times that amount -- if they said, 'You can have three times that amount, or not have this disease' -- I'd choose not having the disease," Panah said. "It is an extremely unfortunate thing that happened to me."