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

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

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

 ----------

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

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

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


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

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

remembering those we have already lost...

  

we must accelerate the fight for the living.

Fight the spread of HEP C today: 

support PHRO (Phoenix Harm Reduction Organization)

Phoenix Art Museum: Art of Resistance

Prisoners' Justice Day Guerilla Installation

August 10, 2012

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

Hepatitis C fight - 'watershed moment'

Erin Allday / San Francisco Chronicle

Tuesday, September 11, 2012

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

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

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

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

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

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

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

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

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

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

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

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

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

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

Hepatitis C drugs offer hope for cure

Erin Allday / San Francisco Chronicle

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

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

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

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

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

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

Hepatitis C's spread

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

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

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

Antiviral drugs

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

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

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

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

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

Strains on the system

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

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

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

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

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

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

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

More seek treatment

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

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

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

Remarkable success

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

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

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

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

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

Multidrug attack

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

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

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

Long incubation period

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

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

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

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

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

FIGHT THE SPREAD OF HEP C TODAY. 

 Phoenix Harm Reduction Organization (PHRO)

Help Stop Prison Violence at the AZ DOC.

Just received this press release this AM. Please come support if you can. The mom, Julie, is a friend of mine, and Davon was our poster boy for the "Hard Time Hep C in AZ State Prisons" Campaign.. She planned this event herself and will stand alone if need be - and really needs support now. This is all bigger than just her family, though - the assaults at the ADC have tripled under Chuck Ryan, and prisoner murders have doubled, as have the suicides....

one of Davon's letters home...

 

------from the Desk of Julie Acklin-----

 

  URGENT PRESS RELEASE

Date: MONDAY April 9
Time: 9:00 am
Location: AZ Dept. Of Corrections
1601 W. Jefferson St PHX
(park at Wes Bolin across from Capitol)
Media contact info:  julie.acklin@yahoo.com

Demonstration of community outrage because of assault of prison advocate Julie Acklin's son recently at ASPC Lewis. Her son is chronically ill and mentally ill. Her son was victimized by a beating that resulted in 17 stitches to the face by another inmate and transported to local hospital. No intervention in the beating took place. Her son was in protective custody where most inmates and families think is a safe place. Most inmates are denied protective custody and shipped to general population to be beaten bullied or worse disfigured or end up on a ventilator. Prison official says he clearly was the instigator even though he was the only one who sustained injuries. He will possibly be ticketed and punished as a victim in this case, leading to isolation and or deterioration under Dept. Of Corrections rules. Gathering will send a message that the punishment and treatment and abuses of our mentally ill still are happening, and we want action taken and a community oversight committee for the prisons formed. Community says."This is gross outrage."

Julie Acklin, Dir. Of The National Association Of HCV Task Force, prison reform, Rep Az.
Co-Founder Dream OF Life Coalition

Office 623-594-4433
julie.acklin@yahoo.com

The long way home: Catching up to Davon Acklin.

Some of you may recall Davon Acklin, the Arizona state prisoner who let us use him as a poster child when his mom, Julie, was fighting to get him treatment for Hepatitis C. I corresponded with him for a year while he was in Tucson prison, and had the wonderful experience of greeting him with his family as he was freed this spring. Then my own life fell apart and we lost touch.

Today I saw Davon for the first time since the day he headed home. Sadly, it was to visit him at the 4th Avenue Jail. He's facing at least four felony charges, and - needless to say - violated his probation. He's going away for a long time this time; it may be more than ten years before we see him walk free again...except that he was once a free man in prison. I keep telling myself that, hoping that wherever he lands he can find himself again - what's he's been wearing lately are the worst kind of chains, anyway.

I still don't know just what happened over the course of the past five months, and will leave that story for him to tell when he's ready. I can say, though, that when I saw Davon today he was calm, rational, and appropriately remorseful for hurting those who love and believed in him. He reports that he's getting his psych meds, at least; the place is just a miserable place to be, and he's sick as a dog right now. I suspect he's going through withdrawal. He denied being suicidal, expressed appreciation for those who have tried to help him, and apologized "for being such a fuck-up". I tried to reaffirm that some folks still haven't bailed on him, and that his mom isn't about to give up.

