Surviving Hepatitis C in AZ Jails, State Prisons, and Federal Detention Centers.

Surviving Hepatitis C in AZ Jails, State Prisons, and Federal Detention Centers.
The "Hard Time" blogspot is a volunteer-run site for the political organization of people with Hepatitis C behind and beyond prison walls, their loved ones, and whomever cares to join us. We are neither legal nor medical professionals. Some of us may organize for support, but this site is primarily dedicated to education and activism; we are fighting for prevention, detection, treatment, and a cure for Hepatitis C, particularly down in the trenches where most people are dying - in prison or on the street... Join us.


Wednesday, June 30, 2010

Harm Reduction in Prison: Under the Skin

We need to be organizing more programs like this here, too. Pretty cool that they went around interviewing the prisoners instead of letting all the "experts" speak for them...


Under the Skin: A People’s Case for Prison Needle and Syringe Programs

What do people in prison have to say about the Canadian government’s unwillingness to permit the distribution of clean needles in prison?

Between 2008 and 2009, interviews were conducted in person and over the phone in British Columbia, Alberta, Manitoba, Ontario, Quebec, New Brunswick and Nova Scotia, resulting in sworn affidavits or testimonials from 50 individuals who have used drugs or shared needles in a federal prison. The hope is that their stories will strengthen the case for change, which governments continue to ignore even as a growing body of evidence highlights the need.

The Legal Network is not alone in calling on the federal government to implement needle and syringe programs in Canada’s prison. Our position is supported by the Canadian Medical Association, the Ontario Medical Associations, the World Health Organization, UNAIDS, the UN Office on Drugs and Crime, the Correctional Investigator of Canada and the Canadian Human Rights Commission. Furthermore, a 2006 review of the scientific evidence by the Public Health Agency of Canada concluded that prison-based needle and syringe programs have largely positive outcomes for the health of people in prison.

Published On 2010-02-02
Author Canadian HIV/AIDS Legal Network
Topics Prisons, Drug Policy and Harm Reduction
Document Type Reports
Language English
Doc Id 1594

Prison Health News: Get It.

Dear friends and colleagues,

After a few years break, Prison Health News is back and better than ever -- with four extra pages of health care and advocacy information in each issue, and a network of over 2,000 subscribers and contributors in prisons and jails across the country.

In 2001, Prison Health News was launched to meet a critical need for information written by and for people who have been in prison or are currently behind the walls. Our readers are living inside a system that denies them prevention tools and treatment information about HIV, hepatitis, and other health issues. They are dealing with medical neglect, daily humiliations driven by intense stigma, and the destruction of their communities by mass imprisonment. Prison Health News works to build community across the prison walls that divide us.

Now a joint project of the Institute for Community Justice and Reaching Out: A Support Group with Action, each Prison Health News issue is produced by a Philadelphia-based collective of writers and editors, most of whom have been in prison and are living with HIV. Through our collaboration with the Philadelphia FIGHT AIDS Library, we are able to answer the many letters to us from people in prisons and jails asking for resources and health information. We also work in partnership with organizations across the country who assist with distribution, support and advocacy for people incarcerated in their cities and states. Contact one of our Resource Partners to get involved in your local area!

Our relaunch issue features:

  • From the Crack House to the White House – on the inspirational journey of one PHN writing collective member from her incarceration to her involvement in national and international advocacy work

  • Hearts on a Wire – on the work of a Philadelphia-based collective fighting alongside trans folks in the prison system and those coming home for justice, dignity and respect.

  • Staying Safe and Healthy in Prison – on the basics of HIV prevention in correctional settings, based on a Roll Call presentation conducted every June in the Philadelphia Prison System

You can view Issue 8 online. You can also download a printable version of Issue 8, formatted for double-sided photocopying.

Sunday, June 27, 2010

The dying, prison, and Adam Montoya.

For those who still think that prisoners get great medical care, think again. This is not an unusual story...sounds like Marcia Powell's.

If you wish you could have helped this guy - or Marcia Powell, for that matter - and want to know how to make a difference here: please take a minute and help someone still living. Free Davon Acklin. That will take you straight to the petition his mom has going supporting her request that he be pardoned by Governor Brewer so she can bring him home for medical care.

He's only
23, and he has hep C and needs a liver biopsy. He's not getting treatment at the ADC, either, so your time and good name for the cause would be appreciated.


Ill. inmate died in agony while pleading for help

For days before he died in a federal prison, Adam Montoya pleaded with guards to be taken to a doctor, pressing a panic button in his cell over and over to summon help that never came.

An autopsy concluded that the 36-year-old inmate suffered from no fewer than three serious illnesses -- cancer, hepatitis and HIV. The cancer ultimately killed him, causing his spleen to burst. Montoya bled to death internally.

But the coroner and a pathologist were more stunned by another finding: The only medication in his system was a trace of over-the-counter pain reliever.

That means Montoya, imprisoned for a passing counterfeit checks, had been given nothing to ease the excruciating pain that no doubt wracked his body for days or weeks before death.

"He shouldn't have died in agony like that," Coroner Dennis Conover said. "He had been out there long enough that he should have at least died in the hospital."

The FBI recently completed an investigation into Montoya's death and gave its findings to the Justice Department, which is reviewing the case. If federal prosecutors conclude that Montoya's civil rights were violated, they could take action against the prison, its guards, or both. A Justice Department spokesman declined to comment, saying that the matter was still being investigated.

The coroner said guards should have been aware that something was seriously wrong with the inmate. And outside experts agree that the symptoms of cancer and hepatitis would have been hard to miss: dramatic weight loss, a swollen abdomen, yellow eyes.

During Montoya's final days, he "consistently made requests to the prison for medical attention, and they wouldn't give it to him," said his father, Juan Montoya, who described how his son repeatedly punched the panic button. Three inmates corroborated that account in interviews with The Associated Press.

The younger Montoya was taken to the prison clinic one day for "maybe five, 10 minutes," his father said. "And they gave him Tylenol, and that was it. He suffered a lot."

The federal prison in Pekin will not discuss Montoya's death. Prison spokesman Jay Henderson referred questions to the Bureau of Prisons, which denied an AP request for information on Montoya's medical condition, citing privacy laws.

It isn't clear whether the prison system, relatives or even Montoya himself knew the full extent of his illness. Montoya's father had no idea his son had cancer or hepatitis. Inmates who knew him said he told them he had cancer, but they knew nothing of his HIV.

According to its website, the Bureau of Prisons tries to screen the health of new inmates within 24 hours of their arrival. A closer examination within two weeks is required for prisoners with serious, long-term illnesses. But officials have not said whether Montoya was given any kind of exam or whether his medical records made it to Pekin.

Montoya pleaded guilty in May 2009 to counterfeiting commercial checks, credit cards and gift cards. Prosecutors will not say how much money was involved in the scheme, but Montoya was ordered to pay a little over $2,000 in restitution.

Montoya, who had a history of methamphetamine abuse, was released while awaiting sentencing and was ordered not to use drugs. At the time, he was living with his father and working for his father's process-serving business, which delivers legal documents. His father said he was paying Montoya's bills and paying him about $300 a week.

Then in mid-June, Adam Montoya was diagnosed with HIV.

"It hit him like a ton of bricks," his father said.

After the diagnosis, Montoya retreated back into methamphetamine. Following a urine test, he admitted using the drug three times in a month, and he was locked up.

Montoya began taking antiviral drugs, so his father still had hope and tried to give his son a sense of the same. "I thought, 'You'll get out. You'll get your probation, and you'll have years of life," the elder Montoya said.

In mid-October, Montoya was sentenced to two years and three months in prison. When he arrived at a federal prison transfer center in Oklahoma City, his medication was waiting for him. His father took that to mean that the prison system knew Montoya suffered from HIV.

Montoya arrived at the Pekin prison on Oct. 26. He lived just 18 more days. The inmates around him say he spent much of that time pleading for help from his cell.

Prison staff told Montoya he had the flu, according to Randy Rader, an inmate in the next cell who wrote letters to his mother about Montoya and discussed him in an e-mail interview with the AP.

"That man begged these people for nine days locked behind these doors," Rader wrote to his mother on Nov. 14. The letter was first obtained by The Pekin Daily Times, which wrote about Montoya's death earlier this year.

