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.


Monday, August 30, 2010

Conditions of confinement: Sheriff Joe's jail is our responsibility, too.

The following is a revised and somewhat more radical version of my post from AZ prison watch earlier in the night. It seemed appropriate for this blog, too. No one is listening to us at the Governor's office or ADC, so try the DOJ now. Please call or write today.

Amnesty International poster: Write a letter, save a life.

For those who missed Stephen Lemons' review of Shaun Attwood's new book, "Hard Time: A Brit in America's Toughest Jail", it's worth the read. I'd post it here but I've already packed in too much for the night. It is, of course, about the Maricopa County Hell they call a jail. Hit Shaun's blog, "Jon's Jail Journal" too, if you haven't already. He posts letters from prisoners there, and is a good friend to many who would otherwise have no audible voice.

As for the conditions of confinement in our jails and prisons: I don't understand why the Department of Justice hasn't held Arpaio criminally responsible for his abuse of so many people over the years - from medical negligence to conspiracies to deprive us of our civil rights. Their failure to do so thus far is akin to the feds' consent for every harm he's done under his tenure, and complicity with every additional prisoner he neglects or kills. I'm really starting to worry that they plan to make some kind of closed door deal with him, then pack their bags and walk away.

The Civil Rights of Institutionalized Persons Act covers prisoners precisely because the People so often end up needing protection from the sadistic cruelty of those wielding power in our name, and few in America are more disenfranchised and vulnerable than those disposed of in jails and prisons - citizens and "aliens" alike. They include our elderly, our poor, our sick, troubled youth, our mentally ill, our developmentally disabled - all those people we once institutionalized elsewhere (and have thrown out into the streets) are thrown into the stew.

Of course, the more vocal idiots in our community argue after every article about prisoner abuse or suicide that because they are in a jail or prison they deserve whatever they get, whatever that may be. Just because those readers like to stone prostitutes, though, doesn't mean they are themselves without sin. Nor do they represent all of us. Those people are twisted bullies hiding behind fake identities looking for someone to kick who's already down. They've probably commented on this blog of Stephen's, in fact.

That's a tangent I can't stop from exploring in this context. The media shouldn't give such people the platform on which to celebrate brutalization, suicide, and murder, including among prisoners, in the first place. That's not supporting freedom of speech - it's just intimidating the voices of reason and humanity into silence. Giving hateful people our shared public space empowers them to use shame to perpetrate cruelty, and it perpetuates the stigma felt by prisoners' families who read "good riddance" from the community after their loved ones die. They screen such things out of printed "letters to the editor"; why not moderate their public forums? Only abusive and rich people seem to get amplified when they speak - the rest of us get censored, even if we head the nightly news.

Frankly, most of "free" Arizona should be locked up, looking at the multitude of laws that require jail or prison for those who break them - and at how unbelievably easy it is to put someone away, especially in this state. We are just privileged or very lucky if we've escaped such a fate so far. Those who think they will never be prosecuted because they really aren't "criminals" need to check out the Arizona Justice Project. There are all sorts of innocent people behind bars.

Once in a while the law reaches out and touches us where we never thought it would - and since it's not a common occurrence in our white, middle class communities, we are sure that there is just a deviant in our midst, or it is a fluke of the justice system that will work itself out. Dad's in an accident while on painkillers following surgery and goes to prison because he had an old DUI. Presumably he will get treatment in prison, but he's already been sober for 5 years - instead he just loses time from his kids' lives and his ability to support his family. The neighbor is arrested for embezzling to save the house from foreclosure and her kids from homelessness - losing everything and everyone in the process. We pay over $20,000 a year to incarcerate her for five years - and God knows how much to put the kids in foster care - while her banker gets a bonus from the taxpayer bailout.  

I hope everyone out there finds those images as disturbing as I do. It happens all the time.

As for the wrongfully-accused: Americans don't really presume innocence, which is why Joe's jail was allowed to get so bad. We recoil from the accused as soon as they hit the news because the possibility that agents of the almighty law might be corrupt or wrong threatens our sense of social order. We sacrifice Innocence like she's the designated virgin just to maintain the illusion that the guilty among us are eventually caught, and that those who are caught are always guilty. 

People who are innocent tend to believe that the truth will prevail, and if it doesn't they end up being punished worse than the real criminals who make a deal. Real-life case in point: Courtney Bisbee, the school nurse accused of touching a 14-year old liar and branded as a child molester, was a feather in the cap of the detective who arrested her and the prosecutor who got the conviction. To assure that the rest of us got our taste of blood, the judge slammed her with 11 years for fighting it out in court instead of taking a plea bargain that would have had her back home with her child by now.

Stephen Lemons even investigated Courtney's case and advocated on her behalf (here and here, too), but no one wants to hear the new evidence that would exonerate her because it implicates incompetence - or worse. For law enforcement's ego and our sense of order, she's been in prison for at least 6 years now. Maybe Romley is the man who will have the courage to help set her free - we'll see. He was the Maricopa County Attorney when she was originally prosecuted, so if he steps up to the plate and looks at it in a new light, I'll be impressed. Andrew Thomas was too much of a political coward.

In these ways the brutality of our courts, Joe's jail, and Ryan's prisons hits home. It's not a freakish thing for families to be ripped apart by "justice" in poor and minority communities - it's all too common. The legal system works exactly as it's designed to there, oppressing resistance to white supremacy and defiance of the rules of capitalism at every turn. Justice is the sheep's clothing that America dons to promote the interests of the few, and the myth that we are a model of democracy is what blinds us - and Her - to the deceit. 