Despite his effort to begin to make amends, I don't think Davon has any idea of how badly he really hurt people this time - I'm figuring out just how to tell him, though. The hurting from this binge has only just begun, too. He didn't just break Julie's heart and devastate his sister, he invited violence into his family's home that may not leave with him when he goes. He compromised the fight to overcome all the barriers to getting Hep C treatment for people with psychiatric disorders and addictions by giving the state a reason to say "I told you so." He may lose his own battle to get interferon now. His mother may well have to recover his body from prison, or see him buried there.

Davon is not responsible for having a mental illness, or even for being an addict any more so than if he had diabetes. He is responsible for his recovery, though, and made decisions when he was well that compromised his ability to make good choices in a very short period of time. Whether or not he was competent at the time he committed the crimes he's accused of is for him and the courts to work out - we didn't discuss any of that. Today he seems to be in his right mind, though - and almost relieved at the prospect of going back to prison. I think he copped out on us all early on, frankly, and I'm mad as hell at him. I'm also angry that I wasn't able to be there for him when he came home myself, though. There were a lot of things I had wanted to share with him, and before I knew it he was gone again. I know it's my egocentricity that makes me think I might have changed this outcome had I been more present for him upon his release; I wish I had been, though.

I never really expected a fairy tale ending to Davon's relationship with the criminal justice system. He grew up in it - he even accidentally referred to returning to prison as going "home". There's absolutely no meaningful treatment or rehab in prison for the vast majority of dually-diagnosed young men like Davon - or for the women, for that matter. He had a lot of good community support - the probation department was awesome, I guess - but few new tools for coping with stress and expectations when he got out. That's not to excuse him from what he needs to own here, but that's the way it is for far too many prisoners I see who have cycled through the system more than once, so I think there's more at work than just Davon's pathology here.

This isn't the end of this young man's story or his struggle to keep from succumbing to either despair or Hep C - nor is his life yet over. In recovery from addictive disorders - especially for those with mental illness as well - relapse is common, and is often so much worse than before because one has to be sicker in order to go back into denial. But Davon doesn't necessarily forget what he learned before - he matured once, and can continue in that direction wherever he lands. Even in prison he can be a positive influence in the lives of others, if he's given the right support so he's able to make informed and capable decisions. Psychiatric disability or not - in prison or at home - Davon can still choose what kind of human being to be. Only when he surrenders that will I believe he's really lost his freedom.

Anyway, I'll let you know when he moves, but will otherwise be giving Davon and his family a break from my blogs while they sort things out. If you've been a correspondent of his, I think it would help him to know that even in back prison he's accountable to his fellow beings for his behavior and commitments. You can trust his mom and I to kick his ass over this, so to speak, but feel free to do so as well if you've been hurt, too. Just try to keep a door open for him if you can; he should be safe, but he really doesn't deserve exile. He needs to make amends and reconcile with not only his family but the community that supported him in order to grow and reduce the chances of this happening again.


Summer Solstice 2011
Firehouse Gallery and Cafe'
Phoenix, AZ

And the World Changed: Mass Clemency for Christmas.

I'm taking Davon Acklin's family to prison today to see him for Christmas and may not be blogging much until tomorrow. Will thus leave you all with the wise words of another to contemplate and dream on: a marvelous holiday essay for all the prisoners and their loved ones out there, printed last year in the Huffington Post...


Blessings to all. Be safe and well this day.


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



What I Want For Christmas: Mass Clemency

Jacob M. Appel
Bioethicist and medical historian
Posted: December 23, 2009 09:41 PM


The United States Constitution and the laws of most states permit the President and governors to issue pardons and commutations, a prerogative frequently exercised during the winter holiday season. Unfortunately, with a few laudable exceptions, our chief executives have displayed considerable stinginess--and even outright political cowardice--in exercising this remarkable power.