Rader has since been moved to a prison in California -- far from his family in Michigan. He suspects the move was retaliation for speaking out about Montoya.

The last time a staff member visited Montoya, about 10 p.m. on Nov. 12, he reported having trouble breathing and complained that he could no longer feel his fingers, Rader said in the e-mail interview. The staff member told Montoya that he would try to get help the next day.

Around 6:30 a.m., prison officials found Montoya's body in his cell.

The autopsy showed that Montoya's spleen was almost 10 times the normal weight because it had been engulfed by a cancerous tumor, which was on its way to doing the same with his liver.

The pathologist who examined Montoya's body said his eyes were also yellow -- an unmistakable sign of hepatitis. Dr. John Ralston is reluctant to speculate whether treatment could have saved Montoya's life by the time he reached Pekin. The doctor suspects he would have needed a liver transplant to have a chance.

That said, "You would think that he would have been feeling bad enough and complaining enough that somebody should have tried to get to the bottom of this," Ralston said.

The AP sought opinions about Montoya's condition from other doctors who did not examine him but were familiar with his diseases. They agreed he probably displayed obvious signs of distress.

Montoya would have had a swollen abdomen because of his spleen. At the same time, he probably was losing weight rapidly because the large tumor would have left little room in his belly for food, according to Dr. Krishna Rao, an assistant professor of oncology at Southern Illinois University Medical School in Springfield.

Someone in Montoya's condition should have been taking heavy doses of chemotherapy for his cancer or receiving stem cell transplants, if he were healthy enough, said Dr. James Egner, an oncologist with the Carle Foundation Hospital in Champaign.

If the cancer was too advanced, Montoya should have at least been treated for pain with powerful drugs, possibly in a hospice, Egner said.

The president of the American Civil Liberties Union's National Prison Project said it isn't uncommon for medical records not to arrive with a federal inmate.

"Sometimes it arrives late, and sometimes it doesn't happen at all," said David Fathi, who has spent 15 years studying prison conditions. "That's why it's so critical that the new facilities do a medical screening" of new inmates.

Fahti said Montoya's death "is really an egregious failure, of the kind that you wouldn't expect from even a small county jail, let alone the largest prison system in the United States."

After his son's death, Juan Montoya wrote to the prison complaining about its medical care. Warden Richard Rios wrote back to defend his institution.

"I must respectfully disagree with your characterization of the medical care Adam received and want to assure you that we carefully monitored you son's medical condition," wrote Rios, who was not hired for the job until months after the death. He did not elaborate, writing that privacy laws limited what he could say.

The elder Montoya is now waiting for his son's medical records, but he doubts they will offer many clues. The family has hired lawyers but has not decided whether to file a lawsuit.

Montoya thinks a lot now about the assurances he offered his son as he headed for prison.

"Your time will go by fast, and you'll get out, and we'll get you a job and be part of the family," Montoya recalls telling his son. "It never happened."

Saturday, June 26, 2010

Capitalizing on Human Suffering...

Just one of many market pitches to get people investing in HCV related "products" - they're thrilled at the projected rate of increase in the incidence of Hep, tell me there aren't dark forces at work in this universe conspiring to capture and exploit the sick, insane, and criminalized. As long as they can make a buck...thousands of bucks actually, just to buy their market forecasts. They do it for just about every medical condition under the sun...

This is really troubling...


GlobalData, the industry analysis specialist, has released a new report, “Hepatitis C (HCV) - Pipeline Assessment and Market Forecasts to 2016”. The report is an essential source of information and analysis on the global HCV market. The report identifies the key trends shaping and driving the global HCV market. The report also provides insight into the prevalent competitive landscape and the emerging players expected to cause significant shifts in the positioning of the existing market leaders.

Most importantly, the report provides valuable insight into the pipeline products within the global hepatitis C sector. GlobalData’s analysis suggests that the global HCV market was worth $4.4 billion in 2009. It is forecast to grow at a Compound Annual Growth Rate (CAGR) of 9.8% for the next seven years to reach $8.5 billion by 2016. The high projected growth rate is primarily attributable to a strong pipeline. The increase in the prevalence of the disease and the availability of new first-in-class therapies with better safety and efficacy profiles are expected to drive the growth of the HCV market. GlobalData found that the global HCV market is becoming more competitive. When seen alongside the currently marketed products and the expectations of patients and physicians, the pipeline is considered to be strong. The unmet need in the HCV is high and if a company wants to capture this unmet need, it will need to overcome the prevailing product weaknesses and adverse effects.


The scope of the report includes:
  • Annualized global hepatitis C market revenues data from 2000 to 2009, forecast for seven years to 2016.
  • Pipeline analysis data providing a split across different phases, mechanisms of action being developed and emerging trends. The key classes of mechanism of action include protease inhibitors, polymerase inhibitors, toll receptor agonists, drugs with interferon-like actions, HCV inhibitors and immunomodulators.
  • Analysis of the current and future market competition in the global hepatitis C market. The key market players covered are Merck, Human Genome Sciences, Novartis, Vertex, Janssen, Mitsubishi, Tibotec and Roche.
  • Insightful review of the key industry drivers, restraints and challenges. Each trend is independently researched to provide a qualitative analysis of its implications.
  • Key topics covered include a strategic competitor assessment, market characterization, unmet needs and implications for the future hepatitis C market.

Thursday, June 24, 2010

Making the case: Extraordinary and Compelling.

Ethical and legal issues regarding federal compassionate release. Interesting article - worth reading the rest.


Maryland Law Review
17 June 2009

“Justice is the tolerable accommodation of the conflicting interests of society, and I don’t believe there is any royal road to attain such accommodation concretely.”—Judge Learned Hand1

Conflicting interests lie at the heart of the sentencing process. Not limited to the obvious competing interests of the state and the offender, the state’s broader punishment interests can often conflict.

The state’s interest in giving an offender his just deserts, for instance, competes with its interests in deterring others from committing the same crime, incapacitating the offender to protect society, and rehabilitating the offender.2 The battle for supremacy between such interests often occurs when a judge considers whether certain evidence is grounds for mitigating a sentence.3

Although parole was abolished with the passage of the Sentencing Reform Act of 1984,4 the potential for mitigating a federal sentence does not end with the sentencing decision of the federal trial judge. Rule 35(b) of the Federal Rules of Criminal Procedure authorizes the court, upon motion by the government, to reduce the sentence to reflect substantial assistance provided to the government by the defendant after the sentence became final.5 In addition, where the United States Sentencing Commission has subsequently reduced the guideline range used to sentence the defendant, the court may reduce the sentence upon a motion by the defendant or the Director of the Bureau of Prisons.6

Federal law, unbeknownst to many, includes another stipulation that authorizes the immediate release of federal prisoners. This safety valve provision demands that the Director move on behalf of the prisoner to secure the prisoner’s compassionate release.7 Not a veiled version of parole, this compassionate release provision is only to be used in circumstances deemed “extraordinary and compelling.”8 The Bureau of Prisons has read this language very narrowly for many years, considering only terminally ill inmates as candidates for compassionate release.9 In November 2007, however, the Sentencing Commission modified its Commentary to the Sentencing Guidelines, defining for the first time criteria for determining circumstances that should be deemed “extraordinary and compelling.” Specifically, the Commission’s new Commentary provides that extraordinary and compelling circumstances can include: (1) terminal illness, (2) debilitating physical conditions that prevent inmate self-care, and (3) death or incapacitation of the only family member able to care for a minor child.10

In addition, the Commentary provides that compassionate release may be granted where, “[a]s determined by the Director of the Bureau of Prisons, there exists in the defendant’s case an extraordinary and compelling reason other than, or in combination with, the [three] reasons described [previously].”11

As explained below, the Bureau of Prisons has ignored, in many ways, the broader statutory language as well as its own regulations in its decision to limit the application of “compassionate release” to prisoners who are terminally ill. By limiting the use of the safety valve to cases of “medical parole,” the Bureau eschews the more difficult categories of prisoners who, for one of the reasons discussed below, may be considered for release given the facts of their particular situation. The Bureau of Prisons, in limiting its need to review compassionate release petitions to medical cases, thus abandons the flexibility to consider truly compelling cases, perhaps in part for a lack of method by which to separate the meritorious cases from the many that do not rise to the level of extraordinary and compelling.

