CURING HCV in prison: The new Community Standard of Care.

"Q: Will we be able to wipe out hepatitis C entirely?

A: In contrast to HIV, we do have the capability of doing that - essentially curing everyone who got infected. While we have made tremendous progress against HIV, we still don't have a cure, we still don't have a vaccine. The situation for HCV is dramatically different. A cure is achievable. Someday soon, the cure using an interferon-free cocktail is going to be routine...."

 ----------

Until now, I thought it was likely that this disease would kill not only my imprisoned friend Davon, sick as a dog on interferon right now, but also my big brother, who hasn't been able to get treatment - both I feared would die very painfully, at an early age. 

This news gives me hope, though. We have the capability to wipe out this disease and cure those who are ill right now - the question remains: do we have the collective will? That much, I still don't know.

Nearly 6,000 AZ state prisoners have tested positive for the Hepatitis C virus, but only a fraction are deemed eligible for a miserable course of interferon treatment because it costs so much and takes such a toll on body and mind. Many drop out from the side effects, having to face debilitating and fatal liver disease instead. Most public health estimates put the jail/prison population at being over 50% HCV+. Imagine how hard it is already to see loved one do time and maybe even make amends for their crimes in prison, and come home only to find that they were sentenced to die from an infectious disease, as well. 


For those who don't care about prisoners, though, think about this: since 95% of then return to the free world eventually, that means there's already an epidemic in communities with high rates of poverty, unemployment, homelessness, felonization, incarceration, uninsured persons, IV drug addiction, HIV/AIDS, and other compromised populations. It also disproportionately affects people of color, the LGBTQ communities, and Baby Boomers. That's a huge public health problem that no one in Arizona likes talking about - why are they so silent now, I wonder? Surely they've heard this by now.

It sounds like it's time for the AZ DOC and Wexford to re-write their Hep C treatment protocols, in any case, in order to assure that the standard of care they provide to prisoners with the virus (HCV) is consistent with the community's new standard. Otherwise, they can both expect to be named in a new class action lawsuit soon, I'm sure. I'd think the public at large could even sue the state for having an infected population unleashed on us - uneducated, untreated, unsupported, uninsured, and unwell.

remembering those we have already lost...

  

we must accelerate the fight for the living.

Fight the spread of HEP C today: 

support PHRO (Phoenix Harm Reduction Organization)

Phoenix Art Museum: Art of Resistance

Prisoners' Justice Day Guerilla Installation

August 10, 2012

--------from the San Francisco Chronicle----------

Hepatitis C fight - 'watershed moment'

Erin Allday / San Francisco Chronicle

Tuesday, September 11, 2012

Earlier this year, an editorial in the New England Journal of Medicine declared that the world was in a "watershed moment" in the history of treatment for hepatitis C, a virus that is believed to infect roughly 180 million people globally. Dr. Warner Greene, director of the Gladstone Institute of Virology and Immunology in San Francisco, agrees wholeheartedly - and believes that with recent advances in treatments and a cure, the world could be on the cusp of nearly wiping out the virus.

Q: What does the hepatitis C virus do to the body?

A: This is an RNA virus that infects hepatocytes, cells in the liver. That's why you ultimately get hepatitis, or inflammation in the liver, and that can progress on to cirrhosis. About 20 percent of people spontaneously clear the hepatitis C virus, and of the rest, about 20 to 25 percent will progress to cirrhosis, and eventually end-stage liver disease. Hepatitis C is the leading reason behind liver transplants in the United States.

Q: For many years, hepatitis C has been treated with interferon. What is interferon?

A: Interferon is a type of protein called cytokine. It normally triggers an antiviral response in the body. It inhibits key steps in the (hepatitis C) virus life cycle that allow it to replicate. But it's doing it at a cost. Cytokine is pretty toxic. It makes patients very sick.

Q: Last year the Food and Drug Administration approved new drugs to treat hepatitis C. How do they work?

A: It's just like with HIV - you're attacking multiple, key proteins needed for the hepatitis C virus lifecycle. Now you have these small molecules that are attacking the virus itself, as opposed to trying to induce an antiviral response, like with interferon.