But Justice is not supposed to prey on the rest of us "ordinary Americans"- it is supposed to protect us. It only seems to be when we fall from grace ourselves (or get falsely accused and imprisoned) that we begin to see the system for what it is. We get inside and see people doomed to spend the rest of their lives in prison for charges as petty as fraud, while murderers walk away with money in their pocket after 15 or 20 years. Looking around, we also realize that the majority of the people behind bars are not a public safety threat - most are public nuisances, eyesores, "sinners" and surplus laborers who legislators thought would be better hidden away. Those still claiming their innocence are all too often out-maneuvered by the state in legal proceedings, and seldom have the luxury of an attorney to help them once appeals are exhausted. 

Look closely and you'll see that America's prisons and jails have, by and large, replaced our mental hospitals, poorhouses, and plantations. And they are major money-making machines for those in power, as long as they skimp on human rights and basic needs like food and health care. That's why the prisoners who would expose them are discredited, discounted, and silenced in every way possible.

Never mind that the desperate and vulnerable are being relegated and abandoned
in these hellholes to sociopaths who will rape and torture them for the fun of it, or even kill them just to score a new gang tattoo. To the private and public prison industries alike, each new body is just an addition to their growing empire - they have no interest in anyone's innocence or special circumstances, and no reason to help prevent or reduce the effects of crime in our communities. 

Despite lamenting about the high recidivism rate (usually as an excuse to be better funded and more brutal), jails and prisons are just as well-paid for recycling the people they chewed up once already. Buying the industry's line of BS, a terrorized public decides that parole officers and prosecutors are always professional and responsible and work in a functional system, so it must be the criminal's own fault for getting put back in - he should have learned his lesson the first time. Our perceptions are too often shaped by the expectation that what we pay nearly 10% of our state budget for includes some effort at "rehabilitation" (hence the AZ Department of Corrections' designation as such, not the "Department of Confinement"). The criminal justice system isn't rehabilitating anyone - they're spending our money lobbying the governor and legislature to pass more laws and assure more prison sentences for less serious crimes than ever.

The prison industrial complex as a whole (of which Sheriff Joe is actually just a small part) cultivates the rest of us to feel exploited and victimized, though, so that we seem defenseless and helpless without them. Then they glorify themselves as our protectors (though they usually arrive after the crime, not in time to prevent it), and we willingly pay them some other kid's lunch money to keep it up.
It's a racket. Actually reducing crime and making us all more safe would just cut into their power and profit margins.  

Anyone who believes such a system really upholds justice or promotes the public good is delusional or has been duped. Law enforcement is an integral part of the fascist decimation of our rights, not the power protecting them. We - the People - are the only power that will protect liberty and justice for the future, but only if we have our eyes wide open and are ready to risk jail, prison, defamation, and even execution in the process. If we are not, then we have surrendered that which is most important in life for nothing more than illusion. We are on a leash, instead of in a cage. At least some prisoners, with their integrity intact, mange to remain free.

The DOJ is grossly negligent for failing to act aggressively under CRIPA against the MCSO, and therefore shares the blame for emboldening our greedy, bigoted, fear-mongering lawmakers and enforcers to continue to imprison, injure, and kill those of us whose nationality or skin color or gender or politics or religion they hate.
But we are also responsible for letting this go on so long without holding either the feds or Arpaio accountable ourselves. So, here are the names and contact info for the people at the DOJ who should be investigating the real public enemies - and taking action - under CRIPA, regardless of what else they're doing. Please call or write on behalf of those fighting  a losing battle to defend their lives. Don't wait for your loved one to end up in trouble: he or she may be the next prisoner of the MCSO or Arizona Department of Corrections to die.

So could you or I.


DOJ - Special Litigation Section

Mailing Address

Special Litigation Section

950 Pennsylvania Avenue, NW, PHB
Washington, D.C. 20530
For FEDEX: 601 D Street, NW, Washington, DC 20004

Telephone Number
(202) 514-0195
toll-free at (877) 218-5228

Fax Numbers
(202) 514-0212
(202) 514-6273

Acting Chief
Judy Preston
(202) 514-6258

Principal Deputy Chief
Tammie Gregg
(202) 616-2009

Deputy Chiefs
Julie Abbate (Acting)
(202) 353-4637
Mary Bohan (Acting)
(202) 616-2325
Luis Saucedo (Acting)
(202) 353-0299

Saturday, August 28, 2010

C. Everett Koop and the Hep C Epidemic: Calling it what it is.

Just came across a Hep C website set up by the The C. Everett Koop Institute at Dartmouth, interestingly titled Some of their general info seems a little out of date, but I though the following quote was useful to keep in mind, and I'm posting their page of links for people to take political action.

The Forum : Political Action

Take action! Learn how you can join Dr. Koop and thousands of others in the fight against Hepatitis C.

Congressional Schedules
Daily and weekly schedules for the U.S. House, Senate, and Committees.

Congressional Directory
Guide to the U.S. Congress, including congressional committees, key phone numbers, leadership.

Find Your Representatives
Don't know your Member? Find your Congressional representatives by ZIP Code, alphabet, state delegation or name.

Write to Congress
The latest Congressional e-mail lists, plus automated forms for posting messages and writing letters to congressional offices.
Congressional Bill Status
Search the Library of Congress for critical legislation affecting healthcare.

Capitol Hill Basics
An overview of the legislative process, and tips for communicating successfully with your representatives.