This Article will consider the theoretical justifications for compassionate release in an attempt to develop a framework to evaluate what circumstances rise to the level of “extraordinary and compelling.”

First, the Article will argue that the state’s purposes for punishment, whether retributive or utilitarian, do not by themselves justify the compassionate release of inmates. As a result, this Article will propose that the basis for compassionate release should lie in the broader interests of the state. Thus, the Article will argue that the non-penal interests of the state (in light of the “extraordinary and compelling” factual circumstance) must clearly outweigh the state’s penological interest in the inmate serving the entire sentence before compassionate release
may be justified.

Part II of this Article will explain the significance of the compassionate release provision in light of the large number of inmates in federal prison, and will provide a vignette of one prisoner’s alleged “extraordinary and compelling” circumstance that was rejected by the Bureau of Prisons Director.

Part III will outline the statutory and administrative landscape surrounding the compassionate release provision and describe the Sentencing Commission’s adoption of the guideline commentary.

Part IV of the Article will argue that the traditional purposes of punishment—just deserts, deterrence, incapacitation, and rehabilitation—cannot alone serve as the basis for awarding compassionate release to prisoners. Part V will argue that the basis for compassionate release should lie in the broader, non-penal interests of the state, and that circumstances should be considered extraordinary and compelling only when such interests greatly outweigh the state’s penological interests as applied to the prisoner at issue…

Finish article at:

Saving Davon Acklin: How to Help

Here's the official campaign strategy, folks. It should take 10-20 minutes of your time, tops.

------------------reprinted from hopeworkscommunity------------------------

On Helping Davon Acklin

Many of you read the original post on Davon Acklin. If you would like to help him there are several things you can do.

  1. Let as many people know about his case if possible. If you are from Arizona or know people in Arizona in particular let them know.
  2. Contact the governor directly and ask that he be considered for compassionate release. There is no reason or nothing to be gained by him staying in prison. In your contact explain the facts as you know them. Her phone number is 1-(800) 253-0883. It will only take a couple of minutes. Also email the governors office. The website is Just follow directions on the site to make the email. And then and this is so important- do it again next week. And again the week after that. Persistence pays. It will only take a few minutes.
  3. Contact at least 5 other people about Davon. Tell them about the case. Tell them what you are doing to help and ask them to do the same thing. Ask each of them to also contact 5 other people and ask each of those 5 to do the same thing. If we do this and carry through soon the Governors office will be receiving thousands of contacts asking for Davon’s release. It makes a difference.
  4. If you live in Arizona write a letter to the editor of your paper about Davon. If you are outside the state write one to a paper in one of the major cities like Tuscon.
  5. The contact information on Davon is in the previous post (see below). Contact him directly and let him know you care. This might be the most important thing.
  6. There is a cause on Facebook called Free Davon Acklin ( If you are on Facebook please join. Be part of a unified and committed effort to help Davon.

Please act now. What you do as an individual makes a difference.

TX to AZ: The Politics of Compassion.

Kudos to this reporter for caring about this story. We have some compassionate release hang-ups in Arizona that need some journalistic help, too...maybe there's even a student out there who would want to make it an investigative journalism or research project? Let us know. Time is running out for Davon and his fellow prisoners; even he suggests that there are men far more ill than him who need to be going home before they die. Terminal illness was not included in their sentencing; perhaps sentencing judges should be reviewing such things when people apply for compassionate release.

So, keep hounding the governor - we need to let these folks find decent treatment in order to survive their sentences, or release them so they can die at home. Let her know that more than just a few of us care about this - she doesn't strike me much as the "compassionate" type, after all this with SB 1070.

But if she's really into helping the people of Arizona, then this is one small way she can make a huge difference in the lives of folks who have otherwise been disposed of and forgotten by all but their families - if they even still have connections with them, then the suffering generated by denying medical releases to terminally or chronically, severely ill prisoners is exponentially magnified. Everyone, including the state and our communities, hurts from our inability to embrace our own humanity, and find within ourselves the qualities of Mercy and Grace.

And the effects of the ease with which we detach from the pain of our fellow beings trickle down to the next is not a kind thing to bestow on them, or much of a gift to leave the world: a callous heart.

And it's all politics. Challenge Brewer to have the courage to step up to this issue and do it right. Word is that too many people since Janet have been approved by the Board of Executive Clemency only to die while sitting on the Governor's desk. Is this governor any less a coward than Napolitano was? I hope so.

- Peg


Few Texas Inmates Get Released on Medical Parole
by Emily Ramshaw
Texas Tribune
June 3, 2010

A gaunt old man, thick with whiskers and stricken with dementia, writhes under the covers of his bed. Down the hall, doctors monitor elderly diabetics with recently amputated limbs, medicate terminal cancer patients shuffling by with walkers and tether shivering dialysis patients to blood-cleaning machines.

Despite the pacing guards, the handcuffs and the bars on the windows, the geriatric and medical wing at the Estelle Unit in Huntsville looks more like a nursing home than a maximum-security prison.

Prison doctors routinely offer up the oldest and sickest of these inmates for medical parole, a way to get those who are too incapacitated to be a public threat and have just months to live out of medical beds that Texas’ quickly aging prison population needs. They’ve recommended parole for 4,000 such inmates within the last decade. But the state parole board, which makes the final decision on “medically recommended intensive supervision,” has only agreed in a quarter of these cases, leaving the others to die in prison — and on the state’s dime.

Texas’ “geriatric” inmates, classified as those 55 and older, make up just 7.3 percent of Texas’ 160,000-offender prison population. But they account for nearly a third of the system’s hospital costs and make three times as many visits to prison medical departments as younger inmates. Elderly inmates have average annual hospitalization costs of $4,700, compared to $765 for inmates under 55. In total, providing inmate medical care costs the state correctional health care system — already facing hundreds of employee layoffs amid a budget shortfall — nearly half a billion dollars a year.

Parole board members say they’re faced with the difficult task of determining whether an inmate is still dangerous and must err on the side of public safety. “You can be sick, have an illness or a disease, and still be a threat,” said board chair Rissie Owens. “Our decisions aren’t based on numbers, on quotas. And we feel like we’re making good decisions.”

But criminal justice and prison funding experts say leaving elderly, terminally ill inmates to waste away behind bars is often unnecessary and exorbitantly expensive. Those costs would be shared with the federal government if the offenders weren’t in state custody.

“These are totally incapacitated inmates, terminally ill inmates, inmates on respirators, who are not paroled at a huge expense to the state and hardship to the inmate’s family because of the nature of a crime they may have committed 20 or 30 years ago,” said Sen. John Whitmire, D-Houston, who chairs the state Senate’s Criminal Justice Committee. “I think it’s largely for political reasons.”

The cost of care

While the total prison population in Texas isn’t growing, it’s quickly aging. The ranks of geriatric inmates are rising by about 6 percent every year, frightening the budget writers who have to figure out how to pay for them. Health care costs are rising too: The average daily medical bill for Texas inmates grows about 4 percent every year — which is low, compared to some states.

The sickest inmates can each cost the state up to $1 million a year in health care costs. If these same inmates were living in nursing homes or hospice facilities, the federal government — through Medicaid — would pay two-thirds of the cost and save Texas taxpayers up to $50 million a year, according to state projections. If the offenders are eligible for Medicare, the feds would pick up the full tab. “We could be transitioning them to some other facility where state taxpayers wouldn’t have to bear the full health care cost,” said Marc Levin, the director of the Texas Public Policy Foundation’s Center For Effective Justice Director, who suggested special nursing homes or hospice centers monitored by parole officers. “It’s a real opportunity to identify some savings without doing anything to endanger public safety.”

But despite the fact that the national one-year recidivism rate for older offenders is miniscule compared to that of younger offenders — 3.2 percent for inmates over 55, compared to 45 percent for inmates between 18 and 29 — an April report by the VERA Institute of Justice, a nonprofit criminal justice policy group, found that the 15 states that allow medical release rarely use it. What stands in the way? Political repercussions, complicated review processes and limited eligibility, the researchers found.

