Fighting Coronavirus, State Prisons Seek to Disable Inmates' Sleep Apnea Machines

The following article was originally published April 16, 2020, and republished through a collaboration with KPCC and LAist.

Story by Emily Elena Dugdale

Here's more fallout from the COVID-19 pandemic: To avoid further spread of the virus, the state prison system wants to disable CPAP machines used by inmates with sleep apnea and other conditions.

But inmates who rely on the machines — and a prominent expert — say that's a bad idea.

"The logic doesn't make sense," said Kerry Roberts, an inmate at the California Institution for Men in Chino who says he has severe obstructive sleep apnea. "I stop breathing in my sleep."

The California Department of Corrections and Rehabilitation (CDCR) stresses that the program is voluntary, and that it will not disable CPAP's that are deemed "medically critical." In those cases, and in instances in which an inmate opts to keep using the device, the CDCR says it will take other precautionary steps, including moving the individual to single-cell housing.

Despite the CDCR's insistence that inmates don't have to stop using their CPAP's if they don't want to, Roberts and two other current and former inmates told us staff at the prison gave inmates who use the devices a verbal ultimatum last week: either sign a form allowing staff to disable their CPAP or risk being transferred to another institution.

"It seemed [like] kind of a lightweight, veiled threat," said Roberts, who's been behind bars for 13 years for robbery and burglary. "Like if you want to stay here and continue your job and you're getting your credits and all that, you've got to sign off on this."

After consulting with his wife, Roberts declined. He said so far he hasn't suffered any repercussions.

The prison says there won't be any. "We are not punishing those who did not volunteer to assist in the reduction of potential COVID-19 spread," spokesman Lt. Tom Lopez said in a statement.

'UNDER DURESS, WE HAVE TO SIGN IT'

John Blagg, another inmate at Chino, says he uses a CPAP because he has coronary artery disease and has had three heart attacks. He said staff told him he risked losing his job or being transferred to another prison if he didn't sign.

"They said, oh we don't need them, it's not dangerous to take away," Blagg told us. "Well then, why did you give them to us? My cardiologist said it's very important."

But faced with the possibility of losing his job and moving to an unknown prison, Blagg said, "of course, under duress, we have to sign it."

Blagg, who's serving a four-and-a-half year sentence for a DUI that caused great bodily injury, said most of the prisoners in his dorm who use CPAPs signed away their use of the device. Prison staff came and removed the machines' power cords, rendering them inoperable.

Joe Anderson, who was released from Chino on parole last week, told us he witnessed the staff interaction with Blagg. "There's a lot of guys here that have health problems," he said. 'Why are they doing this?"

Neither prison spokesman Lopez nor CDCR spokeswoman Dana Simas answered our question as to whether inmates have been told they could be transferred or lose jobs or good time credits if they refused to disable their CPAPs.

'THE POTENTIAL TO EXPOSE A LARGE NUMBER OF PEOPLE'

A CPAP delivers a constant flow of pressurized air that allows the user to breathe normally as they sleep.

Simas told us the state prison system is limiting the use of "aerosol-generating procedures" like CPAPs because of their potential to spray droplets into the air. That's especially risky in a dorm setting, "which has the potential to expose a large number of people," she said.

That risk, Simas added, outweighs the risk of temporarily taking someone off a CPAP.

After we first published this story, Simas noted in an email that the CPAP policy was "reviewed and agreed upon by multiple medical experts within our system and the Federal Receiver appointed to oversee healthcare within the institutions."

She provided us with the form inmates are asked to sign that permits the prison to disable their CPAP by removing its electrical cords. The form says inmates can notify medical staff to request the return of the cords.

As of Thursday, 81 state prison staffers and 69 inmates had tested positive for COVID-19, according to a live tracker maintained by the CDCR. The majority of these cases are at the prison in Chino.

Nearly 600 inmates across the system have been tested for COVID-19.

INCREASED ODDS OF A HEART ATTACK OR STROKE

"It doesn't make sense to take everybody's machine away," said Dr. Richard Castriotta, a pulmonary critical care and sleep medicine specialist with Keck Medicine of USC.

The prison system's concern about spreading COVID-19 through a CPAP is valid if the person using the machine tests positive for the virus and doesn't have a "good seal" on the device's oxygen mask, said Castriotta, who's an internationally-known pioneer in the field of sleep medicine, according to his USC bio. "Most of that evidence comes from the SARS epidemic," he said.

But Castriotta said the increased odds of a heart attack or stroke for someone who stops using the machine is a greater risk. Seventy percent of people who have a stroke have sleep apnea, he said.

"It's sort of like having people with high blood pressure and just taking their pills away," Castriotta said. "Missing a few days isn't going to make much difference, but if you take it away permanently, you'll put those people at risk for adverse consequences."

Roberts, Blagg and Anderson told us the effort to disable CPAPs was especially troubling given the fact that at least 20 men were moved into their dorm from another dorm that was being converted into an area to quarantine exposed inmates.

"They're crowding 200 people into a dorm," Anderson said. "There's no such thing as social distancing in these dorms. And a lot of guys are getting sick right now."

CDCR spokeswoman Simas said she couldn't comment on the status of a particular housing unit within a specific institution.

Castriotta acknowledged that prisons are in a "tough situation" as they try to contain the spread of COVID-19.

But the risk of a CPAP machine is "negligible compared to the risk that they're all breathing each other's air all the time anyway," he told us.

The best thing prisons can do, Castriotta said, is reduce crowding and separate dorms.

Anderson, now staying in Northern California with John Blagg's family, said he's constantly worried for his friends on the inside. "I feel like I got out alive," he said.

UPDATES:

April 17 at 10:15 a.m.: This article was updated to include the information that inmates are allowed to request the return of the CPAP's power cord. That information was inadvertently left out of the original version. We regret the error. We have also included the new information provided by CDCR about the policy being approved by the agency's medical experts.