Arkansas health officials discussed whether the Federal Bureau of Prisons fully understood the "seriousness" of the coronavirus outbreak in the Forrest City federal prison and whether prison officials were fully cooperating with the mitigation effort, according to email correspondence.
The outbreak in the Federal Correctional Institution in Forrest City -- as well as an outbreak affecting dozens of inmates in the Cummins Unit, a state prison -- has contributed to a spike in the number of new cases of covid-19, the disease caused by the coronavirus, in Arkansas. As of Tuesday, 46 inmates, eight staff members and one contractor at the Forrest City prison had tested positive for the virus, state officials said.
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Shortly after the first positive covid-19 case in the prison was disclosed April 3, officials with the Arkansas Department of Health questioned the prison's efforts and expressed a desire for backup from the Centers for Disease Control and Prevention. The Arkansas Democrat-Gazette obtained the internal Health Department emails under Arkansas' public records law.
On April 4, Dr. Naveen Patil, the department's medical director for infectious diseases, sent Health Secretary Nate Smith an email with a draft of preliminary guidance for testing to be provided to prison personnel in the intervening days before a CDC team arrived.
"The inmates they are okay, staff some guidance will help [sic], otherwise they are not inclined to test any," Patil noted.
The following day, Smith wrote to Patil and the Health Department's medical director for immunizations and outbreak response, Dr. Jennifer Dillaha, asking for an update.
"Do you feel you are getting full cooperation now?" Smith asked.
"Yes sort of," Patil replied. "Lot of other factors to consider including political, unions etc. They seem to be getting around to the seriousness of the situation. Hoping CDC comes soon as they need someone at the facility to guide them."
When asked about the exchange in an interview Monday, Patil said, "I think they understood how important it was, but I think it took some time for them to understand how rapidly it could spread between inside the unit and between the units, you know?"
"So I think it took them a day or so to come around," Patil added.
Patil said his remark about the prison not being inclined to "test any" reflected a disagreement between prison officials and the state Department of Health, with state officials recommending a targeted testing approach and prison personnel interested in testing everyone.
"They wanted to test everybody, but we did not have the capabilities to test everybody," Patil told the Democrat-Gazette. "So they were never against testing, but it's just that we could not test everybody."
Because the state public health laboratory could not test hundreds of samples per day, much less thousands, the Health Department could not let one prison consume all of the testing resources, Patil said, which was partly why health officials wanted the CDC to come to Arkansas and shoulder some of the burden.
"We had to take care of the entire state," Patil said.[DOCUMENT: Email correspondence from the Arkansas Department of Health » arkansasonline.com/415email/]
In their guidance to the Forrest City warden, Patil and Dillaha recommended testing staff members who had been in close contact with ill inmates for 30 minutes or longer.
For inmates, they recommended daily temperature checks for everyone and testing of individuals with covid-19 symptoms or a temperature above 100.4 degrees Fahrenheit.
As far as his comment that suggested political or union influence as factors in the federal response to the outbreak, Patil attributed the remark to the back-and-forth surrounding testing.
"We wanted targeted testing of the closest people, whereas the staff wanted everyone to be tested. The inmates wanted everyone to be tested," Patil said.
When asked whether the facility's response exacerbated the outbreak, Patil said: "I don't think so. They tried to act in the best possible way they could."
The main limiting factor for the outbreak response was the state's inability to test everyone, he said repeatedly, an issue officials tried to explain to prison personnel.
The Bureau of Prisons did not respond to specific questions from the Democrat-Gazette. In an emailed statement Tuesday afternoon, spokeswoman Sue Allison wrote that bureau institutions are operating under modified procedures that minimize inmate movement and gatherings because of the virus.
She said the executive staff and warden in Forrest City have been working closely with the Arkansas Department of Health's Infectious Disease Branch and with the CDC.
"We are appreciative of the CDC making a site visit to Forrest City on April 9. We are looking forward to discussing their findings with them, hopefully this week," Allison wrote.
The Forrest City complex consists of medium-, low- and minimum-security facilities with a total population of 3,236 inmates, according to the Bureau of Prisons' website. In an email to CDC officials April 4, Smith noted that the covid-19 cases are in the low-security part of the prison. The medium-security part of the prison has cells, "so isolation issues there are different," Smith wrote.
Federal prisons nationwide are struggling with covid-19 outbreaks. As of this week, 388 inmates and 201 federal prison staffers have been infected, according to the agency's website. Thirteen federal inmates have died.
Asked about the email dialogue during the governor's covid-19 briefing Tuesday, Smith called Forrest City prison Warden DeWayne Hendrix an "excellent partner." Hendrix asked for assistance, which the state Health Department provided, Smith said. Nevertheless, he alluded to the problem of jurisdictional overlap.
"There are some challenges in working as a state Department of Health with a federal facility in that they have their own chain of command and issues of who's in charge here," Smith said.
Patil's emails also address testing concerns that have since been raised in regard to state prisons. In his April 4 message, Patil suggested that Forrest City inmates exhibiting a high fever or other symptoms should receive tests.
On Tuesday, after the announcement of an outbreak at the Cummins Unit, Smith and officials with the state Department of Corrections said they would begin sample-testing inmates at Cummins but would not be increasing testing at other facilities.
Meanwhile, state inmates who begin showing symptoms are being tested for the flu before they receive covid-19 tests from the department's medical provider, Wellpath, according to a spokeswoman for the prison system.
Gov. Asa Hutchinson said he and Smith discussed the prison's covid-19 outbreak response with U.S. Attorney General William Barr over the phone Tuesday. According to Smith, Barr informed them that federal medical staffers at the prison are consulting with the CDC.
Some of the issues have to do with "determining who actually is calling the shots" in the contact investigation tracking down people who have been exposed to the virus, Smith said.
"I think we have some clarity at this point on that, but we'll continue to support as needed in that," he said.
CDC officials visited Arkansas from Atlanta recently to assist with the Forrest City outbreak. But on Monday, Hutchinson said the state has asked a CDC team to return and conduct more testing at the prison.
In the email exchange earlier this month, state public health officials expressed eagerness at the CDC team's imminent arrival in Forrest City.
On the afternoon of April 5, Dillaha emailed Smith and others to ask, "Are details available yet about the arrival of the team coming from CDC?"
Smith replied to say that he didn't know.
"I have no clue either," Patil replied. "I have my champagne bottle ready to celebrate their arrival."
A Section on 04/15/2020