Getting Texas inmates released on medical parole is no easy task. To be eligible for it, an offender can’t be on death row or be serving life without parole, and must be either terminally ill (six months or less to live) or require intensive long-term care, said Dee Wilson, director of the Texas Correctional Office on Offenders with Medical or Mental Impairments. Sex offenders must effectively be in a vegetative state for consideration.

If inmates qualify, the office, in conjunction with the Correctional Managed Health Care Committee, recommends them for medical parole, then submits them to the seven-member Board of Pardons and Paroles for a decision. “It’s all about how long you have to live, and what your prognosis is,” Wilson said. “You can have a terminal illness but still be fully functioning.”

Dying behind bars

The parole board, in turn, relies on a pre-existing condition threshold of sorts. If an inmate with a particular illness commits a crime, Owens said, it’s unlikely he or she will get medical release for that same diagnosis. Some inmates with multiple amputated limbs may look incapacitated, Owens said, but managed to commit their crimes that way. Of the roughly 4,000 inmates prison health officials recommended for medical release in the last decade, the parole board turned down nearly 3,000.

In the last fiscal year alone, more than 440 Texas inmates died in prison. Thirty-one inmates who’d been recommended by medical staff for release died while awaiting the parole board to take up their case; another 26 died after the parole board rejected them for release. Twelve inmates were approved for medical parole but died before they could be sent home.

“There are documented cases where individuals had days or weeks left to live” and were rejected for medical parole, Whitmire said. “I saw no reason why they shouldn’t be paroled so the family could make plans for their funeral.”

Texas is not the only state struggling with skyrocketing prison health care costs and concerns around medical release. Between 1999 and 2007, the number of inmates 55 or older in state and federal prisons grew by more than 75 percent, to 76,000. To date, more than a dozen states have units set aside for elderly inmates; eight have dedicated hospice facilities. Estelle has an impressive medical facility, with a bustling emergency room, high-tech telemedicine equipment and a team of nephrologists that perform 1,800 dialysis treatments a month — sometimes on aggressive or unstable inmates.

“From a medical perspective, I’m comforted that [offenders are] getting a level of care they may not be getting on the street. On the other hand, we’re about to un-employ 363 people,” said Dr. Owen Murray, the chief physician for the University of Texas Medical Branch’s correctional managed care program, which oversees health care for the majority of Texas’ prisoners — and is facing layoffs this summer. “Are there other strategies to reduce our costs? And how do we prevent having to build more expensive units in the future?”

Charles Dill, a 71-year-old offender who started a 20-year sentence in 2000, has been hospitalized multiple times himself for costly heart problems, including getting stents for his carotid arteries. He’s befriended several elderly inmates in Estelle’s geriatric unit, only to watch them die on the ward.

“I’ve seen several of these guys drop over dead,” Dill said, gesturing across a prison dorm room of prosthetic limbs and wheelchairs, adult incontinence products and white-haired men in Coke-bottle glasses. “I guess they completed their sentence.”

Captives of an Industry of Pain: Terminally ill in California prisons.

If corrections officers in Arizona find some of this offensive, my apologies. I found many parallels in this editorial between Arizona and California, and felt some of her points were worth making. I am mindful that officers have it a little better in CALI prisons than here...but really, do they need two of you to guard a dying old woman already in shackles every time she goes to the hospital? And do we need to lock up young men for burglary and property crime who have since developed neurological disease and become quadraplegic?

I think these prisoners' judges and juries would have ordered something different from the hell they landed in, in most cases, if they knew the social, economic, and human costs of abandoning people to die in prison. Unless the court ordered death, life or its equivalent in years, they expected these prisoners to end up home one day...that should be honored, too - the right of judges to know the truth about their sentencing, and to re-do it when chronic or terminal illness strikes someone they locked away...


CA: Enforcing prisoner compassionate release law would save a billion...
Sacramento Prison Reform Examiner
Editorial - B. Cayenne Bird
June 19, 2009

Senator Mark Leno explained during Monday's online Senate Town Hall Meeting that the lawmakers can sometimes jump the 2/3 vote requirement hurdle and actually pass reform bills. However, due to a lack of oversight, it can take years for the changes in laws to be enforced. Then, Senator Steinberg described the financial consequences brought about as a result of harsh laws such as Three Strikes and Jessica's Law. These are but two laws foisted upon us by special interests via the initiative process which had no funding source, meaning that they are paid for from education, human services or some other existing program.

Implementation of Three Strikes and Jessica's Law and now Prop 9 are certainly not for free and have already driven up the cost of corrections from 5.4% to 11% in just seven years, which doubled the percentage of spending in the General Fund alone. Add to these costs the millions that will be required to bring California into compliance with the hysterical federal Adam Walsh Act and it is no surprise that this $10 billion expense is still growing. Senator Steinberg is correct when he points out that such extravagant laws have contributed greatly to our meltdown. Leno says that the cost of incarcerating a prisoner under 50 years old is $49,000, but the cost doubles after the age of 50 and triples after the age of 60, which means that many elderly prisoners cost upward of $150,000 a year. Leno says that 70% of this outlay is in employment costs alone.

Imagine, an entire industry built for the purpose of punishing sick people. I. for one, am ashamed and outraged that this is being done in my name,with my precious tax dollars. I am appalled that my legislature is in total gridlock due to the malicious will of the minority party who caused the prison overcrowding crisis and refuses to remedy it other than possibly agreeing to a miniscule 12% - 15% cut which will be decided this week. There should be at least a 50% cut to Corrections, a black hole of waste that is providing few valuable services and has devolved into more of a criminal college where nobody is coming out "corrected."

See this important, eye-opening webcast about the budget crisis here.

Around the 1 hour 20 minute mark (1:20), the two senators address one of the questions I submitted to them during the broadcast, but they don't really directly answer it. I asked, "When will prisoner releases begin and why haven't they already started considering there are about 80,000 non violent people incarcerated for minor technical parole violations?"

After all, the elderly and disabled have already received an 8.5% cut in income and had all their dental services eliminated, as if teeth aren't necessary to good health or frail people being able to chew their food. It is common sense that cuts to the poor, which make bad situations worse, almost always result in a rise in crime. But common sense doesn't rule governments, organized groups and the people they put into office make the decisions for everyone. The weakest voting groups are taking the most serious cuts. After all, the elderly and disabled aren't organized well enough to elect or recall a politician, so they can take away their food and utility money, cause them to go homeless, and there won't be much of a public outcry about such unwise public safety endangerment at all.

But any move that would interfere with the job security and a salary of a prison guard has yet to be implemented. This supremacy is because the guards' union, CCPOA, can elect or recall politicians and have already put many of the lawmakers into power to serve their wants and needs. The teachers and nurses are far bigger voting lobbies, but they aren't as agressive, or generous to the politicians, so the bullies rule the day with very little public outcry from those who should be out posting at the news sites voicing opposition.

Today's prison guards are paid more than university-level professors with years of education. About $40 million per month in overtime pay alone is being spent for guards to stand over sick prisoners who can't swat a fly off their noses. This is in addition to their regular pay to just sit or stand at the door for 24 hours a day on four shifts . Very little of these billions are actually going to benefit or heal the prisoners, which would be a wise thing to do since they are almost all going to be eventually released into our neighborhoods. The goal should be to return them better off instead of broken in mind, body and spirit but that is far from the reality of what is actually taking place.

This dysfunction that Senator Leno mentions of a years-long delay in actually enforcing changed policies, even when they would remedy crisis situations, has certainly been true in the case of AB 1539, This urgent bill was passed into law in 2007 for the compassionate release of terminally ill and permanently medically incapacitated prisoners. It took 15 years of painful struggle to get both parties to agree upon and a Governor to sign this desperately needed bill which would reduce prison overcrowding and medical costs. People died and are still dying cruel deaths in overcrowded prisons long past the time when they could be sent home to spend their final days with their families or to skilled nursing facilities which would cost far less than having them die in prison under costly heavy guard.

Additionally, our prisons are full of quadriplegics such as Steven Martinez (see his parent's side of the story and statement of his attorney at the links to the right of this article) and of terminally ill prisoners such as Mark Grangetto, whose torture case I have been writing about for years as it travels through the back-logged and corrupt courts. There are prisoners who cannot care for themselves dying from cancer, AIDS and every disease known to man. I have witnessed guards just standing there with their batons and pepper spray in readiness for the unlikely event that one of these dying, pathetic people might make any move at all. It's revolting and beyond ludicrous for our education and human services dollars to be wasted in this manner.