These drugs are proving to be just dynamite. We're very close to being able to cure everybody of hepatitis C. The natural history of hepatitis C virus infection has been fundamentally changed.

Q: Why has hepatitis C been so hard to treat historically?

A: One thing that limited progress was the lack of an infectious molecular clone to use in the laboratory to test drugs. It was only in the last few years that an infectious molecular clone came out of Japan. Before that, none of them fully replicated (in the lab). When the molecular clones came along progress just took off at light speed.

Then the blueprint for working on HIV became very informative - protease inhibitors, polymerase inhibitors, they were all targeted very quickly, by multiple pharmaceuticals. Many of the pharmaceuticals just moved their HIV discovery teams into HCV. Progress has been made so rapidly here because the trail had been blazed by all of the HIV drugs.

Q: Will we be able to wipe out hepatitis C entirely?

A: In contrast to HIV, we do have the capability of doing that - essentially curing everyone who got infected. While we have made tremendous progress against HIV, we still don't have a cure, we still don't have a vaccine. The situation for HCV is dramatically different. A cure is achievable. Someday soon, the cure using an interferon-free cocktail is going to be routine.

Then it becomes more of an implementation issue - how you distribute these drugs, what you charge for them. There are 180 million people infected worldwide, five to six times the size of the HIV epidemic, and many are living in resource-poor settings. We're going to have to figure out how to deal with the developing world.

Hepatitis C drugs offer hope for cure

Erin Allday / San Francisco Chronicle

Updated 4:09 p.m., Wednesday, September 12, 2012

Scientific breakthroughs, one piled on top of another at breakneck speed over the past few years, have put medical researchers on the cusp of curing almost everyone who suffers from hepatitis C, if not wiping out the disease entirely.With 180 million people in the world thought to be infected with the virus - 12,000 of them in San Francisco alone - that's potentially a huge public health coup, doctors and scientists say.

In a little more than a decade, a virus that was once almost untreatable could be made nearly extinct.
"It is just a remarkable moment in the history of hepatitis C," said Dr. Warner Greene, director of the virology and immunology division at the Gladstone Institute in San Francisco. "I think hepatitis C and its sequela - liver cancer, cirrhosis, liver transplants - can largely be gone in the future. We just won't have to worry about it."

In the past year, new treatments have come out that already have doubled the number of people who can be cured of hepatitis C. Now the race is on among drug developers to market the first medical cocktails that would cure almost everyone on the planet, and do it safer and faster than the best treatments currently available.

New treatments - both those already available and those expected to be approved in the next five or so years - were a large part of the reason the U.S. Centers for Disease Control and Prevention recommended this summer that all Baby Boomers get screened for hepatitis C.

That generation is thought to have the largest number of undiagnosed cases of the disease, with so many of them potentially exposed to the virus in the wild, drug-friendly hippie years of the '60s and '70s. Until recently it wasn't practical to screen millions of people for possible cases of hepatitis C because few good treatments were available.

Hepatitis C's spread

Hepatitis C is a virus transmitted through the blood, similar to HIV. It's often spread through shared needles used by intravenous drug abusers. Decades ago, and even still in some developing parts of the world, people were exposed to hepatitis C through unsterilized equipment used for tattoos or surgical procedures. Also, the U.S. blood supply wasn't screened for hepatitis C until the early 1990s, so people sometimes became infected from a blood transfusion or organ transplant.

In roughly 20 percent of hepatitis C cases, the body's immune system fights off the virus without any medical intervention and probably without the individual ever being aware of having it. The remaining cases develop into chronic hepatitis C.

In some of those cases, the virus may lie dormant for decades, or even a lifetime, but in about 1 in 5 chronic cases, the virus will attack the liver, scarring it and causing cirrhosis, and potentially leading to liver cancer and liver failure. The infection causes about 10,000 deaths a year in the United States, and it's the leading reason for liver transplants. Hepatitis C is especially prevalent in people who also have HIV infections; in fact, HIV-positive patients are more likely to die of hepatitis-caused liver disease than of AIDS or HIV.

