San Quentin Chief Medical Officer
What’s the Leading Cause of
Death for Former Inmates?
In 2007, the New England Journal of Medicine published an article titled “Release from Prison- a High Risk of Death for Former Inmates.”
The researchers looked at 443 deaths of more than 30,000 inmates released from the Washington State Department of Corrections from 1999 to 2003 and compared them to the mortality rate of other state residents who were of the same age, race, and sex.
The average age of inmates at the time of release was 33 years old; most of the people were white and male, with an average incarceration of 2 years.
Results of the study are shocking.
In the first 2 weeks after release, former inmates were 12.7 times more likely to die than similar, non-incarcerated, Washington state residents.
The rate was also much higher compared to men and women who stayed in prison. The researchers collected data for 2 years after the inmate had been released. Over the course of those 2 years, the former inmates were still 3.5 times more likely to die.
The leading causes of death of the released inmates were drug overdose, heart attacks, and homicides (in that order).
The article demonstrated that parole or discharge from prison is a significant risk of death.
Several themes demonstrated that there might be things incarcerated adults can do to decrease their risk on release:
Avoid drugs and alcohol. Overdose was the cause of death of at least one quarter of all the deaths. Many inmates have serious addiction problems that have not been confronted. Get treatment now by joining AA or NA inside prison. Don’t “celebrate” on release. After being incarcerated, the body no longer has the same tolerance to drugs and an overdose may happen unintentionally.
Avoid guns. Firearms were involved in 12 percent of the deaths which included homicide, suicide, and accidents.
Take your medications. Heart attacks and strokes were the second leading cause of death in this study. Some of the heart attacks or strokes may also have been caused by illegal drugs. If you have high cholesterol, high blood pressure, or diabetes, it is important for you to continue to receive treatment for these conditions.
Don’t smoke. Cancer (mostly lung) was the cause of death 6 percent of the cases.

Paroling soon? Don’t forget to arrange for medical care on the outside.
The institution will provide 30 days of prescription medications when you leave. You will need to see an outside medical provider to get a new prescription for medications.
Most county clinics require ID (like a driver’s license) for you to be seen. We can also provide you a verification letter that explains that you have been incarcerated recently, which may help. You can now make an appointment with most DMV offices to expedite your driver’s license appointment.
You will not receive any over-the-counter medications when you leave, such as naproxen, ibuprofen, or loratidine. You should take your over-the-counter medications with you when you leave. You can purchase these medications at any pharmacy, such as Walgreens, Rite-Aid, or CVS. Look for the generic version of these medications (usually the pharmacy has its own brand) which will cost less.
If you would like assistance to make a medical appointment when you leave S.Q., please contact your health care provider. The provider can either print out a list of county health care clinics that offer low-cost services, or refer you to the discharge planner who can help you make an appointment.
Make copies of the relevant medical records by contacting the medical records department. X-rays, CT scans, specialty consults, and vaccinations are important for your new medical provider to have. If you are currently receiving controlled substances such as methadone or Tylenol with codeine, your new medical provider will likely request documentation that you received these medications while incarcerated.
If you are eligible for disability (SSI), we can help submit the application. Eligibility criteria are:
You are physically unable to work for at least a year after leaving prison.
You have a firm parole/discharge date.
You will leave prison within 90 to 120 days from the submission date of the SSI application.
Good luck, and please do not return to prison.

IMPORTANT NOTICE TO ALL INMATES: ANNUAL INMATE TUBERCULOSIS TESTING STARTS APRIL 26, 2013

East Block, AC and NS: Mid-April
California State Law requires that every inmate be screened yearly for Tuberculosis. San Quentin will start doing the annual Tuberculosis testing in the next few weeks. If you have had negative TB tests in the past, you will be tested. If you have had documented positive TB tests in the past, you will be screened for symptoms, but not tested. You are required by law to be screened!
What Is Tuberculosis?
Tuberculosis is a disease of the lungs that is commonly called TB. TB is caused by a germ that floats in the air. You can be exposed to TB if a person with infectious TB disease talks, coughs, shouts or sneezes. This sprays TB germs into the air around you. Anyone nearby can breathe the TB germs into their lungs. Some of these people could become infected with TB.
Why Is It Important To Have A TB Skin Test?
You can be infected with TB and not know it. TB germs can live in your body without making you sick right away. The TB Skin Test can tell you early that you need treatment.
Residents of prisons are at risk for developing TB. Since TB is spread through the air, all people who share the same air space can get TB. Residents of prisons are at risk for developing TB. Inmates should be tested regularly to make sure TB does not spread.
The TB Skin Test can catch TB early. The earlier you find TB infection, the easier it can be to treat.
What Is A TB Skin Test?
A TB Skin Test is a simple test to determine whether a TB infection is present. A small amount of PPD (purified protein derivative) is injected just under the skin with a sterile, unused needle. This forms a small bump, which soon disappears.
You may experience some redness or minor swelling in your arm – this is not unusual or harmful. You may have had a TB Skin Test recently. It is not harmful to have another. PPD is not a blood product. You can not get AIDS from a TB Skin Test.
The Skin Test is read 48 to 72 hours after the test is given. The medical staff read the test by feeling, and then measuring, the firmness at the site of the test. If your test is not read within 48 to 72 hours, it must be repeated.
What Is A Positive Skin Test?
When the Skin Test measures greater than 10 millimeters, your test is positive. In some higher risk individuals, a Skin Test measuring five millimeters is positive. A positive test does not necessarily mean you have the disease. It means you have the germs in your body and need follow-up. It is important that a medical evaluation be performed. You will be scheduled for a visit to the clinic.
What Does A Negative Skin Test Mean?
A negative skin test means one of the following:
You have not been infected with TB, or
You may have been infected with TB, but it’s too early to tell, or
Your immune system is weak and did not react properly. This can happen with cancer and HIV patients.
What Do I Do If My TB Skin Test Is Positive?
You should receive a medical evaluation, which could include a chest X-ray. Your doctor may recommend medications for you to take. An appointment will be scheduled for you in your clinic at the earliest available time.
By Dr. E. Tootell