From $1-$2 billion of taxpayer dollars have been unnecessarily spent since 2007 alone to continue to punish people who meet the standards for a compassionate release or more technically, a recall of sentence. Arrogant attitudes, political posturing and unbearable incompetence by individuals in CDCr and the Board of Prison Terms, which lawyers say exceed their authority, are forcing taxpayers to pay an extravagant price for public safety services that we're not even getting. The bungling of physicians who couldn't get a job anywhere else actually caused permanent harm to many of the inmates, which is why more than 100 doctors were fired. The violence in the mismanaged prisons and the state's failure to protect the inmates in over-crowded environments have also resulted in many life-long disabilities. Hundreds of millions of dollars have been spent in lawsuit settlements which were preventable if only the state had been following and enforcing their own laws. Still, many of these problems continue today. Why?

Attorney General Jerry Brown fights the reforms and healing programs as well as defying court orders mandated by the three judge panel and almost never prosecutes those whose deliberate indifference resulted in a death or permanent disability. The careless double celling policy, continual lockdowns in cells the size of a small bathroom where they put two men 23 hours a day, one of whom might be severely mentally ill, has caused untold maiming and deaths to occur. Some of this carnage would be stopped if the new law AB1539 were being enforced because it would reduce the over-crowding and free up space for healthier inmates.

The lawmakers from both parties passed AB 1539 for good reasons, to remedy the present crisis, and yet two years later state employees still think that they have the jurisdiction to deny compassionate releases when it is now up to the judges. CDCr administrators are doing everything in their power to stop such releases for the purpose of maintaining the human bondage industry and no one is calling them on these unlawful practices.

Steven Martinez' mother, Norma, says that "the decision to deny a compassionate release to my paralyzed son was made by Suzane Hubbard. She says she was acting on behalf of Matthew Cate." The law clearly states that only a judge can make the final determination of whether or not an inmate should be released. Both Hubbard and Cate have no jurisdiction to deny release. Martinez fits the criteria of AB1539 by being totally unable to care for himself. Both state administrators are violating the law by making such a denial which is out of their purview. Even in the Martinez case, where it is so clearly evident with him being paralyzed, the administrators continue their unlawful arrogance and still ignore that AB 1539 was passed just to remedy such an expensive and inhumane situation. How can they sleep at night?

Martinez' father is a retired fireman and he comes from a solid, loving home. Even the victim in his case has joined his release campaign. Martinez has three small children who are being disallowed regular visits with their father, a cruel practice taking place in all the prison hospitals. These three children would benefit from having him in the home because he still has his voice and they love him. There are medical providers who will care for Martinez, saving the taxpayers the expense of upwards of a million dollars just for this one prisoner. The same is true in the Grangetto case, yet the state officials refuse to obey the law and many physicians are being threatened for making compassionate release recommendations.

Taxpayers should demand that every recall of sentence denied since 2007 is immediately reviewed and that the Director of the Department of Corrections and the Secretary of the Agency, Matthew Cate, be informed and held accountable for implementing the changes that this law brought into effect. AB 1539 is still being ignored at great fiscal and humanitarian expense for political reasons which all concerned, should find unacceptable.

The solution to these problems is not to build more prisons but to release those who shouldn't be there in the first place. We as taxpayers are being sold a "security service" which we can't afford and which provides no security. And we're paying for it with actual crime prevention dollars because that's why we have human services and education, to reduce crime. No matter how hard anyone tries, a sick person cannot be punished into being well. It is very clear that the purpose of prisons is to punish sick people. Where is the public outcry about laws not being followed by those we put into power?

Wednesday, June 23, 2010

Free Davon Acklin.

Davon's in a no-win situation: this can't be the way we all intended for things to work out for kids like him - first prison, now Hep C. He's pretty ill, too; Julie's been getting the run-around from some of the folks at the ADC, but she has his medical records now and knows better what she's dealing with. Davon's getting sicker, fast, and there's no more time to mess around with these people.

Anyway, I'm posting the Hopeworks Community write-up on Davon because I'm so close to him that I've been having a hard time blogging about him; this really breaks my heart. But he's easy to write to (here are the ADC mail policies), and he usually draws something awesome on his letters and envelopes for me. So, as the author of this post suggests, drop him a line.

I don't think Julie or Davon would mind me saying that he can always use a few bucks, too, for medical co-pays, stamps, and food/vitamins if you can spare it - the ADC doesn't exactly have healthy menus (they just replaced tomatoes with pickles as an equivalent). Even cancer patients have to worry about paying for their own nutritional supplements in Arizona's prison; "special diets" that actually have any improved nutritional value are considered "special" to prisoners mainly because they're so hard to get. Everything "extra" (like health care) has to be paid for, and if you're poor - as in the "real world" - you're SOL.

Here's Davon's story. Writing a note or sending a postcard to him will be time well-spent. If you send a money order or certified check, make it out to the "Arizona Department of Corrections for Davon Acklin (223880)", then tuck it in the envelope. No need to be extravagant - $10 is a lot of money when you have none. It will be deeply appreciated.

Governor Brewer's office a line in the meantime, too, letting her know you want to see this kid treated or home ASAP. Follow emails up with snail mail on your letterhead. You guys work on her for now; we'll work on the Board of Executive Clemency and the ADC. If we need help with them, as well, we'll let you know.

----------------------from Hopeworks Community------------------

Free Davon Acklin

By hopeworkscommunity

Davon Acklin didn't just fall between the cracks. He lives there.

He is 23 years old and an inmate of the Arizona prison system. Like many people with severe mental illness he found out that a system which offers inadequate or no services at all to people with serious emotional problems leaves many of them in prison and too many of them in a hell which ultimately destroys their chances for recovery and any kind of life worth having.

He may be dying. He has hepatitis C courtesy of the prison environment he lives in. His liver has been affected and without serious medical attention his chances of making it much longer are virtually nil. He has 10 months left to release. His mother has appealed to the authorities to give him compassionate release. She only wants to be with her son and if he must die she doesn't want it to be in a hell hole with people who look upon him as only a number and less than a person. She wants him home. She just wants him home.

He was convicted originally of assault with a deadly weapon. He was psychotic, had stolen a battery. Two security guards ran after him. In a panic he brandished a box cutter at them. His first year was spent in solitary confinement in a Super Max prison. He found out that his punishment for being sick, being scared, and being psychotic was to have a planned, brutal attack on the tattered shreds of his sanity. Imagine what one year in solitary confinement would be for you. Now imagine if you were already emotionally ill.

There is some treatment available in the prison, but the state of Arizona has a protocol to decide who should get it are not. Davon doesn't meet the criteria.

He “committed” a crime, but he is not a criminal. His family was trying to find placement for him before anything happened. His illness struck first.

His mother tells me he has given up. He sees himself as being alone and powerless against a system which seems determined to get its pound of flesh. But you can help.

Take a few minutes out of your day and write him. Let him know you care. Let him know he is not alone. His contact information is ….

Davon Acklin (223880)

ASPC-Tucson/ Manzanita

PO Box 24401

Tuscon, AZ 87345.

It will be the best few minutes you spend tomorrow. Please act.

Please spread the word and tell others. Share this post with as many people as you can. This is a horrible injustice. Mental illness should not be a capital crime. There are many, too many Davon’s. Please stand for him.

In the next couple of days I will have additional posts telling about other concrete things you can do. Please spread the word…. And please, please, please HELP FREE DAVON ACKLIN!!!!!

Monday, June 21, 2010

Called to Care: Hospice of the Valley.

Hey all,

Called to Care is one of the main ministries addressing the needs of people with disabilities that has been supporting the efforts of the Hard Time Alliance, which is organizing Arizona's Hepatitis C + prisoners/ex-prisoners and their families. They had us give a little presentation at their coordinating meeting a month ago (where they had an awesome main speaker), and were on hand for the Candlelight Vigil last month at the ADC. Robert's also been a real support to my friend and comrade, Julie, who's trying to get either treatment for her son in prison or compassionate release so he can get it at home before the disease progresses further.