Antiviral drugs

It's only in the past seven years or so that doctors and scientists discovered the first antiviral drugs that can stop the virus, giving the body's natural immune system a chance to fight it off. The cure rate with those drugs is 75 to 80 percent, but they require that patients also take interferon, a toxic medication that can cause disabling side effects for a year.

In the next five years, researchers expect to develop even more potent antiviral medications - drugs that will cure more than 90 percent of patients, and do it in half the time and without the interferon.

"There's no question that with these new treatments, cure is going to be the rule and not the exception," said Dr. Brad Hare, medical director of the HIV/AIDS ward at San Francisco General Hospital, who studies HIV and hepatitis C co-infections. "It's more important than ever to identify people with hepatitis C, because we have something even better to offer them."

That said, Hare added, it's unlikely that the virus will ever be eradicated. There will always remain a pocket of people who don't respond to drug therapy or aren't able to take it for some reason. Those who have been cured can be reinfected.

And getting new medications to the tens of millions of people affected by hepatitis C won't be easy, especially because the drugs will almost definitely be expensive.

Strains on the system

Just screening the millions of Baby Boomers in the United States, and getting those who test positive for hepatitis C into treatment, could be an overwhelming strain on the health care system, public health experts say. Drugs in development could ease some of that burden if they're easier to take and more effective than the current treatments.

Hepatitis C was discovered in the late 1980s, although scientists had known for years that a virus existed that was causing inflammation in the liver and that wasn't the hepatitis A or B viruses.

The U.S. Food and Drug Administration approved the first treatment for hepatitis C - the chemotherapy drug interferon - in 1991, and added a second drug, ribavirin, in 1998. Those two medications were considered a breakthrough therapy for a virus that had previously been untreatable, but the treatment itself was rough and not all that effective.

The ribavirin comes in pill form, but the interferon has to be given intravenously three times a week for 48 weeks. Both drugs, especially the interferon, often come with awful side effects - major depression and, sometimes, suicidal thoughts, plus fatigue, nausea and flu-like symptoms.

And the worst of it is that the treatments lead to a cure only roughly half the time - less than half for patients with the most common strain of hepatitis C.

"A lot of us didn't have bad symptoms before we went on treatment," said Daniel Berrner, a San Francisco resident who was diagnosed with both HIV and hepatitis C in 2005, and underwent successful treatment for the latter in 2009. "People maybe feel some fatigue, but that's it. So to convince them to feel awful for a year when they're not feeling that bad to begin with is a really hard thing to do."

Because treatment was, for many people, tougher to endure than the virus itself, many doctors over the years have "triaged" patients by performing liver biopsies or blood tests to determine if hepatitis C was causing severe enough damage to treat even at the risk of failure. If patients weren't experiencing acute symptoms and their livers seemed relatively healthy, they'd often postpone treatment.

More seek treatment

Whether to get treatment for hepatitis C is still a personal decision and best made after a thoughtful conversation with a primary care doctor or a liver expert, doctors said. But increasingly patients are being encouraged to get treatment, even if their infection isn't particularly virulent.

"I still try to triage based on the risk of end-stage liver disease. But now more patients are willing to be treated," said Dr. Natalie Bzowej, a liver disease specialist at California Pacific Medical Center.

Bzowej helped lead national research into one of the first antiviral treatments that targeted hepatitis C, a protease inhibitor called telaprevir made by Vertex Pharmaceuticals, which was approved by the FDA in June 2011. A similar drug, boceprevir from Merck, also won FDA approval last year.

Remarkable success

In clinical trials, about 80 percent of patients with the most common strain of hepatitis C who took one of those drugs, plus the usual interferon and ribavirin combination, were cured. That was a remarkable improvement over the previous 40 to 50 percent cure rate.

Also encouraging: Most of the patients who were cured were able to stop taking the medications after just 24 weeks, cutting the treatment time in half.

The reason for the difference is that the new drugs single out the hepatitis C virus specifically, whereas the interferon and the ribavirin essentially just give a boost to the body's natural immune system. For many people, the immune system is not strong or fast enough on its own to fight off the virus.

Protease inhibitors are best known as a class of drugs used to treat HIV infection. They work by attacking specific enzymes, or proteases, in a virus that are a key part of the replication process. By inhibiting those enzymes, the virus is unable to reproduce and eventually dies off.