Hepatitis C, Hispanic Ethnicity Linked to HCC Mortality

Those with HCV infection have 18-fold higher risk of hepatocellular carcinoma mortality
FRIDAY, Aug. 20 (HealthDay News) -- Hepatitis C infection and Hispanic ethnicity are associated with a higher risk of hepatocellular carcinoma (HCC)-related mortality, according to research published in the August issue of Clinical Gastroenterology and Hepatology.
Zobair M. Younossi, M.D., and Maria Stepanova, Ph.D., of the Inova Fairfax Hospital in Falls Church, Va., analyzed data from 15,866 participants in the Third National Health and Nutrition Examination Survey from 1988 to 1994.

The researchers found that, over a median follow-up of 160 months, 14.55 percent of the subjects had died, with 25 of the deaths related to HCC and 58 deaths non-HCC liver related. Factors that predicted mortality related to HCC were hepatitis C infection (hazard ratio [HR], 18.12), Hispanic ethnicity (HR, 5.14), and age (HR, 1.10). Factors predicting non-HCC liver-related mortality included hepatitis C (HR, 27.00), nonalcoholic fatty liver disease (HR, 11.56), alcoholic liver disease (HR, 10.81), and iron overload (HR, 6.18).

"Although early diagnosis and treatment of all liver diseases and diabetes mellitus may favorably impact all liver-related mortality, screening and treatment of hepatitis C virus may specifically improve the rate of HCC-related mortality. In addition, screening and treatment programs must target all individuals at risk for HCC, including Hispanic Americans," the authors conclude.


Full Text (subscription or payment may be required)

Copyright © 2010 HealthDay. All rights reserved.

Thursday, August 26, 2010

Dear Director Ryan: Community standards for treating Hep C.

More unanswered correspondence with Director Ryan about Hep C. For all I know he's just sending me to his Spam Box now. The only way I can be relatively sure he sees this is by posting it or hand-delivering it - and I don't want them to trespass me down there if I show up too much.

Besides, this has useful info for everyone. Check out the links to the professional standards. Keep in mind when they were written, too.


Arizona Prison Watch Fri, Aug 20, 2010 at 10:15 AM
For all my criticism of them (which still stands), at least the CDC has easily-accessible information on the basics. Robertson stopped evaluating the extent of Davon's liver disease - and possible co-morbid conditions - when he should have kept going. He still needs the genotyping done to make sure he doesn't have more than one strain of HCV, and to determine the likelihood that he'll even respond to treatment. And in light of the increased risk for disorders like diabetes (and his weight loss and fatigue), his glucose should be monitored more regularly to determine what his ranges are. Davon should also be treated like a human being, not a veterinary specimen - no one seems to really be trying to educate him on his medical condition or lab results, or even ask him about his fatigue, weight loss, headaches, etc. despite hearing concerns from Julie multiple times a week.



Testing and Diagnosis

Who should be tested for HCV infection?

HCV testing is recommended for anyone at increased risk for HCV infection, including:

  • Persons who have ever injected illegal drugs, including those who injected only once many years ago
  • Recipients of clotting factor concentrates made before 1987
  • Recipients of blood transfusions or solid organ transplants before July 1992
  • Patients who have ever received long-term hemodialysis treatment
  • Persons with known exposures to HCV, such as
    • healthcare workers after needlesticks involving HCV-positive blood
    • recipients of blood or organs from a donor who later tested HCV-positive
  • All persons with HIV infection
  • Patients with signs or symptoms of liver disease (e.g., abnormal liver enzyme tests)
  • Children born to HCV-positive mothers (to avoid detecting maternal antibody, these children should not be tested before age 18 months)

What blood tests are used to detect HCV infection?

Several blood tests are performed to test for HCV infection, including:

  • Screening tests for antibody to HCV (anti-HCV)
    • enzyme immunoassay (EIA)
    • enhanced chemiluminescence immunoassay (CIA)
  • Recombinant immunoblot assay (RIBA)
  • Qualitative tests to detect presence or absence of virus (HCV RNA polymerase chain reaction [PCR])
  • Quantitative tests to detect amount (titer) of virus (HCV RNA PCR)

How do I interpret the different tests for HCV infection?

A table on the interpretation of HCV test results is available at Adobe PDF file [PDF - 1 page].

Is an algorithm for HCV diagnosis available?

A flow chart on HCV infection testing for diagnosis is available at Adobe PDF file [PDF - 1 page].

What is the next step after a confirmed positive anti-HCV test?

The level of ALT (alanine aminotransferase, a liver enzyme) in the blood should be measured. An elevated ALT indicates inflammation of the liver. The patient should be checked further for chronic liver disease and possible treatment. The evaluation should be performed by a healthcare professional familiar with chronic Hepatitis C.

Can a patient have a normal liver enzyme (e.g., ALT) level and still have chronic Hepatitis C?

Yes. It is common for patients with chronic Hepatitis C to have liver enzyme levels that go up and down, with periodic returns to normal or near normal levels. Liver enzyme levels can remain normal for over a year despite chronic liver disease.

Management and Treatment

What should be done for a patient with confirmed HCV infection?

HCV-positive persons should be evaluated (by referral or consultation, if appropriate) for presence of chronic liver disease, including assessment of liver function tests, evaluation for severity of liver disease and possible treatment, and determination of the need for Hepatitis A and Hepatitis B vaccination.

When might a specialist be consulted in the management of HCV-infected persons?

Any physician who manages a person with Hepatitis C should be knowledgeable and current on all aspects of the care of a person with Hepatitis C; this can include some internal medicine and family practice physicians as well as specialists such as infectious disease physicians, gastroenterologists, or hepatologists.

What is the treatment for chronic Hepatitis C?

