How Flint MD solved rash mystery that stumped women's prison officials

LANSING – A dermatologist who played a lead role in examining rashes during the Flint water crisis cajoled his way into Michigan’s only women’s prison as a volunteer to correct months of inaccurate diagnoses and identify a widespread scabies outbreak that has lasted for more than a year, officials have confirmed.

Though Corrections Department officials earlier said they “brought in” an outside dermatologist to identify the mysterious rash, Flint dermatologist Dr. Walter Barkey said — and prison officials later confirmed —- he pushed to get inside Women’s Huron Valley Correctional Facility after reading reports about the outbreak in the Free Press, receiving pleas from a friend whose daughter is locked in the prison, and getting a state health department official to vouch for him.

"Only after several phone interviews was my offer to come and see inmates at the facility accepted," Barkey, of Pinnacle Dermatology, told the Free Press in an email.

"To my knowledge there were never any plans to 'bring in' a dermatologist."

Based on Barkey’s findings, prison officials, who last February had ruled out scabies as the main source of the prison rash, are about to take the extraordinary step of treating all 2,070 women inmates for the microscopic mites, which cause rashes and severe itching, next week.

The fact an outside doctor had to act on his own initiative to gain entry to the Ypsilanti-area prison to figure out the cause of the persistent rash, so it could finally be properly treated, raises questions about how the department and its private health services provider handled the crisis. Tennessee-based Corizon Health Inc. holds a five-year, $715.7-million prison health contract.

Chris Gautz, a spokesman for the Michigan Department of Corrections, said prison officials have been too busy trying to solve the problem to assess whether mistakes were made.

"We haven't even had time to think in those terms," Gautz said.

"I can tell you from the facility and department side, the staff there and here in Lansing were doing everything they could to figure this out."

Corizon spokeswoman Martha Harbin said she was working on a company response, but had not provided one by early Friday morning.

Barkey, who was not paid and said he will not accept payment, said he applied lessons he learned from examining skin rashes during the Flint water crisis in making the decision to intervene. One was that examination of individual patients was not sufficient and the entire community of affected people needed to be assessed, he said.

“I just knew the task at hand required a specialist to figure it out,” said Barkey, who brought his microscope to the prison so he could take skin scrapings from women and immediately examine the samples.

More:Prison will close to visitors while all 2,000 women treated for scabies

More:Itchy rash spreads at women's prison in Mich.; officials blame inmates

"He showed scrapings under his microscopes of live mites that he found to the staff at the facility," Gautz said. "It was clear he found scabies."

Gautz said prison officials were "open all along to hearing from different medical experts," sought out opinions from doctors that prison staff knew, and worked with officials at the Michigan Department of Health and Human Services.

Earlier, skin scrapings were sent to outside dermatologists from inside the prison, as were some women, Gautz said. All tests came back negative, he said.

Then, "Dr. Barkey came forward and volunteered and we brought him in," Gautz said.

Identifying scabies from skin scrapings can be difficult. A nurse at Women's Huron Valley, who spoke on condition of anonymity because she is not authorized to speak to the news media, said health officials at the prison, who had not received training in diagnosing scabies, were taking scrapings near where lesions were visible, but these were areas where the women had likely scratched and already removed the mites. Dermatologists know to take scrapings from the webs of fingers, the inner wrist, and insteps of the feet — not necessarily where a rash is visible — according to medical literature.

"It's awful that they've had a condition that was misdiagnosed and they've had to suffer for this long," the nurse, who, like Barkey, had reached out to the Free Press during the lengthy period when the rash had not been properly diagnosed, told the Free Press in a telephone interview Thursday.

Barkey was required to sign a confidentiality agreement related to the work he did inside the prison. He said he won't discuss any information covered by that confidentiality agreement. But he had contacted the Free Press in early December, weeks before he was allowed inside or signed such an agreement, to voice his concerns about what the prison was communicating about the rashes.

"I just want to help get to the bottom of this issue and help everyone get some relief," Barkey said in a Dec. 4 email to the Free Press.

"I have some experience handling this type of situation and wish to get connected with the people involved and volunteer my services. I would be willing to travel to the facility and work with state health care providers."

Barkey was able to visit the prison for the first time after Christmas.

Prisoner Rebecca Maureen Smith, 44, told the Free Press last March that she'd had the rash since October 2017, and some women showed signs of the rash even before that.

"It itches unlike anything — it's like the worst mosquito bite," Smith said in March.

She said she had cut her fingernails extra short to keep from scratching herself and making things worse.

In early December, prison officials blamed inmates for the rash, theorizing it was caused by improper mixing of prison-issued cleaning fluids by inmate porters who are charged with cleaning the prison, along with an inmate practice of using homemade laundry detergent to hand-wash their brassieres and underwear, rather than sending them to the prison laundry, 

In an email sent Monday, Smith said she is housed in a six-person cell where at that time only one of the six inmates —not including her — were being treated for scabies.

"It's ridiculous how they are executing this," she said.

The Free Press has reported on a wide range of problems at Women's Huron Valley, including leaky roofs, overworked corrections officers, and prison overcrowding that has caused officials to convert offices, storage rooms and recreation areas into prisoner cells.

A 2007 article in Clinical Microbiology Reviews said "overcrowding is believed to have a significant effect on the spread of scabies, reflecting the fundamental role of physical contact in person-to-person transmission."

Beside's Barkey's involvement, there are parallels between the Flint water crisis — in which the city's water supply was contaminated with lead while under the control of a state-appointed emergency manager — and the women's prison rash.

Both involved populations who couldn't get government to adequately respond to their concerns. Flint residents, who in many cases lack financial resources, complained for months about dirty, smelly and bad-tasting water before state officials acknowledged a problem. Similarly, female prisoners, who are stigmatized as felons, complained for a year about the itchy rash before it was properly diagnosed.

Now, as it did with Flint, the state could be facing legal action over the rash issue.

Detroit attorney Jonathan Marko said Thursday he has been contacted by several prisoners and their families and is researching a possible class-action lawsuit.

"First they ignore, then they deny, then they deflect," Marko said.

"I do see parallels."

Contact Paul Egan: 517-372-8660 or pegan@freepress.com. Follow him on Twitter @paulegan4.