Now, scientists are looking for the next line of drugs to attack other points of the hepatitis life cycle. The pharmaceutical industry is racing toward clinical trials - companies battling to be the first to get new drugs, especially those that would make interferon obsolete, to the market.

Multidrug attack

Doctors and scientists alike expect the first of the new wave of drugs to be available in four or five years. Part of the reason not everyone can be cured of hepatitis C is that, like many viruses, it mutates so quickly and becomes immune to drugs. So ideally, doctors will have at their disposal several drugs - maybe dozens - that will attack the virus on several fronts at once.

If those drugs are strong and fast enough, they could cure patients without the need for interferon. Protease inhibitors and other antiviral drugs aren't without side effects, but the symptoms are much less severe than those from interferon, and the newest classes of drugs may work in as little as 12 weeks, or about half the time it takes telaprevir, the protease inhibitor, to do the job.

"I feel like we are glimpsing the beginning of the end for hepatitis C," said Dr. Cami Graham, vice president of global medical affairs at Vertex. "We really are beginning to see what that path to eradication is going to look like."

Long incubation period

Both drug developers and doctors alike said they are advising patients not to raise their hopes too high. Almost all of the clinical trials are in their earliest stages, and for the Baby Boomers especially, patients with decades-old infections may not have even a few years to wait for new treatments.

"What we have now is better than anything we've had in a long time," said Dr. Joanna Ready, chief of gastroenterology at Kaiser Santa Clara. "What will be even better is interferon-free therapies, and the early studies have been very, very, very promising. But the disease has such a long incubation period and damages the liver over decades, so we really need to be following people over time.
Still, Ready said, she's hopeful.

"If we don't wipe out hepatitis C entirely, we can probably make it go away like polio, where you haven't gotten rid of it but you've really beaten it down," she said. "The science behind these treatments is improving every day. And the more we know, the better we are at treating it."

Erin Allday is a San Francisco Chronicle staff writer. E-mail: eallday@sfchronicle.com 

---------------------

FIGHT THE SPREAD OF HEP C TODAY. 

 Phoenix Harm Reduction Organization (PHRO)

AZ Republic: Ignore the prisons at our own peril...

 AZ Department of Corrections

(November 1, 2010)

Excellent editorial from the folks at the AZ Republic. They've been doing a great job covering the prisons this past year - which takes a lot of courage for mainstream media to do  in this town.

This exposure incident is potentially devastating for those men affected - up to 20% will likely die from liver cancer or cirrhosis as a result, if they don't get successfully treated. Hep C is epidemic in our state prisons already, though -that incident was a drop in the bucket compared to the 12,000 already infected (almost 6,000 confirmed cases alone, compared to less than 200 with HIV/AIDS...it's pretty bad).

As long as they aren't treating addictions inside or doing an aggressive harm reduction campaign, though, the disease will continue to be spread by needles among IV users and tattoo recipients - 95% of whom ultimately return to the community, becoming a serious public health concern. One of the things that could do most to reduce the incidence and impact of Hep C in the community is to provide adequate substance abuse treatment and Hep C education, screening and treatment in prison, but neither is really happening.

According to the DOC 75% of prisoners are coming in with serious substance abuse issues, yet they aren't providing substance abuse treatment for more than 4% of the total prison population in a year - not even for all those guys being sent off to DUI prison, where everyone thinks we pay for a special treatment setting so they don't relapse and kill someone on the road next time. Coming into the mess we already have in the DOC medical system, I don't see how Wexford is going to do any better by prisoners - especially those with Hep C - AND turn a profit.

------------

Out of sight, out of mind

Sept. 8, 2012 01:26 PM
The Republic | azcentral.com

On Aug. 27, a nurse working for a company called Wexford Health Sources Inc. administered a dose of insulin to a diabetic patient who has hepatitis C, a deadly and extremely infectious liver disease.

The nurse then inserted the needle into another vial of insulin to draw still more of the drug for the patient.

She put that second vial, and the remainder of its contents, onto a shelf with other vials of insulin.