Anyway, I don't think these folks would mind if a few of us crashed this meeting in order to address concerns about the terminally ill in prison: is there even hospice space available to release dying prisoners to? Do hospice workers go into Arizona's prisons or jails? Does Hospice of the Valley deal at all with the prisons (like training other prisoners to be end-of-life caregivers, for example)? Are they a resource for the families of elderly and terminally ill prisoners?

I'm sure the rest of you can think of more questions to ask. Do just that - ask questions that concern these issues - wherever you go. In fact, if you can, make a point of going to things like this specifically to engage the rest of the community in a relationship with people dying behind bars: we have to do something about the hang-up on compassionate release (word is, there have been none/few signed by the governor since the Baseline Killer - that means Janet let a lot of sick people die in there who the ADC found eligible and the Arizona Board of Executive Clemency recommended for release).

So, if you have a chance to talk with someone from the American Cancer Society or other patient education/support/advocacy groups, please speak to the issues of compassionate release and hospice care for dying prisoners. If they hear it from several sources, maybe they'll jump in and help.

Thanks again, Robert, for your kindness and solidarity.

------------------from Called to Care---------------------

Dear Friends:
This is a reminder for the Called to Care Coordinating Council meeting, Sunday, June 27, 2010, 12 noon, Anthony Lounge, First Congregational United Church of Christ 1407 N. 2nd Street, Phoenix,, potluck, carry-in meal. All are welcome. Sue Bartz, First Church member and Hospice of the valley Patient Insurance Department Coordinator, organized this speaker meeting. She invited Heather Chapple, Community Liaison, Hospice of the Valley, to speak on "The Hospice of the Valley's Senior Placement Service" that helps families find appropriate care for their loved ones at no cost to the family. Check attachment for details. For more information, contact Robert Koth by telephone at: 602-284-4159 or by email at:

Our speaker, Heather Chapple, is a long-time Valley resident, moving to Arizona from Colorado in 1988, Heather served in the U.S. Navy for four years as an executive assistant at a submarine base in San Diego. She joined Hospice of the Valley in July 2009. She works as a community liaison, giving educational presentations about end-of-life care. Heather graduated from the University of Phoenix in 2008 with a bachelor's degree in education. I hope that you can join us to hear this exceptional speaker.


Robert Koth

Saturday, June 19, 2010

Ninburg testimony: Hepatitis prevention.

More House testimony. Contact your representatives to express opinions on this bill.


Committee on House Oversight and Government Reform

June 17, 2010

As Executive Director of the Hepatitis Education Project and a Steering Committee Member of the National Viral Hepatitis Roundtable, I respectfully submit testimony for the record for the hearing "Viral Hepatitis: The Secret Epidemic" and in response to the Institute of Medicine's recent report, Hepatitis and Liver Cancer: A National Strategy for Prevention and Control of Hepatitis B and C.

Since 2001, I have had the privilege of managing the Hepatitis Education Project (HEP), a national nonprofit organization based in Seattle, Washington dedicated to improving the lives of those affected by hepatitis. HEP works with populations most affected by viral hepatitis and often least connected to the health care system. Our partners include local, state and federal agencies as well as other community-based organizations. In this testimony, I will address the urgency of the hepatitis B and hepatitis C epidemics; the role of community-based organizations in addressing this crisis; and my personal experience.

Two Viruses, One Crisis

The urgency of the public health threat posed by hepatitis B and hepatitis C to our country cannot be overstated. More than 5 million Americans are living with chronic viral hepatitis, or almost 2 percent of the U.S. population. Most of those living with hepatitis B or hepatitis C are unaware of their infection and often remain asymptomatic for decades. Those who remain undiagnosed can unwittingly transmit the viruses to others and unknowingly do things to exacerbate their own liver damage. Many will be diagnosed only when their liver is failing. Sadly, thirty percent or more will eventually develop cirrhosis of the liver and some of those will die from endstage liver disease. Others will die from liver cancer.

Much of the disease burden from viral hepatitis is preventable. Hepatitis B is preventable through a simple series of vaccinations. For those who are already living with chronic viral hepatitis, the prognosis is usually very good when diagnosis is made early. Hepatitis B and hepatitis C are treatable conditions; and hepatitis C is often curable. For people to be treated for hepatitis, however, they have to be diagnosed. This remains one of our greatest challenges.

Viral hepatitis in the U.S. must also be viewed through the lens of health disparities. Hepatitis B disproportionately affects Asian Americans and Pacific Islanders (API) at rates more than twenty times that of their non-API counterparts. A staggering 1 in 10 foreign-born APIs has chronic hepatitis B. For new hepatitis B infections, there are racial, behavioral and geographic disparities. African American men and injection drug users have the highest rates of those newly infected with hepatitis B; and southern states have a disproportionate number of those new infections.

Hepatitis C disproportionately affects African Americans and Hispanics. And the majority of new hepatitis C infections occur in injection drug users. The real ticking time-bomb, though, is the prevalence of chronic hepatitis C among baby boomers, those born between 1946 -1964. It is estimated that 2-3 million boomers are currently living with hepatitis C. Most of these men and women were infected more than 30 years ago; the overwhelming majority remains unaware of their status. For the fortunate minority who get diagnosed, many will already have advanced liver disease that is more difficult to treat and manage and leads to progressively worsening and costly health outcomes such as end- stage liver disease and liver cancer. These outcomes are preventable but not if we maintain the current programs, policies and levels of funding for prevention.

Addressing the Epidemics - the Role of Community-Based Organizations Community-based organizations like the Hepatitis Education Project do much of the work related to viral hepatitis prevention, testing, education and referral to medical care. Programs at my agency include hepatitis A and B vaccination; hepatitis C antibody testing; a national support hotline; education programs for at-risk youth, prisoners, public health workers and medical providers. HEP also operates one of the few walk-in resource centers for hepatitis patients in the country.

Unlike many other disease states, there is very little federal support for these efforts. In FY2010, for example, the Division of Viral Hepatitis (DVH) at the Centers for Disease Control and Prevention (CDC) received $19.3 million. By way of comparison, the budget for domestic HIV prevention for the same period was more than $600 million. Of the $19.3 budget CDC allocated in FY 2010, about $5 million went to states and some city health departments, or about $90,000 for each state and each of five cities. This is a woefully inadequate amount to address epidemics that affect more than 5 million people less than $1 per patient per year.

As a result of this inadequate government response, organizations like the Hepatitis Education Project are vaccinating more people against hepatitis A and B, and testing more people for hepatitis C than any public health district in our state. We are proud of the work we do, but the efforts of community-based organizations like ours should complement, not substitute, the work of governmental and public health agencies. I am hopeful that this hearing and the IOM report will help to outline and stimulate an appropriate governmental response to these twin epidemics and provide the rationale needed to increase funding for critical programs and services.

Two Viruses, One Family

Until very recently I was a hepatitis patient, an experience that is often fraught with uncertainty. When I was diagnosed with hepatitis C relatively little was known about the virus. Hepatitis C was only discovered in 1989, and from the early through the late 90's this new epidemic was often compared to HIV except that it attacked the liver, not the immune system. Through the mid-90's, reports about hepatitis C grew increasingly dire. People with hepatitis C were dying from their disease. Some people were lucky enough to get a liver transplant, but that was thought to just delay the inevitable.

I sought medical care for my hepatitis C in 2000. By then, the medical community had a better understanding of the natural history of the disease, but there was still much that they did not know. In 2002, I had a liver biopsy which showed that I had some liver damage, but not enough to warrant immediate treatment. I had the kind of hepatitis C that responded to treatment about 50% of the time. With newer, more effective treatments thought to be commercially available within 5 years I decided to wait for the next class of drugs and in the meantime monitor the health of my liver. Five years came and went and so did the expected due date for the next class of drugs. Now, I was looking at 2010 at the earliest. I had my second liver biopsy in 2007 and the results were not what I wanted to hear. My liver damage was progressing and if I didn't do something, it was likely that I would progress to cirrhosis relatively soon. Once I had progressed to cirrhosis, there would be other potential complications.

In January, 2009, I was very fortunate to enter a clinical trial looking at a promising experimental new drug to treat hepatitis C. The virus rapidly became undetectable in my body and I completed treatment in December, 2009. Just last month I received my final lab results and learned that I am cured. I happily use the past tense now when I say that I was a hepatitis patient.