Combination therapy with pegylated interferon and ribavirin is the treatment of choice, resulting in sustained virologic response (defined as undetectable HCV RNA in the patient's blood 24 weeks after the end of treatment) rates of 40%–80% (up to 50% for patients infected with genotype 1, the most common genotype found in the United States, and up to 80% for patients infected with genotypes 2 or 3). Combination therapy using interferon and ribavirin is FDA-approved for use in children ages 3–17 years. Treatment success rates are now being improved with the addition of polymerase and protease inhibitors to standard pegylated interferon/ribavirin combination therapy.

How many different genotypes of HCV exist?

At least six distinct HCV genotypes (genotypes 1–6) and more than 50 subtypes have been identified. Genotype 1 is the most common HCV genotype in the United States.

Is it necessary to do viral genotyping when managing a person with chronic Hepatitis C?

Yes. Because there are at least six known genotypes and more than 50 subtypes of HCV, genotype information is helpful in defining the epidemiology of Hepatitis C and in making recommendations regarding treatment. Knowing the genotype can help predict the likelihood of treatment response and, in many cases, determine the duration of treatment.

  • Patients with genotypes 2 and 3 are almost three times more likely than patients with genotype 1 to respond to therapy with alpha interferon or the combination of alpha interferon and ribavirin
  • When using combination therapy, the recommended duration of treatment depends on the genotype. For patients with genotypes 2 and 3, a 24-week course of combination treatment is adequate, whereas for patients with genotype 1, a 48-week course is recommended.

Once the genotype is identified, it need not be tested again; genotypes do not change during the course of infection.

Can superinfection with more than one genotype of HCV occur?

Superinfection is possible if risk behaviors (e.g., injection drug use) for HCV infection continue, but it is believed to be very uncommon.

Does chronic Hepatitis C affect only the liver?

A small percentage of persons with chronic HCV infection develop medical conditions due to Hepatitis C that are not limited to the liver. These conditions are thought to be attributable to the body's immune response to HCV infection. Such conditions can include

  • Diabetes mellitus, which occurs three times more frequently in HCV-infected persons
  • Glomerulonephritis, a type of kidney disease caused by inflammation of the kidney
  • Essential mixed cryoglobulinemia, a condition involving the presence of abnormal proteins in the blood
  • Porphyria cutanea tarda, an abnormality in heme production that causes skin fragility and blistering
  • Non-Hodgkins lymphoma, which might occur somewhat more frequently in HCV-infected persons

Where can I find more information about management and treatment of patients with chronic Hepatitis C?

Arizona Prison Watch
A community resource for monitoring, navigating, surviving, and dismantling the prison industrial complex in Arizona.
“The degree of civilization in a society can be judged by entering its prisons.”
- Fyodor Dostoyevsky (1821-1881)

Monday, August 23, 2010

Fight with the Truth, Director Ryan, or get out of the way.

One of my e-mails to Director Ryan and his corporate counsel last week, addressing the shoddy medical evaluation of Davon's condition, and what I think is really underlying a lot of this resistance. We are collectively, silently lending our consent to the widescale extermination of people with addictions and serious mental illness via Hep C, diverting them from hospitals and treatment programs in order to feed the prison industrial complex in the process, where many will ultimately die of neglect.

I must have hit a nerve or two with this one - it was never answered by either of them. I wasn't that surprised - just disappointed. I'd been holding out hope that Ryan just had a bunch of incompetent subordinates who were covering themselves by keeping the truth from him, and that if he knew the truth, he'd step up to the plate himself. But I think he knows full well what goes on in that place, and it's him that his people cover for. What a no-win situation that must be for them.


This is Davon Acklin's prison doctor.


1 result (0.17 seconds)

Search Results

  1. [PDF]


    - 3:04pm
    File Format: PDF/Adobe Acrobat
    David Robertson, DO. Surgery. Maricopa Integrated Health System .... had no risk factors for viral hepatitis. She reported 1-2 drinks no more than 2-4 times ... - Similar


Or maybe this is.
(I Googled them both to see what he's doing about the epidemic of Hep C in AZ prisons.)

Your search - "david w. robertson, DO" hepatitis - did not match any documents.


  • Make sure all words are spelled correctly.
  • Try different keywords.
  • Try more general keywords.
  • Try fewer keywords.

In order to show you the most relevant results, we have omitted some entries very similar to the 0 already displayed.
If you like, you can repeat the search with the omitted results included.


This is Julie's friend.


About 61 results (0.20 seconds)

Did you mean: "bill remak" hepatitis

Search Results

  1. Millions of Hepatitis C Funding Dollars Hijacked

    Apr 27, 2009 ... William Remak, Chairman of the National Association of Hepatitis Task Forces and a two-time liver transplant recipient due to HCV is also ... - Cached
  2. The Status & Recommendation for Public Health Education ...

    National Association of Hepatitis Task Forces, CA National Association of Hepatitis C Task Force, William Remak, B.Sc. MT, B. Public Health, SGNA, Chairman ... - Cached
  3. [PDF]

    Hepatitis C Virus (HCV)

    File Format: PDF/Adobe Acrobat - Quick View
    The focus of this paper is on the Hepatitis C virus (HCV), ..... William Remak, Chairman, California Hepatitis C Task Force (Phone interview Nov. 2008) ... - Similar
  4. [PDF]

    CALIFORNIA HEPATITIS C TASK FORCE Little Hoover Commission Stuart ...

    File Format: PDF/Adobe Acrobat - Quick View
    Chairman, California Hepatitis C Task Force, Inc. Chairman, National Association of Hepatitis Task Forces. 2X Liver Transplant Patient, Cancer survivor. ...
  5. Bill Remak - Email, Address, Phone numbers, everything!

    Bill Remak is Chairman of California Hepatitis C Task Force ... 04 Continued from Segment .... William Remak Santa Rosa, US. William Remak West Warwick, US ...
  6. CDC DVH - Viral Hepatitis - Resource Center - National Viral ...