You can well imagine where this health-horror story is going: More than 100 other diabetes patients who later were given insulin treatments may have been infected with hepatitis C.

Mistakes happen. Including potentially tragic ones like this. But there is a bit more to this story.

Wexford is a private company that just this spring won a $349 million, three-year contract to provide health services to Arizona's nearly 40,000 prison inmates. The nurse, who already was under investigation for providing slipshod care, worked for Wexford at the Arizona state prison at Buckeye.

State rules require health-care providers, including those working out of prisons, to alert county and state health authorities about a potential outbreak of an infectious disease within five business days.

Wexford alerted public health officials of the incident on Sept. 4, more than a week afterward -- and only after Wendy Halloran of 12 News learned what happened from an inmate's family and The Republic's Craig Harris broke the story online.

In Arizona's seemingly inexorable march toward privatizing ever more of its prison system, this incident is but one more red flag about the pitfalls of that policy.

Sure, it was an accident. Accidents happen. But are more such accidents occurring at prisons whose profit motives tempt supervisors to cut corners?

Corner-cutting appears to have been a factor in the escape of three prisoners on July 30, 2010, from a Kingman prison operated by Management & Training Corp. A faulty alarm system appears to have contributed to the incident, during which the escapees murdered a New Mexico couple.

Another private contractor hired by Arizona, GEO Group Inc., has lost at least 27 of its prisoners around the country since 2004, including one from a facility in Florence, albeit from mostly low-security facilities.

The Wexford incident, however, raises a still more unsettling concern: Are there more accidents and incidents than we know about? Is Wexford's slow-mo reaction to following established protocol evidence of other incidents being swept under the rug?

The state Legislature's most ardent Republican critic of private prisons, Mesa Rep. Cecil Ash, argues that private prisons "are the wrong business model" for exactly that reason: "They are out of sight, out of mind."

If private-prison operations were cheaper to operate, that might mitigate the more minor operational concerns. But they are nearly 10 percent more expensive to operate. Lawmakers like them because of the up-front cost savings on construction, which the private firms often bear.

Legislators need to take this Wexford incident for what it is: stark evidence that transparency is a serious issue with private prisons.

Prisons are out of sight, out of mind, at our peril.

Parsons v Ryan: Suicide Prevention Day, 2012, AZ DOC.

Remembering the suicide victims of Jan Brewer 

and Charles Ryan at the Arizona Department of Corrections.

 

 "SOS from Arizona's Other Death Row"

Firehouse Gallery and Cafe, Phoenix

June 2012

This is the state of suicide prevention in Arizona's Department of Corrections, under Director Charles Ryan. I hope the DOC responds to this critique with a detailed description of what else they're doing to reduce the rate of despair and violence that's driving Arizona prisoners to kill themselves at twice the rate than the national average for state prisoners. I want to know what the training consists of. So do the families who have already suffered a death in custody - as well as the loved ones of those mentally ill prisoners fighting to be safe and well in custody now. How have the conditions described below changed since Parsons v Ryan was filed?

If you have a loved one in prison with a serious mental illness whose safety or sanity you fear deeply for, please feel free to contact me. I'm just an artist and activist - I'm not a lawyer or professional anything, but I can refer you to resources in your community, and connect you with other families who share your struggle. 

Have your loved ones write me as well. 

Arizona Prison Watch  /  PO Box 20494  / PHOENIX, AZ 85036

thank you again to all the attorneys working on this case...but most of all, to the prisoner-litigants who had the courage to put their names and faces to the abuses and neglect going on behind bars in this state...

Peggy Plews 

480-580-6807

arizonaprisonwatch@gmail.com

Parsons V Ryan (p. 47)

2. Defendants Deprive Suicidal and Self-Harming Prisoners of Basic Mental Health Care

82. Defendants have a policy and practice of housing prisoners with serious mental health needs in unsafe conditions that heighten their risk of suicide. In FY 2011, there were 13 suicides in ADC prisons, out of a population that averaged 34,000 during that time. That is a rate of 38 suicides per 100,000 prisoners per year, more than double the national average suicide rate in state prisons of 16.67 per 100,000. Three prisoners committed suicide in one week in late January 2012, including a 19-year-old woman.

