Budget Ax Hits Jail’s STD Screening

May 17, 2007

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The Cook County Jail last year diagnosed almost 1,500 cases of sexually transmitted diseases.

This year the number is expected to be much lower.

That doesn't mean the jail is healthier. It means fewer inmates are getting tested.

The county has curtailed a nationally recognized program of screening detainees for sexually transmitted diseases. It was a move to save money.

Health experts say it's a crisis for people in the jail -- and the communities they return to.

Chicago Public Radio's Chip Mitchell has more.

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In a fenced-off area deep inside Cook County Jail, the day's new detainees remove their shirts and follow every other order too.

JANUS: Right now we have about 200-some male inmates. They are in line to turn in their property.

Superintendent Stanley Janus manages this part of the jail.

JANUS: They will be going for the medical screening, the blood pressure. And psychological evaluation will be done over here too.

Until three months ago, the jail encouraged men up to age 25 -- that's most people here -- to make one extra stop.

They'd take their turn behind a concrete barrier, dropping their pants for a medic.

JANUS: “They would take the swab from the inmate.”

The jail tested samples from those swabs for gonorrhea and chlamydia.

And it offered everyone a blood test for syphilis.

Most inmates took the opportunity.

And the screening turned up a sexually transmitted disease -- or STD -- in roughly one in 10 of them.

DART: We have about 100,000 people that come in and out of here every year.

Tom Dart oversees security in the jail as Cook County sheriff.

He says the STD screening was vital for the inmates.

DART:  Eighty percent go right back into the streets because of a probation sentence or their time's considered served or whatever it may be. The vast majority do not have insurance and, as a result of that, get their only treatment through Cermak Hospital.

That's Cermak Health Services, the jail's medical operation.

Dr. James McCauley directed Cermak from 1998 to 2003.

McCAULEY: This is why STD screening was done at the jail. It was because you had a large population of people who had relatively high rates of these infections. And you had the opportunity to identify their contacts. And perhaps, more importantly, once they left the jail they were no longer contagious to anyone else.

The program dated back to the 1980s. Cook County had the nation's first big jail to screen for STDs.

At one point, the jail was diagnosing more than 40 percent of the city's known chlamydia cases among males.

The national Centers for Disease Control and Prevention considered the screening a model.

So did Dr. Peter Kerndt. He directs the STD program of Los Angeles County and helps lead the National Coalition of STD Directors.

He used to send his staff to Chicago to see the jail screening.

KERNDT: Cook County and their work in STDs is a national treasure. The work that's been done there is pioneering. It really set the stage for work that's been done in the past decade in corrections.

In recent years the county has been trimming back the program to save money.

This year, after Board President Todd Stroger ordered budget trimming, the county curtailed the STD screening again.

All women still get the tests, but the jail offers tests to men only if they have symptoms.

Jail officials estimate the savings total less than a million dollars a year, though the Stroger administration hasnt reported a precise figure.

BROWN: There will be implications for decreased screening.

Christopher Brown is the Chicago Department of Public Health's assistant commissioner for STDs.

BROWN: We believe, strongly believe, that we will start seeing increased disease in our community because of the reduced screening that's taking place at the jail.

It appears Dr. Robert Simon, who heads the county's health system, is standing by the decision to cut the screening.

After repeated requests for information, his spokesman forwarded a message that says the jail wasn't physically suitable for the program.

The message also says the inmates were getting more attention in the jail than they would have received in a typical hospital emergency room.

Some of these issues faced McCauley, the doctor who once ran the jail's health system.

McCAULEY: At least during my tenure and before, the people in leadership at the Cook County Bureau of Health Services understood that preventive medicine was always cost-effective medicine. So, in other words, if I identified people with syphilis during their time at the jail and treated them, then I would see a lot less syphilis out in the community, which would mean things like less congenital syphilis in newborns.

The city's public health department says it's willing to devote staff and funds to help resume the screening.

Toward that end, city health officials say they've held two special meetings this month with their counterparts at the county.

But no one is sure when -- or if -- the jail's STD screening might be brought back.

I'm Chip Mitchell, Chicago Public Radio.