Recently, four patients at Coalinga State Hospital ("CSH"), were told that they had the "Bird Flu." Historically, the term "Bird Flu" has been applied generically to many maladies. In this situation, the term "Avium Flu" was also used. Since the patients initially had nothing in writing from which to see the spelling, coupled with the difficult to hear pronunciation difference between "avium" flu and "avian" flu, numerous patients and staff associated the term "Bird Flu" with the very deadly Avian Flu. Thus, there was an avian flu panic at CSH that resulted from a poor dissemination of information by medical staff.

The two "Bird Flu" victims have actually been confirmed as suffering from Mycobacterium avium Complex, referred to in the medical community as "MAC." Because MAC is caused by a bacteria not a virus, it is not the flu at all. Influenza is caused by a virus not a bacteria. Although MAC is not the deadly Avian Flu that is feared world wide, it is nevertheless a very dangerous and debilitating disease.

Literature from the Center for Disease Control in Atlanta, Georgia states:

"Several different syndromes are caused by Mycobacterium avium complex (MAC). Disseminated infections are usually associated with HIV infection. Less commonly, pulmonary disease in nonimmunocompromised persons is a result of infection with MAC. In children, the most common syndrome is cervical lymphadenitis."

Neither of the CSH patients diagnosed with MAC suffers from HIV infection. The medical literature suggests that Mycobacterium avium can cause fever, anemia, and diarrhea in HIV infected individuals, but that MAC often affects non-HIV infected individuals in the form of pulmonary infections.

Tuberculosis (TB) is a chronic disease of animals and humans, caused by bacteria of the genus Mycobacterium. The common form of Tuberculosis is a severe lung infection caused by the bacterium Mycobacterium tuberculosis. According to some literature, Mycobacterium avium is known to cause a lesser known form of tuberculosis, particularly in non HIV-infected people. There is also another rare form of TB called Mycobacterium bovis.

Another historically famous Mycobacterium is "Mycobacterium laprae." This is the highly feared disease commonly known as "Leprosy" or "Hansen's Disease."

The nearly $400 million state-of-the-art CSH facility, which was opened in 2005, sits on the grounds of Pleasant Valley State Prison ("PVSP"). Both facilities are in a "hyper endemic" Valley Fever area. PVSP has been in the news recently as a result of 514 inmates and staff becoming infected with Valley Fever during the last year. There were four inmate deaths, and one staff death reported in the last two years as a result of this Valley Fever epidemic.

It is well known that Valley Fever results from cocci mold spores that grow in the region's soil, and that the spores become airborne when the ground is disturbed, such as through construction, wind, earthquakes, or farmers plowing the ground. The wind can then spread the spores even further. The recent PVSP Valley Fever epidemic is being blamed on the construction of CSH.

However, no one seems to have any idea from where the recent Mycobacterium avium Complex pathogens originated. The Center for Disease Control states, "Although the mode of transmission is unclear, MAC is most likely environmentally acquired." This lack of knowledge has other patients at CSH extremely concerned, especially since the hospital will not disclose the locations or identities of the two additional victims and other suspected cases.

The first of the confirmed cases of MAC was on Housing Unit RRU-4 at CSH, and the second confirmed case on RRU-3. One possible common denominator is that these two housing units share the same air handling (ventilation and air conditioning) system. As such, there are unanswered questions about whether or not the State is using filters in the air handling system that are of sufficient quality to remove the dangerous airborne pathogens known to be in the area. Four units total share this same air handling system. Are the unidentified MAC victims on one of these four units? The hospital will not divulge this information.

A major contributor to the severity of any epidemic within both the State Hospital system and the State Prison system is the lack of adequate medical staff. This is exacerbated by the callous attitudes of the medical staff who are available. It is routine procedure for a patient at CSH to be treated as a hypochondriac when first reporting symptoms. By the time the symptoms become so severe that staff takes notice, the all important "early intervention" concept will have been forfeited by the professional staffs' inaction.

Furthermore, there appears to be a reluctance to make a diagnosis of dangerous diseases. Apparently, it makes the already troubled facilities at Coalinga look even worse in the public eye. Many inmates become treated, using the standard protocols for known diseases, but with their malady being listed as "unknown," the "flu," a "cold," or some other generic human illness. However, this usually occurs only after a lengthy period of medical inaction. And actual diagnosis, if it ever occurs, only seems to occur after the patient has become so sick that lab tests are required.