83. One factor responsible for such a high suicide rate is Defendants’ policy and practice of maintaining suicide watch facilities that offer no meaningful treatment. Usually the only people who interact with prisoners on suicide watch are correctional officers who check on them periodically, medication assistants who dispense pills, or psychology assistants who talk to them through the front of their cell. Plaintiff Swartz did not receive psychotherapy for more than two months in the summer of 2011 while on suicide watch at the Lewis facility. After he swallowed glass and was taken to an outside hospital, the hospital psychiatrist recommended that he be taken to an inpatient mental health unit. These units are in the Phoenix complex. Instead, Mr. Swartz remained at Lewis where he continued to harm himself. He finally was moved to the Phoenix inpatient unit almost three months after the hospital psychiatrist had made that recommendation, but after a short period of time he was again returned to Lewis. Plaintiff Thomas did not see a psychiatrist for 11 months despite being placed on suicide watch multiple times.

84. Defendants also have a policy and practice of holding suicidal and mentally ill prisoners in conditions that violate all notions of minimally adequate mental health care and basic human dignity, and are not compatible with civilized standards of humanity and decency. Suicide watch cells are often filthy, with walls and food slots smeared with other prisoners’ blood and feces, reeking of human waste. Mental health staff show a lackof professionalism and little compassion for prisoners enduring these conditions: for example, prisoners in suicide cells are taunted for being in “the feces cells.” When Plaintiff Swartz complained to a LPN about the unhygienic conditions of the suicide cell at Lewis, the LPN described him in the mental health notes from the encounter as “bitching about cleanliness – germs and disease.”

85. Defendants have a policy and practice of keeping suicide watch cells at very cold temperatures. Prisoners are stripped of all clothing and given only a stiff suicide smock and a thin blanket, making the extreme cold even harder to tolerate. Plaintiffs Rodriguez and Verduzco report that the suicide smock used in Perryville barely comes to the top of female prisoners’ thighs, so both their legs and arms are exposed to cold air. Many prisoners are also deprived of mattresses and as a result must sleep on bare steel bed frames, or on the floor made filthy with the bodily fluids of prior inhabitants. Plaintiff Brislan spent several weeks in a frigid suicide cell with no mattress.

86. Defendants have a policy and practice of exposing prisoners on suicide watch to gratuitously harsh, degrading, and damaging conditions of confinement. Prisoners are given only two cold meals a day, and are denied the opportunity to go outside, brush their teeth, or take showers. The only monitoring prisoners receive in suicide watch is when correctional officers force them awake every ten to 30 minutes, around the clock, ostensibly to check on their safety. In some suicide cells, bright lights are left on 24 hours a day. The resulting inability to sleep aggravates the prisoners’ psychological distress.

87. Mentally ill prisoners on suicide watch complain of correctional staff behavior that interferes with any therapeutic effect of being on suicide watch, including harassment, insults and taunts, and the excessive and practically sporting use of pepper spray. Prisoners at the Perryville suicide watch units, including Plaintiff Verduzco, have jerked awake when awoken by staff on the “safety checks,” and are pepper sprayed for allegedly attempting to assault the officers. Guards in the Perryville suicide watch units also frequently pepper spray female prisoners in their eyes and throats when they are delusional or hallucinating. Plaintiffs Rodriguez and Verduzco have asthma and rely upon inhalers, and they have had asthma attacks from the regular use of pepper spray in the women’s suicide watch unit. On multiple occasions after she was pepper sprayed in the eyes, nose, and mouth, Ms. Verduzco was dragged to a shower, stripped naked, and sprayed with extremely cold water to rinse away the pepper spray; she was then left naked to wait for a new vest and blanket. A prisoner in the Florence prison’s suicide watch unit reports that while there he was handed razor blades to swallow by other prisoners, and told “just die right away.” He started to swallow the blades, and security staff pepper sprayed him while he coughed up blood, and did not provide other emergency response.