    Aug 27, 2008 ... Summary: This workshop will be provide an overview of viral Hepatitis A, B, C, D, and E, including basic epidemiology, risk factors, ... - Cached


He also goes by "Bill".


About 304 results (0.16 seconds)

Search Results

  1. California Hepatitis C Task Force

    Jan 23, 2009 ... Bill Remak is Chairman of California Hepatitis C Task Force & Chairman of National Association of Hepatitis Task Forces. ... - Cached - Similar
  2. Mission Statement - California Hepatitis C Task Force

    CALIFORNIA HEPATITIS C TASK FORCE BOARD OF DIRECTORS AND ADVISORY BOARD. BOARD OF DIRECTORS. 1) Bill Remak, Petaluma -Chair. 2) Phyllis Borchardt, San Diego ... - Cached - Similar
  3. Bill Remak is Chairman of California Hepatitis C Task Force ...

    He is a survivor of liver cancer and two transplants and is diabetic. He was a laboratory scientist at UCSF, but after his illness he started organizations ... - Cached
  4. Bill Remak (wmremak) on Twitter

    Get short, timely messages from Bill Remak. ... To watch a webcast of the Congressional hearing on Viral Hepatitis, click here... 1:54 ... - Cached
  5. Hard Time: Hepatitis C in Arizona's State Prisons.: Remak: The ...

    May 4, 2010 ... By Bill Remak, B.Sc. MT , B. Public Health, SGNA, AHCJ. ( ) Chair, National Association of Hepatitis Task Forces and ... - Cached

Any questions?


August 18, 2010

Charles L. Ryan, Director
Arizona Department of Corrections
1601 W. Jefferson St.
Phoenix, AZ 85007

Dear Director Ryan,

This is actually the closest to a white flag that you may ever see from me. I'm just showing you part of my arsenal to get your attention because you think I'm outgunned. I haven't posted that Google yet (nor, as far as I know, has Julie, but Facebook is her territory). By the time what I'm offering here expires I'll have thought of something better, though. Hopefully I'll have also figured out the software for my camera so I can upload that video of Julie, too. I don't expect it to ever enter a courtroom, but that doesn't mean it doesn't carry weight.

Davon could be getting well right now, for all the money and staff time you've invested in diverting his mom from getting him appropriate health care. That kid needs to be seen by a specialist competent in treating Hepatitis C before you claim he doesn't have a life-threatening condition with any credibility. So far, I'm not convinced that he's not in imminent danger, and I'm leaning towards thinking there's a whole class of men and women in there who are dying from your neglect.

But no one wins if Davon dies from this illness; we both know there isn't time for a class action suit. You may have fallen for your people's BS (assuming you aren't the source), but we aren't, so please stop sending people who don't know what they're talking about as if we don't get it. You may not have been made aware of this, but Davon's liver enzyme values are not only way out of range, they've multiplied since he was tested nine months ago. He should have been seen by a specialist and considered for treatment immediately. Instead, ever since his most recent labs were done, people have been trying to convince Julie - and now the governor's office - that she's just ignorant and over-reacting.

If the rapid rate at which Davon's liver functioning has deteriorated doesn't trouble you enough, then open his medical chart yourself - the first thing Julie noticed was what was missing. She has volumes of information she provided you folks on his psychiatric history and needs. He had 8 case managers and an ACT team that couldn't keep him out of prison, but you've only given him nine pages worth of care? That's shameful. You're not treating his mental illness, you just have him in chemical restraints.

It gets worse from there. Apart from Dr. Robertson's show of ignorance about his patient's medical conditions and needs, your staff have given Davon medications for illnesses he doesn't even have on more than one occasion. Are we really supposed to be convinced they know him at all? Did Jim Clenney think that giving us some guy with credentials would make us shrug our shoulders and quietly walk away? Did either of you?

Do you know what an aggressive strain of Hep C can do in ten more months? We aren't giving it one more month. I won't wait for the Clemency Board - I'm not putting all my stock in them, and a qualified assessment of Davon's status should have been done at least 3 months ago. You could have had a huge lead on this disease if he started treatment of any kind sooner - he's not even getting vitamin or protein supplements, and Julie's been screaming to your people - and everyone else in range - for months about his fatigue and malaise. There's absolutely NO reason he should be expected to be his own advocate in the face - and custody - of the state. I think he's pretty competent, myself, but he's nonetheless been designated as disabled by the severity and persistence of his mental illness for a long time; his mother even has power of attorney. That should have given someone a clue.

But even the guys who are certifiably sane give up asking medical for help, there. I have volumes of mail to that effect. That tells me a lot. I already know you wanted to save money by revamping how you do things in that arena - like increasing co-pays to discouraging requests for MD visits by people earning pennies an hour (if they're lucky enough to have paying jobs in the first place). I hope you also want to save lives, given the chance, despite the fact that those under your immediate sphere of influence are slaves and criminals. If so, you're investing resources in the wrong places. Prevent lawsuits by offering consistent, decent care.

I don't need an attorney or Julie's okay to tell you that there's nothing more we'd like to see than solid evidence that Davon's health care needs are being competently met and he has a chance to get well. An attorney will want more from you than that, so please don't waste any more time or public resources stalling us. Prove us wrong with the truth. That's what Julie's been asking for all along.

A lot of your other families are hurting too, actually, and the longer you leave me standing out here challenging you, the more there are who will find me. I make no promises to you about how I'll deal with their loved one's illnesses - I won't agree not to come after your department myself again - with an attorney, even - and I'll probably help anyone poor enough to need me. I'll grant that you're stubborn, but you've been wrong about Davon, and your resistance has only made me stronger and more creative as an advocate for prisoners with Hep C - as has time, too much of which has passed now.