A case in point is the second confirmed MAC victim, Daniel Cebada, who spent months complaining of being sick before being taken seriously.

Daniel first began complaining in the spring of 2007 of a mild cough and mild chest congestion. Those symptoms then appeared to go away. However, at the time of his initial complaint, CSH staff offered to conduct tests if the symptoms persisted. Since the symptoms appeared to recede, Daniel did not pursue treatment at this time.

In early July 2007, the same symptoms reappeared, but more severe this time. He was seen by a Nurse Practitioner, who prescribed an allergy medication, and a chest Xray. On approximately July 26, 2007, the first "Blood-draw" was performed.

On approximately August 2, 2007, Daniel was again seen by the Nurse Practitioner, but was not told about the results of his blood test until he specifically asked. The results of tests are often not followed-up upon. As in this case, the patient must make inquiries. He was then told they had tested for Valley Fever, and his test was negative.

On approximately August 3, 2007, Daniel had another "blood-draw." He also had a chest Xray, and was given a cup for a Sputum sample which he turned-in later. This sputum sample came back as "normal" a couple weeks later.

Although tests were being performed, it was taking far too long for the test results to be returned - usually at least two weeks, and for some tests, seven to eight weeks. This resulted in long periods of suffering by the patient. This, because subsequent and follow-up tests were not performed, nor were medications prescribed until the results of earlier tests were received.

By August 15, 2007, Daniel's symptoms had worsened. He complained about the long periods between tests, and not being treated. He asked to see the NOD ("Nurse of the Day"), and was told that his present treatment was adequate. He was told it was normal for these tests to take up to six to eight weeks to come back. Daniel described the NOD's attitude as implying that he [Daniel] was exaggerating the seriousness of his condition.
 
On approximately September 4, 2007, Daniel checked with the Nurse Practitioner about the results of the Xrays taken in early August. The Nurse Practitioner did not have the results.

On approximately September 7, 2007, Daniel again checked on the Xray results, and was told they were "normal."

At some point during this process Daniel took an antibiotic for five days. He states his symptoms almost disappeared. At this time, he asked the Nurse Practitioner about the Avian Flu since he believed another person had been so diagnosed. Daniel pushed the Avian Flu issue because his symptoms were similar to the other person's.

In early September 2007, the Nurse Practitioner suspected a sinus infection that may have migrated to Daniel's lungs, and ordered a second sputum sample and also a sinus Xray.

Daniel reiterated to the Nurse Practitioner that the antibiotics had nearly cured his symptoms. The Nurse Practitioner said maybe he needed a longer antibiotic course. However, instead of prescribing more antibiotics, she put him on an asthma medication.

After trying this for two weeks he stated, "It did nothing." He then informed the Nurse Practitioner, who said she would put him on the waiting list to see an outside pulmonologist, but that it would be a several month wait.

In mid September, Daniel asked the Nurse Practitioner if he could see a doctor. He was told it would take upwards of six weeks. He would be going on a long waiting list. That if he wanted to get any help he would need to keep seeing the Nurse Practitioner.

Later in the month, Daniel became frustrated with the lack of progress and made requests at the medical clinic, and with the "Med-Room" (medication room) person for an appointment with a doctor. The medication room person said she would put him on the list.

On October 5, 2007, Daniel was called to see the Nurse Practitioner because the results from the last sputum test were back. This was when he was verbally told he tested positive for "Avium," where due to the pronunciation likeness he thought he heard "Avian."

The Nurse Practitioner ordered a course of two antibiotics over the next two weeks. She also ordered another chest Xray to see if his lungs were deteriorating.

On October 6, 2007, Daniel finally began receiving medication.

As of October 22, 2007, even though his condition is worsening daily, Daniel has never seen an actual doctor at CSH for this dangerous, chronic, debilitating disease. Daniel is a young man with no prior history of asthma or other respiratory disorder. He now has breathes heavily from the slightest activity and must carry an inhaler.

Staff at CSH knows that its patients are at risk for Valley Fever and now MAC. Why is it taking in excess of two months to diagnose illnesses for which they should be on alert? Particularly, when a severe Mycobacterium avium Complex infection is chronic and can result in conjunctivitis, or life-threatening complications such as bacterial or viral pneumonia and acute respiratory illness.