88. Defendants’ policy and practice of holding suicidal prisoners in excessively harsh conditions does not prevent but rather promotes self-injurious behavior. Plaintiff Brislan has cut himself numerous times with razors and pieces of metal while on suicide watch at multiple prisons, including Tucson, Lewis, and Eyman’s SMU 1 and Browning units. At the Tucson prison, staff put him on suicide watch in a cell with broken glass on the floor which he used to cut himself. During another stay in suicide watch, Mr. Brislan was given a razor blade that he used to deeply lacerate both of his thighs. While on suicide watch in the Lewis prison during the summer of 2011, Plaintiff Swartz, on separate occasions, swallowed multiple foreign objects, including two large staples, plastic wrap, a piece of glass, a lead-head concrete nail, a spork, two pens, sharpened paper clips, a metal spring, a steel bolt, and two copper wires. As with Plaintiff Brislan, Mr. Swartz’s repeated suicidal gestures and ability to access dangerous objects while on suicide watch confirms that he was not being properly monitored and that any mental health treatment he might have been receiving was inadequate.

89. Defendants also have a policy and practice of improperly using the suicide watch cells to punish prisoners for alleged disciplinary infractions. An Eyman prisoner who went on a hunger strike to protest prison policies, but did not display signs of mental illness or distress, was put in a suicide watch cell for several weeks and was told by a mental health provider, “If you weren’t on this hunger strike, you wouldn’t have to live in the feces cell.”

UPDATE: ASPC-Lewis Hep C exposure incident.

excellent report by Craig Harris at the AZ Republic is at the bottom.

 --------------------

Bury Hep C, Not People.... 

Wexford Health Sources, Phoenix (JULY 2012)

Wexford connection for prisoner health information:

toll free 1-855-890-6307, or email your request to azcorrections@wexfordhealth.com. 

This media release comes to us this afternoon from Wendy Halloran at KPNX Channel 12 News. They will be covering the story tonight at 5pm and 6pm. Wendy was recently nominated for an Emmy for her investigation of the highly preventable suicide of Tony Lester.

Hep C is already a leading killer in our state prisons. Nearly 6,000 prisoners are already diagnosed with it, and another 20-30% of the prison population likely have it but don't know it yet...

From: LAMOREAUX, BILL [mailto:BLAMOREA@azcorrections.gov]
Sent: Tuesday, September 04, 2012 11:35 AM
To: Halloran, Wendy
Subject: RE: MEDIA REQUEST FROM WENDY HALLORAN AT 12 NEWS

Ms. Halloran:

On August 27, 2012, a potential exposure event occurred at the Arizona State Prison Complex – Lewis while administering medication. A vial of medication, which may have been compromised with a previously used syringe, was subsequently used to treat additional inmates.

Review of this event determined the potential exposure to Hepatitis C and involved up to 105 inmates. As a result, these inmates were notified and are currently being screened for infectious diseases as per protocol in such an exposure event. An independent laboratory, under contract with Wexford, will provide continued medical monitoring and testing of these potentially exposed inmates over the next several months. All patients will be informed of the results of the testing.

The medical protocols related to this potential exposure have been reviewed to ensure that subsequent events do not occur. The initial event remains under review by Wexford Health, the contracted provider responsible for inmate health care.

The nurse who violated the basic infection control protocols is an employee of a staffing agency under contract with Wexford Health. Wexford has banned the nurse from working under any of its contracts and has also requested that the individual be referred to the State Board of Nursing for investigation.

Regards,

Bill

---------from the AZ Republic------------

Prison nurse tied to hepatitis C exposure

by Craig Harris - Sept. 4, 2012 11:12 PM
The Republic | azcentral.com

A nurse for the new medical provider for Arizona prisons may have exposed 103 inmates at the Buckeye state prison to hepatitis C by contaminating the prison's insulin supply, and state and local health officials were not alerted for more than a week.

Officials with the state and Maricopa County health departments, who confirmed to The Arizona Republic on Tuesday that they had not been informed by Wexford Health Sources Inc. of the problem, said they will launch investigations into the incident.

Official notification of the Aug. 27 error only came late Tuesday afternoon, hours after an inmate's family member had told 12 News of the potential health risk.

State rules require health-care providers and correctional facilities to notify health departments within five business days of a hepatitis C diagnosis, treatment or detection.