It's urgent that Davon is assessed by a hep C specialist - not just have his physician rubber-stamped by a committee. If he was home we'd be calling 911 for an ambulance - a whole lot of people would be.

I can't swing Davon's medical bills - I can't even keep him stocked with peanut butter. Catch up with my credit report if you didn't know that already - I can't keep up with my own doctors. But I'll sell everything I have down to my computer, pledge a part of my monthly income for the cause, sign whatever you draw up that gets the state off the hook for it, and take responsibility for finding more people to help cover it. I'm not shy about asking for help when I find someone in trouble, and I am a witness that this family is in trouble.

I can fundraise a lot easier if this offer is made publicly than if it's just between us, but right now, if you get Davon help this week, you can pretty much write the terms. I'll even surrender my ego - just not other prisoners. I'm sure my little brother - the one who does health policy stuff for the United Way - would tell me that an attorney would never be stupid enough to say such a thing, but I'm not the one with the law degree in the family. Not yet, anyway. I'm already pretty occupied as a writer.

You will ultimately be the villain or the hero here, Director Ryan. In either case, I'll give credit where it seems to be due. I'll figure out my next move in a day or two if you block this one - we aren't playing the waiting game any more with you. Please tell Julie you're having Davon seen by a specialist, and then offer him the option of a full course of the best treatment a guy can get in there - for all any of us know, once he gets a taste of what his mom is fighting for, he'll opt out of interferon treatment until something better for people like us hits the market.

I know what the algorithims boil down to, by the way, that no one wanted to dare say out loud to Julie, because she's going to nail you for it already: treatment "isn't indicated" because he's a bad risk by way of co-morbid psychiatric diagnosis and substance abuse history. Everything else but those things and income level is actually just right for treatment to be recommended, otherwise. In fact, looking at his age and even Dr. Robertson's appraisal of his physical presentation, Davon would be seen by most experts as a really good candidate for treatment now - someone who would probably be successful staying Hep C-free, too.

That's bigger than you, though, I realize. It's the case all across the country, in the prisons and the community (though your standards - as demonstrated by your failure to even assess Davon thoroughly for the Clemency Board's recommendation - are below the community's. You don't even know if he has AIDS???). The scale of the epidemic - and the amount of bureaucratic cowardice in its face - won't stop me from doing everything I can to stop it, though.

In fact, it compels me forward every time I begin to feel too old and tired to keep the pace up. The dually-diagnosed are outright slated to die off from this thing, and I bet the CDC is paying close attention to their mortality rates, co-morbidities, and resiliency factors. If they aren't yet, they should be. But I think it's more insidious than passive observation - they're helping to starve your medical budget by way of issuing treatment guidelines that are way behind current research. A decade, at least. Check it out yourself (don't entrust it to your medical staff, anyway). They're leading the pack in their complicity with something I see as being the equivalent of murdering AIDS victims because they're gay. Only these people are also overwhelmingly poor, too. And people of color - that's why it's taking so long to catch up to HIV.

Can you imagine how many people would be freaking out if they grasped the truth about this disease? They don't have a clue unless their loved one has been to prison - that leaves most of white America in the dark. I'm planning to shine avery bright light in their eyes, too. They think they prevent cirrhosis and liver cancer by being tea-totallers, and they don't even consider the possibility that this could escape like AIDS and kill their own kids. The CDC's leadership role in Hep C wreaking havoc through so many lives may actually be your best defense - but when you have to answer for how you dealt with this epidemic to the generation that will inherit it, do you want it to be "I was just following recommendations?"

You do realize that you're on the front lines, don't you? At least, your prisoners and lowest-paid employees are, anyway. They are directly in the line of fire. They are the fodder creating the illusion of a buffer zone for something that won't be contained and isn't about to burn itself out, at this rate.

I bet mentally ill prisoners with Hep C constitute a large portion of the CDC's control group - the main population that's pretty much guaranteed to be denied treatment. Ever think of that? That's what's driving me to deal with you - it is not the pleasure of your company I seek. I'm much more interested in breaking through your denial - if you have any to begin with - about what's really going on with Hep C than I am in suing you. I need the kind of help you might give someone who was a victim of your merciless enemy - that enemy being Hep C, and hopefully not me. I assure you I will not be shutting up soon about this, whatever you do, so please don't write that into anything I might sign, or it will waste our time. What's happening with this disease in America is extermination.

And my own family has been hit, so don't expect to shake me. I have nothing better to do with my life.

You actually have less than a day, now, before I write again, cc or publish. Consider this to be my call to 911 on Hep C brutalizing someone I love behind your walls - or think of it as your last shot across the bow; that's up to you. It's hard not to post this thing while it's fresh, but like most distress and warning signals no one else has to replay it if it's answered responsibly - it just gets filed. Everyone gets to hear if I have to keep yelling for help from your doorstep, though - and I won't be waiting for you to kill anyone before I holler again.

So, if you're sincere about the public welfare and deserving of any medals for courage under fire, then please stop waiting me out. Invite me in, again, instead. You control the time, the place, and the witness - I only trust Karyn, though, to have both a conscience and a clue. She's the only one I'll talk to other than you without bringing another Copwatcher along.

I'm not asking a lot for Davon, here, but I'm expecting a lot from you. I hope you appreciate what an extraordinary leap of faith I'm taking in both of you to offer to meet you by myself, in fact. That's why this window won't be open very long. Julie doesn't even know that I'm offering to do this, or she would probably stop me - as would most of my friends. You haven't exactly given us much evidence to think that you can be trusted. But, I figured if you were in the pockets of politicians I have good reason to be wary of, I'd already be incapacitated by now.