I talk about my hepatitis story because it the story I know best. It is not, however, the story that is most important to me - that would be the story of my wife, Lily, and our little boy, Sacha. Shortly after I met Lily, I told her that I had hepatitis C and explained to her what that meant and how it was transmitted. Later I explained that there was another epidemic that was equally invisible to the general public - hepatitis B. I knew that among the groups at greatest risk were people born in countries where hepatitis B is endemic. One of those countries is China - where Lily was born. I asked Lily if she had ever been tested for hepatitis B and she said she didn't know. I suggested that it would be a good idea to find out her status. She didn't seem to think it was that important. After some cajoling - and close to another year - Lily was tested for hepatitis B.

The results showed that she had chronic hepatitis B, likely contracted at birth from her mother. Fortunately it was inactive, the doctor said, but as she gets older she would need to be monitored regularly and checked for early signs of liver cancer. She took the news almost as stoically as she had when I suggested she get tested in the first place.

Confronting the Crisis - A Time for Leadership

I would like to end this testimony on a note of optimism. There are gaping holes in this country's response to viral hepatitis - that's why we're here. There are, however, examples of successful, life-saving initiatives we can look to for inspiration. Since the early 90's there has been a recommendation in the U.S. that all pregnant women get tested for hepatitis B, and all babies born to hepatitis B positive mothers be given a series of protective vaccinations beginning within 12 hours of birth. A pregnant woman with hepatitis B will transmit the virus to her newborn about 90% of the time. However, if the newborn gets this series of shots, including the hepatitis B vaccine, the child will almost always develop immunity and not develop chronic hepatitis B. As a result of this initiative, we have seen new hepatitis B infections contracted in the U.S. plummet.

Also, as a result of this initiative, my little boy was given life-saving vaccinations that spared him the potential fate of dying young from complications related to chronic hepatitis B. I am encouraged by recent events that show a growing awareness of this public health crisis. Promising developments include the IOM report on Viral Hepatitis and Liver Cancer, the introduction last year of the Viral Hepatitis and Liver Cancer Control and Prevention Act (HR 3794) and the new Interagency Workgroup on Viral Hepatitis headed by Asst. Secretary of Health Koh.

We have an opportunity and we have a responsibility to use this momentum and act now. It should be a collaborative effort - government, industry, payors, health care providers, advocates and patients - but government needs to lead. We need strong leadership within the U.S. government to coordinate a comprehensive response that uses the information we have now, seeks to collect additional information on best practices and effective interventions and implements nationwide programs that include and build upon the core elements of public health to provide information, services and referral into quality care for everyone at risk for, and infected with, hepatitis B and hepatitis C. If we wait, hundreds of thousands of Americans will die unnecessarily premature deaths. If we act now, we can save many of those lives.

Rep. Mike Honda: We will not be silent...

By Rep. Mike Honda (D-Calif.) - 06/18/10 09:05 AM ET 
At a Government and Oversight Reform Committee hearing this week, I testified to the devastating and deadly impacts of an unsuspecting disease: Viral Hepatitis. The fact that I was joined by Dr. Howard Koh, Assistant Secretary for Health, and Dr. John Ward, Director of the Viral Hepatitis Program at the Center for Disease Control, underscores the importance of the issue. Government oversight is a good start to getting the American public more informed, but much more is needed, according to the Institute of Medicine's 2010 report titled "Hepatitis and Liver Cancer: A National Strategy for Prevention and Control of Hepatitis B and C". 

Few realize how highly infectious viral hepatitis is. Hepatitis B is 100 times more infectious than HIV. Few realize that, left untreated, it can cause liver disease, liver cancer, and premature death decades after infection. Few realize that roughly 2 billion people worldwide have been infected with Hepatitis B; over 170 million people are chronically infected with Hepatitis C; and in this nation alone, an estimated 5.3 million people are infected with either Hepatitis B or Hepatitis C. Tragically, an average of two-thirds of those infected are unaware of their status.

It is no surprise, then, that some are calling this a silent crisis. However, we cannot afford to be silent anymore. In fact, we will not be silent any more. Why? Because our countrymen and women are dying daily, needlessly, from a disease that is entirely preventable if detected early. Each year, approximately 15,000 people die from liver cancer or liver diseases related to Hepatitis B and Hepatitis C. That's over 40 Americans dying every day, with no state or district in our nation exempt from its deadly reach. 

Beyond the tragic and preventable loss of human life and its subsequent hit to our country's productivity, the costs to our country our explicitly economic as well. Without effective prevention and vaccination methods in place, chronic Hepatitis B and C is expected to cost our country at least $20 billion, in treatments alone, over the next 10 years. As a result, over the same time frame, commercial and Medicare costs will more than double. Projecting further out, over the next 20 years, total medical costs for patients with Hepatitis C infection are expected to increase more than 2.5 times from $30 billion to over $85 billion.

We must, therefore, change the way Hepatitis is diagnosed and treated. With the help of Chairman Towns and Reps Cassidy, Johnson, and Dent, I introduced the Viral Hepatitis and Liver Cancer Control and Prevention Act, H.R. 3974, which provides nearly $600 million over the next five years to treat hepatitis. Our legislation focuses federal efforts on a strategy that saves lives and makes our health system more efficient. We bring together the common concerns of the diverse viral hepatitis community to fight chronic viral hepatitis by establishing, promoting, and supporting a comprehensive prevention, research and medical management referral program. And we strengthen the ability of the Center for Disease Control to support state health departments in the prevention, immunization and surveillance efforts.

Through this legislation, and with strategic investments in public health and prevention program, billions of dollars can be saved, so too the lives of tens of thousands of people in states and cities all over American. I urge all of you to join me in supporting activities that promote early detection and education. With your help, we can sound the alarm on this silent crisis.


Hep C risk and treatment for prisoners.

----------------From The HCV Advocate----------------

Hepatitis C Infection in Prisons

William Cassidy, M.D.
Louisiana State University-Health Science Center

Due to the epidemiology of hepatitis C (HCV), a higher percentage of inmates are HCV infected than in the general population. Depending on the prison system, 13 to 54% of inmates have hepatitis C. Recent Centers for Disease Control and Prevention (CDC) recommendations are that all incoming inmates be screened for HCV and those infected be evaluated for the presence of liver damage and the need for treatment.

This presents opportunities and challenges. Opportunities in that: 1) expensive treatment which requires close follow up is available for a group of people who quite likely would be uninsured if they were not incarcerated; 2) that those with a history of alcoholism and drug abuse are under enforced sobriety which may improve treatment outcomes; 3) and that these patients can be exposed to educational programs on how to decrease the risk of progressive liver disease and transmission of the infection.

The challenges are that: 1) prisons have restricted budgets and treating HCV is expensive; 2) the ability to address side effects of interferon may be limited because of the expense of hematologic growth factors, restrictions upon the use of sedatives and security issues inherent in the correctional setting.

Most prison systems are treating at least some HCV infected inmates. To standardize management, many prison systems have developed standardized protocols. Different systems take different approaches. Texas and Pennsylvania treat without performing liver biopsies. If a patient is infected, does not have a contraindication and desires treatment, he is treated. Other systems such as Louisiana, Georgia and the Federal Bureau of Corrections require a biopsy prior to treatment and only treat those with significant fibrosis. This approach is based upon the variability of the natural history of HCV.

To understand this approach, it is important to realize that when chronic HCV infection causes death, it does so by first causing cirrhosis (i.e., severe scarring of the liver). Technically, it is not HCV which causes death, it is the cirrhosis which HCV causes. This may seem to be splitting hairs but the importance of the distinction is apparent when it is realized that as many as 80% of HCV infected patients will not develop cirrhosis and therefore ultimately die with their infection but not die because of HCV. Ideally, therefore, those HCV infected patients treated first would be those at greatest risk of developing cirrhosis.

The question, then, is, are all HCV patients equally at risk for developing cirrhosis? The simple answer is no. Concomitant alcoholism, obesity, and hepatitis B or human immunodeficiency co-infections increase the risk for cirrhosis. Even if these factors are not present, some HCV patients will develop cirrhosis and some will not.