The norovirus is a highly infectious virus that causes gastrointestinal illness, commonly spread during the winter months. It spreads by touching items that an infected person has touched, such as doorknobs, flush toilets, and railings. It is also sporadically spread through the air.
Symptoms of Norovirus Symptoms of norovirus involve sudden vomiting, diarrhea, nausea and stomach cramping, lasting 12-48 hours. However, a person may remain contagious for up to 72 hours.
What to Do If You Experience Symptoms: If you experience norovirus symptoms, you should contact the Medical. Department
Recommendations: Avoid preparing food for other people. Stay home or in your cell for at least 48 hours after symptoms disappear. If you are a food service worker, stay home or in your cell at least 72 hours.
Precautions: To prevent the spread of Norovirus: Thoroughly wash your hands for a minimum of 30 seconds with soap and warm water after using the bathroom and before preparing or eating food.
Routinely clean all hard surfaces areas commonly touched by prisoners, visitors and staff with a chlorine bleach solution. This includes handrails and stairway rails, door handles/knobs, benches, doorways, visiting room, showers and restrooms. When cleaning, make sure to use a mask and gloves. If you notice vomit or diarrhea, alert medical staff.
Chlorine bleach is highly effective in controlling the spread of infection caused by the norovirus. The most effective ratio is two ounces (1/3 cup) of bleach to one gallon of water. Using a higher concentration is wasteful and creates a safety hazard

Influenza (“the flu”) has recently arrived in Marin County, and it’s occurring in congregate living settings and in other places where people live in close quarters.
What is influenza?
It’s a virus that causes respiratory symptoms such as a fever, headaches, chills, body aches, runny nose, and sometimes a sore throat and or coughing. It is different from a regular cold, which usually only lasts a couple of days and presents mild symptoms. Influenza causes a fever and people feel very sick and are often confined to their beds.
How is influenza transmitted?
If someone infected with the flu coughs or sneezes, the virus will become airborne and a non-immunized person who inhales the infectious air can become sick. They don’t have to be near the person who coughed or sneezed: If somebody with the flu coughs or sneezes on one of the rails in the blocks, and another person touches it and then touches his own mouths or eyes, he can get the flu from the other person.
Who is susceptible to the flu?
Almost half of the inmates at San Quentin have not been immunized and can get the flu. This year’s vaccine is particularly effective at preventing the current season’s flu.
Who is at risk of death?
Certain people are at higher risk of death than others, such as people with asthma, the elderly, and people with cancer, diabetes, heart disease, and HIV. Every year thousands of people in the U.S. die from the flu. Although the disease is highly preventable by vaccination, it is one of the top 10 causes of death in the U.S. If inmates, visitors or staff get sick, they can transmit it to babies, who are not immune and could die. Pregnant women are also at risk of death if they get the flu.
How will it arrive at San Quentin?
Through reception center inmates, staff, visitors and volunteers. The flu has an incubation period of one to four days; the average is two days.
People who care about the health of the inmates will get vaccinated.
What are the common side effects of the vaccine?
The most common side effect is a sore arm and maybe a low fever or achiness. This is not the flu; it’s your immune system doing what it was designed to do. For one or two days you might be feeling a little under the weather, which is far better than getting the flu and being bed-ridden for two weeks.
What are the chief concerns about the flu vaccine?
The most frequent concerns are that the vaccine will make people sick or give them the flu. However, this is not true. Occasionally, people get the flu after they get the vaccine, but this is likely because that person was exposed to the flu after they were vaccinated but before the vaccine took effect (it takes about two weeks after vaccination for the body to build up sufficient antibodies). Another possibility is they were exposed to a non-flu virus or a different strain of the flu: The vaccine protects against the three most serious strains of the flu, but not all, and it’s not 100 percent effective. However, the vaccine will prevent serious illness and hospitalization.
-Nurse Allyson Tabor contributed to this article-