Wexford said it suspended the nurse on Aug. 27, immediately after learning the person "had violated basic infection-control protocols while administering medication that day."

"In talking with the Department of Health Services, they believe it should have been reported first to the county," Corrections Director Charles Ryan said late Tuesday. "That is a question we will have of Wexford -- as to the lack of notification or an explanation as to why that did not occur.

"The department has concerns about this issue, and we will be having further discussions with Wexford in terms of this requirement and some other issues as well."

Ryan said the incident occurred when a diabetic inmate who also has hepatitis C was administered a routine dose of insulin by the nurse on Aug. 27. The needle used on that inmate was inserted into another vial to draw more insulin for the same inmate.

Ryan said the contaminated needle was inserted into a vial which was then put back among other vials in the prison's medication refrigerator. It got mixed up with other vials used throughout that day to administer insulin injections to more than 100 other diabetic inmates. Later that day, Ryan said, officials realized that the vial that potentially had been tainted with hepatitis C may have been used to dose other inmates.

At that point, the nurse in question was suspended and prison officials sought to determine how many inmates may have been exposed.

All the vials of medicine were destroyed after the discovery.

Wexford spokesman Larry Pike on Tuesday minimized the potential exposure of other inmates. He said that the company acted "expeditiously" to identify those who were potentially affected and that the company believes the potential for their exposure was small.

Though corrections officials and Wexford declined to name the nurse, the Arizona State Board of Nursing identified her as Nwadiuto Jane Nwaohia. She has been under state investigation since June 2012 for unsafe practice or substandard care, but the board would not provide additional information on the nature of the previous problem.

Corrections officials first acknowledged the matter Tuesday morning after 12 News asked about the incident at the Arizona State Prison Complex-Lewis, which houses 5,382 inmates in minimum- to maximum-security facilities.

Hepatitis C is the leading cause of liver transplants and causes liver cancer. Seventy-five to 85 percent of people with hepatitis C develop a chronic infection, according to the U.S. Centers for Disease Control and Prevention.

Shoana Anderson, head of the state Office of Infectious Disease Services, said one of the biggest dangers for those infected with hepatitis C is "it sits in the liver quietly, and 20 years later, a person can develop severe liver disease."

Anderson and Jeanene Fowler, a spokeswoman for the Maricopa County Department of Public Health, said Wexford should have notified them of the issue.

"It's extremely disturbing that something like this could happen. It calls for a thorough investigation to determine all of the surrounding causes of the mistake or the negligence," said Don Specter of the Prison Law Office, a prison watchdog group based in Berkeley, Calif.

Ken Kopczynski, executive director of the Private Corrections Working Group in Tallahassee, Fla., called the incident "scary" and said it shows a lack of oversight by corrections officials.

"This is a problem with privatization," Kopczynski said. "They are just accepting who Wexford will hire."

Wexford, which has previously lost contracts for poor service in other jurisdictions, this spring won a $349 million, three-year contract to provide health care for Arizona inmates. The company began providing services for nearly 40,000 Arizona inmates on July 1.

In a written statement, the Pittsburgh-based company said it suspended the nurse immediately upon learning she "may have compromised a vial of medication by placing it in contact with a previously used syringe."

Wexford, in its statement, said a local staffing agency assigned the nurse to the prison complex. The company said that at no time was the same syringe and needle used on more than one patient and that no staff members were exposed.

Wexford said it reported the nurse to the state nursing board for investigation, but that did not occur until late Tuesday afternoon, after the news had been reported. The company also banned the nurse from working under any of its contracts in the future. Wexford provides health-care services nationwide to roughly 124,000 inmates and other residents at more than 100 institutions.

The state said inmates exposed were notified and are being screened for infectious diseases. An independent laboratory under contract with Wexford will provide continuing medical monitoring and testing of the potentially exposed inmates over the next several months, the state said. All patients will be informed of their results, though Ryan noted that some inmates may previously have been exposed to hepatitis C.

Before the problem at the Buckeye prison, Wexford had issues in other states. Clark County, Wash., declined to renew a contract with Wexford in 2009 at its county jail and juvenile-detention center after complaints that Wexford was not dispensing medications to inmates in a timely fashion.