I'm counting on both your autonomy and your honor really meaning something to you. If they do not, then at least I know that whatever your response is, I will have done what I need to in order to retain mine - and in turn, my own freedom. You may hold a bunch of keys, but that doesn't mean you aren't bound by chains and auctioned off at the market when they're done with you. I won't be; not that way.

This is your chance to stop me, help me, or get out of the way - either way, I need to know where you really stand, and I don't think you can afford to ignore me any longer. I can put this thing on the November ballot, still, by making Hep C in the prisons a pivotal issue. I may yet. Please get back to me today.


Peggy Plews

“The degree of civilization in a society can be judged by entering its prisons.”

- Fyodor Dostoyevsky (1821-1881)

Prison Abolitionist
Arizona Prison Watch
Arizona Juvenile Prison Watch
Hard Time: Hep C in AZ Jails and Prisons
Free Marcia Powell

¡El pueblo unido, jamás será vencido!

Sunday, August 22, 2010

Harm Reductionists denied "medical necessity" defense for needle exchange.

These two courageous activists trying to stop the spread of Hep C and HIV in the community through an unauthorized needle exchange program have already been hit with sanctions by employers and licensing boards, and are now facing up to a year in jail. I believe their trial has been set for February 2011. This is actually an update - see the previous post on this story for more background


Newshawk: Syringe Exchange Facts
Votes: 1
Pubdate: Tue, 18 May 2010
Source: Modesto Bee, The (CA)
Copyright: 2010 The Modesto Bee
Author: Merrill Balassone
Bookmark: (Needle Exchange)


A judge ruled Monday that two people arrested for handing out clean syringes to drug users and collecting dirty ones will be barred from telling a jury they did so to help prevent a public health emergency.

Kristy Tribuzio, 36, and Brian Robinson, 38, face up to a year in jail after undercover officers said they caught the two operating an unauthorized needle exchange in a south Modesto park in April 2009.

Stanislaus County Superior Court Judge Ricardo Cordova said the pair had other options that were legal, such as lobbying local officials to change the law. In September 2008, the county Board of Supervisors voted against legalizing needle exchange programs over the recommendation of county health officials.

"Frankly, this is a political decision with which the defendants disagreed," Cordova said.

Tribuzio called Cordova's decision "insulting."

"This doesn't have anything to do with politics," she said. "It's a public health issue."

During a nearly two-hour hearing, Tribuzio and Robinson's defense team argued their clients were acting out of medical necessity: that conducting a needle exchange program was a justified act aimed at saving lives and preventing such diseases as HIV and hepatitis C among drug users.

Nearly two dozen needle exchange activists from Oakland, Sacramento, Fresno and Modesto were in court for the ruling.

Tribuzio's attorney, Alonzo Gradford, likened the rate of new hepatitis C cases in Stanislaus County -- nearly 12 per week -- to a ticking bomb.

"People are dying every day as a result of dirty needles," Gradford said. "That's an imminent emergency."

Prosecutor Merrill Hoult said the defendants knew what they were doing was illegal and operated the needle exchange as an act of civil disobedience.

"We have a systematic breaking of the law," Hoult said. "Needle exchanges may have been legal in other counties, but it's illegal here."

In California, there are more than 40 needle exchange programs, but the Central Valley has just three, according to the state Department of Public Health. Fresno County approved a needle exchange pilot program in December 2008.

Robinson's attorney, Ruben Villalobos, described the scene in Mono Park on a recent afternoon. He said he and an investigator found four dirty needles left in the park, nicknamed "Needle Park" and "Heroin Park."

"If we were in another county, what Mr. Robinson did would be perfectly legal," Villalobos said. "We as a society have decided you can't do it."

Tribuzio and Robinson will be back in court Aug. 2 for the setting of their trial date.

Sunday, August 15, 2010

Dead Man Walking: the prisoner with Hep C.

This is a thoughtful article about a prisoner dying from hep C. The paper is out of Denton, Texas.

Death at his back

As his body succumbs to hepatitis C, inmate spends last days trying to warn others
11:33 PM CDT on Saturday, August 14, 2010
By Donna Fielder / Staff Writer 
Denton Record-Chronicle  

This is a cautionary tale from a dead man walking.

Michael Mabry doesn’t have a lot to be proud of.

He’s been in and out of prison all his adult life. He’s been a speed fiend and a cokehead most of that time.

He’s been busted for drugs and burglarizing buildings and tried two jailbreaks, and he has a criminal record in three states. He has eight children “scattered around,” he says, but he’s mostly alone now.

He’s a dead man, he says.

He won’t leave the infirmary at the Denton County Jail alive. Hepatitis C attacked his liver before he knew anything was wrong. By the time it was diagnosed, he was in the final stages of cirrhosis of the liver, and there’s nothing anyone can do for him, in jail or not.

So the 49-year-old Denton man sits on his cot in a medical cell, with a commode in the open a couple of feet away and the only decoration a roll of toilet paper and some graffiti scratched on the wall, and he thinks about his life and what he’s done wrong. He wonders what he could do to maybe get one small mark on the right side of his sheet.

DRC/Barron Ludlum
DRC/Barron Ludlum
Michael Mabry shows some of the tattoos he’s received while in prison. He says the tattoos are to blame for his contracting hepatitis C, which medical staff at the Denton County Jail believe will soon lead to his death. 
“I don’t think I’ve done anything to warrant going to hell,” he says. “But you never know. It sure wouldn’t hurt to get a few points in with the Man up there.”