There are 3 major subgroups of HCV patients as regards risk for cirrhosis. These groups are called slow, intermediate and rapid fibrosers and are related to the amount of scarring in a patient’s liver biopsy compared to how long he or she has been infected.

The amount of scar tissue is quantified or “staged” on a scale of 0-4. Stage 0 is no scar tissue, stage 1 is minimal, stage 2 is moderate, stage 3 is moderate-to-severe and stage 4 is severe scarring of the liver. Stage 4 is also called cirrhosis.

Another term used is the “fibrosis index.” The fibrosis index is the stage of liver scarring divided by the number of years the patient has presumably been infected.

For example, if someone had a blood transfusion in 1968, and is diagnosed with HCV in 2003, it is presumed that they have been infected for 35 years. If they have a liver biopsy revealing stage 1 fibrosis, their Fibrosis Index is calculated as: stage 1/35 years or 0.029 stages of fibrosis per year infected. This suggests that it will take another 35 years to progress to stage 2. This person is clearly at low risk of developing cirrhosis. Since at this rate he will not develop cirrhosis for at least 70 years, even if cured of HCV, his life is not prolonged.

In another example, assume that the patient shared needles with a known HCV infected drug user 10 years prior to his liver biopsy. If the patient has stage 2 fibrosis now, his Fibrosis Index is 0.2 (stage 2/10 years = 0.2) suggesting that he will progress 2 stages every 10 years. This patient is at high risk for developing cirrhosis in most treatment protocols; treating him would be a priority.

These concepts of the variable progression of HCV and the Fibrosis Index apply to all HCV infected patients whether they are incarcerated or not. They are more important in correctional treatment protocols, however, due to the higher percentage of the inmate population who are HCV infected. The sheer numbers infected can overwhelm the resources available to treat infected inmates in even the most generous prison system. Using the Fibrosis Index allows triage of HCV infected inmates as to their relative risk of death from cirrhosis and prioritizing treatment to those at greatest risk.

If treatment is given, it may be with peg interferon, which is given once weekly, and ribavirin. For cost reasons, some systems are still using thrice weekly interferon and ribavirin. Most systems follow the National Institutes of Health Consensus Conference recommendations that therapy can be stopped at week 12 if there has not been either a 2 log decrease in HCV RNA relative to the baseline HCV RNA or a negative HCV RNA if the initial viral load was too low to fall 2 logs. Additionally, these treatment protocols stop treatment after 24 weeks for patients infected with genotypes 2 and 3.

In addition to treatment, the incarcerated HCV infected individual is ideally given information about reducing risk of disease progression and of infecting others. This includes information about abstaining from alcohol after discharge, avoidance of blood exposure and maintenance of ideal body weight. The CDC also has recently recommended that all HCV inmates be vaccinated for hepatitis A and B if not already protected.

The future of HCV management in prisons will see increasing standardization of protocols. Liver biopsies will be required by most for scientific and financial reasons and also because the Federal Bureau of Prisons’ recently published guidelines incorporates liver biopsy. Although the Federal Bureau does not dictate what states do, it is influential is establishing what the standard of care is.

There will hopefully be more research protocols made available for inmates to enroll in. Because of past abuses, it was made practically impossible to enroll inmates into drug treatment research protocols. This has been relaxed somewhat but is still extremely difficult and rarely done. Although these restrictions were originally instituted to protect inmates from exploitation, they now have the effect of denying access to cutting edge treatments. With the advent of informed consents, institutional research boards, prisoner advocacy groups and other entities, it is reasonable to assume that the past abuses could now be avoided.

In summary, HCV infection disproportionately affects inmates. Recent CDC recommendations are that incoming inmates be screened for infection and treated where indicated. This presents opportunities and challenges to the prison system. Understanding the natural history of HCV infection allows treatment to be focused upon those at highest risk of dying from HCV induced cirrhosis. The CDC also recommends education efforts directed towards minimizing disease progression and the infection of others with HCV. CDC also recommends HAV and HBV vaccination for HCV infected inmates.

Monday, June 7, 2010

HEP C treatment, depression, and liability.

Some protection for those otherwise afraid to treat Hep C in people with mood or thought disorders. Give us the chance to be a part of the decision-making team despite this woman's story...the medical profession already discounts our voices too often now.


No. 2009 CA 2242.
Court of Appeals of Louisiana, First Circuit.
June 4, 2010.
MICHAEL C. PALMINTIER, Baton Rouge, Louisiana, Attorney for Plaintiff/Appellant, Linda Ballard.
JANIE LANGUIRANO COLES, Baton Rouge, Louisiana, Attorney for Defendant/Appellee, Walter Kirk Mullins, M.D.
TIMOTHY J. McNAMARA, GREG R. MIER, Lafayette, Louisiana, Attorneys for Defendant/Appellee, Schering Corporation.
Before: PARRO, KUHN, and McDONALD, JJ.

Linda Ballard was diagnosed with Hepatitis C, a viral infection of the liver, by her family physician.

She also complained of blood in her stool and of feeling tired. Her family physician referred her to Dr. Walter Kirk Mullins, a gastroenterologist, for further testing. Dr. Mullins ran tests, including a liver biopsy, in October of 2001, and the diagnosis of Hepatitis C was confirmed.

Ms. Ballard had a pre-existing history of depression, including a hospitalization in 2000 after her mother died, and was taking Zoloft, an anti-depressant, when she saw Dr. Mullins. Before he began treatment, Dr. Mullins sent Ms. Ballard to a psychiatrist for an evaluation.

To treat the Hepatitis C, Dr. Mullins prescribed a combination of Peg-Intron (Peg Interferon Alfa-2b) and Rebetol (Ribavirin), collectively known as Rebetron, both of which are manufactured by Schering Corporation. On November 23, 2001, Dr. Mullins gave Ms. Ballard consent forms to sign before beginning her treatment. The consent forms warned that "Severe depression, psychotic episodes, and more rarely suicide have been reported" by patients taking the medication. Ms. Ballard signed the forms. She completed the treatment around February 8, 2002.

On February 16, 2002, Ms. Ballard attempted suicide by ingesting antifreeze. She was rushed to a hospital and survived, but suffered debilitating kidney disease, requiring extensive medical care, including dialysis. The Rebetron treatment successfully cured Ms. Ballard of Hepatitis C.

More than one year after her suicide attempt, on July 23, 2003, Ms. Ballard sued Dr. Mullins and Schering Corporation, asserting that her attempted suicide and resulting injuries were caused by the drugs prescribed by Dr. Mullins and manufactured by Schering Corporation. Ms. Ballard asserted she should never have been given these medications due to her history of depression.

Dr. Mullins and Schering Corporation filed peremptory exceptions raising the objection of prescription.[ 2 ] The district court sustained the exceptions raising the objection of prescription, dismissing Ms. Ballard's case. Ms. Ballard filed a motion for new trial, which was denied. Ms. Ballard appeals those judgments.

The district court found that Dr. Mullins and Schering Corporation carried their burden of proof demonstrating that Ms. Ballard either knew or reasonably should have known no later than February 16, 2002, of all relevant circumstances necessary to excite her curiosity regarding any legal claims she may have had against Dr. Mullins and Schering Corporation; that suit was not filed until July 23, 2003, rather than within the prescriptive period of one year under La. R.S. 9:5628 (as to Dr. Mullins) and La. C.C. art. 3492 (as to Schering Corporation); and that the evidence showed that the prescriptive period was not suspended, interrupted, or extended. Thus, the case was prescribed.
After examining the record, we cannot say the district court was clearly wrong in sustaining the exceptions raising the objection of prescription or abused its discretion in denying the motion for new trial. Thus, the district court judgments granting the exceptions raising the objection of prescription and denying the motion for new trial are affirmed, in accordance with Uniform Rules of Louisiana Courts of Appeal, Rule 2-16.2A(2), (4), (6), (7), and (8). Costs are assessed against Ms. Ballard.


1. At the time of her deposition, Ms. Ballard had remarried and was Linda Kelley. However, for consistency, in this opinion we will use her name as found in the record and the briefs, which is Linda Ballard.
3. Schering Corporation also filed a peremptory exception raising the objection of no cause of action, which was found moot due to the district court's ruling on the exception of prescription, and a motion for summary judgment, which was deferred by the district court as not properly presented.

This copy provided by Leagle, Inc.