He doesn’t have much time. He’s a con man, he admits. But he can’t con his way out of the trouble he’s in.
The only thing Mabry can offer is his life experience and its consequences as a warning to others. He got hepatitis C from jailhouse tattoos, he says. Everybody in prison gets tats; many contract hepatitis C from the methods they use.

But it’s the youngsters he’d like to help now, he said. Tattoos also are popular with the general population. Most adults go to tattoo parlors that are licensed by the state and have strict guidelines to hold down the chance of contracting a disease from infected implements. But those younger than 18 must have parental permission to legally obtain a tattoo. Many young people turn to more informal — and more dangerous — methods of inking up.

Gang wannabes use homemade devices to ink in their gang affiliations. Other kids get a friend to help them render forever their girlfriends’ names or symbols that have meaning to them. If they knew, Mabry says, if they understood that dirty needles, shared tattoo devices made of paper clips, safety pins — the myriad other unhealthy, sharp things — can kill them, maybe they wouldn’t get started down that road.

According to medical information provided by a website devoted to hepatitis, 4 million Americans now have hepatitis C.

It is more prevalent in Europe, but it emerged in the U.S. in the 1960s, related to blood transfusions and intravenous drug use. A reliable test for it was developed in the 1990s, and it was revealed to be a much larger problem than anyone knew. It causes cirrhosis of the liver and liver cancer.

When casual users share a needle to inject drugs or an instrument to inject ink under the skin, blood can be transmitted from one person to another. Hepatitis C is one of the diseases that can be transmitted in blood. It attacks the liver — and left untreated, destroys it.

The liver has many functions, including filtering harmful substances from the blood, breaking down fats, storing vitamins and producing urea. The body cannot survive without it. Cirrhosis inflames the liver and ultimately causes it to fail. Caught early, the symptoms can be treated. But it is incurable.

Jailhouse prevalence of hepatitis C
Doug Sanders supervises the medical staff at the jail. He believes that Mabry is within weeks of death. Since Mabry’s disease is only communicable by bodily fluid exchange, there’s no reason to isolate him, he said. The staff manages his medication to try to keep him comfortable.

Since Mabry also injected drugs, he could have contracted hepatitis from a dirty needle. But he is convinced it was a tattoo needle, and since he has so many tattoos, it is reasonable to think that he is right, Sanders said.
“It’s alarming. It’s extremely prevalent in jail populations. You might think the HIV virus would be more prevalent, but the greatest risk exposure in jails and prisons nationwide is hepatitis C.”

Jail administrators try hard to keep inmates from finding ways to make jailhouse tattoos, Sanders said. Guards seize anything that could be used to make them.

“We are absolutely discouraging it. We confiscate it. But they have so many ways of engineering a machine. They find ways around it,” he said.

Mabry’s isn’t the first advanced case that the jail medical staff have treated. They are preparing him as best they can for the suffering he’s about to endure, Sanders said. “He has some very difficult days ahead.”

A dim future
Death is becoming real for Mabry. He spends a lot of time talking to chaplain Bobby Ayers. He’s working on a bill he’d like to become a law. He knows he’s not going to finish it, so he offers advice.

DRC/Barron Ludlum
DRC/Barron Ludlum
Michael Mabry, 49, sits on his cot in a medical cell at the Denton County Jail on Friday.
“Kids are knuckleheaded, you know,” Mabry says. “If I could save one kid ...”

Perched on his cot, his longish black hair slicked down, his orange jumpsuit covering the numerous tats on his back, chest and legs, he thinks about that for a minute.

“It ain’t just the needle you get it from. It’s the ink they reuse,” he said. “You know, I studied the law and I beat it one time. I slicked out of a charge I did on a technicality. They wrote on my paperwork that I’m a master manipulator of the law. I studied this disease. I’m not stupid. I studied to find a way to beat it, but you can’t.”

He pulls up his shirt to display drug- and gang-related tattoos. He has a bandito tat on his chest, a large dagger with a snake wrapped around it — he says it’s related to Rex Cauble and the Cowboy Mafia — on one leg, and a fairly good rendering of the Grim Reaper on his back.

“He’s coming for me, by God,” he said. “It’s day by day now.”

Mabry demonstrates how a tattoo machine can be made with things not considered contraband in the jail and some that are. A decent jailhouse tattoo machine can be constructed with a ballpoint pen, a paper clip, some string and the tiny motor from a Walkman, he says. Ashes and shampoo can be combined to make ink.

Walkman tape players are no longer available at the county jail. Mabry said an inmate can always figure out another way.

“We say you can put one prisoner on one roof with a match and another one on another roof a mile away with a cigarette, and before you know it both of them have half a match and half a cigarette and they’re both smoking,” he said.

Mabry says his liver no longer functions. It swelled, he said, until it broke his ribs. He said he’s had eight heart attacks since he was diagnosed less than a year ago, and his aorta burst because his veins and arteries thinned out. He also has diabetes. He’s in pain, which the medical personnel in the infirmary try to lessen with drugs.

He’s a poster boy for staying away from casual tattoos. If you have to get them, go to a licensed tattoo shop, he says. They have rules to keep things clean.

Mabry often loses his train of thought. He rambles and forgets.

“The worst part of this disease is your brain goes,” he said. “They tell me that when it gets that far, it’s the best thing for me. But I don’t want my brain to go and just be lying here.”

He thinks a minute and then laughs.

“I have a million dollars worth of medical bills right now. But they ain’t never gonna get it. Maybe somebody will read this story and it will save them. It’d be good if I could at least do that.”

DONNA FIELDER can be reached at 940-566-6885. 
Her e-mail address is