President George W. Bush drew criticism from liberals for only pardoning 189 individuals and commuting 11 prison sentences during his eight years in office, but Bill Clinton cut short a merely marginally better 61 prison terms and pardoned only 396 convicts. Most of those pardoned each year have committed small-stakes crimes in the distant past such as selling bootleg whiskey or passing bad checks. Others, like Dan Rostenkowski and George Steinbrenner, are politically well-connected. It often seems that the principal purpose of these rare reprieves, much like the pardoning of a Thanksgiving Day turkey, is to make the pardoning politicians appear generous and affable to the electorate.


Yet with the United States now boasting the highest incarceration rate in the world -- more than 1 in every 100 Americans in currently behind bars -- our nation is long overdue for a mass clemency of non-violent felons and those unlikely to re-offend. Such a collective pardon and commutation would reunite hundreds of thousands of families, save billions of dollars in incarceration costs, and might foster a national spirit of forgiveness and reconciliation.


Few American politicians have dared to issue mass clemencies in the past. Andrew Johnson's grant of amnesty to former Confederate soldiers and Jimmy Carter's pardon of Vietnam-era draft evaders are likely the two largest acts of blanket forgiveness -- and both helped to heal our national wounds after periods of great division. Former New Mexico Governor Toney Anaya and ex-Illinois Governor George Ryan both deserve credit for commuting all of their state's death sentences to life terms. However, our current political leaders -- in both parties -- far more often appear afraid to ask for broad or bold clemencies.


John McCain's drive to secure a pardon for African-American boxer Jack Johnson -- convicted in 1913 of violating the Mann Act for his relationship with a white woman -- embodies this problem. Don't misunderstand me: I am all for pardoning Johnson, and Ethel Rosenberg, and Sacco & Vanzetti, and righting as many of the moral miscarriages of history as possible. However, I would much rather free the thousands of non-violent offenders serving long sentences under the draconian Rockefeller drug laws in New York State. So here's my Christmas wish: Each chief executive should order a special panel to determine, as quickly as possible, which prisoners either have a history of extreme violence or pose a high risk of re-offending. Those meeting neither criteria should be transitioned home as quickly as possible.


The advantage of a mass clemency is that it can be framed in terms of social policy and a spirit of charity, rather than the merits of any specific incident. That is not to say that there are not thousands of individual cases worthy of attention. In Michigan, for example, Shontelle Cavanaugh has now gone nearly five years without a trial for smothering her infant during a psychotic break -- a calamity compounded when the local prosecutor withheld video footage of Cavanaugh at the height of her psychosis. Governor Granholm could order this unfortunate woman's release. And there is the tragic case of Michelle Collette in Massachusetts, whose own trial judge blasted the severity of her seven-year sentence for possession of 14 to 28 grams of illicit oxycodone -- an injustice that could be rectified by Governor Patrick. But by focusing on these individual cases, as compelling and heart-wrenching as they may be, one risks losing sight of the greater cruelty of denying human beings liberty long after they pose any meaningful threat to society.


An individual pardon focuses on the nature of the crime. A mass pardon allows us to transcend questions of right and wrong. Unlike an individual grant of clemency, which often suggests that a miscarriage of justice has occurred, a mass clemency avoids the controversial issue of whether justice has been served and focuses on the question of whether it furthers any ethical purpose to perpetuate the punishment. One could simultaneously pardon Scooter Libby and all of the undocumented immigrants detained on identity-fraud charges while still avoiding the political hot potato of endorsing their specific conduct.


While an individual pardon may appear to be a slight to crime victims, who also merit our recognition and empathy, a collective pardon does not mitigate the respect that we should accord these victims' suffering. Moreover, a one-time mass clemency does not undermine the deterrent effect of stiff criminal penalties, because no potential offender is ever going to break the law in the hope that a second, future mass clemency will free him if he is arrested.


One of the glaring -- yet too often overlooked -- failings of contemporary America is that we have become a nation obsessed with justice and retribution. We claim to be The Land of the Free, yet we have lost sight of what it means to be imprisoned: denied liberty and access to one's family, subjected to isolation and violence and unspeakable boredom. We have come to believe, in the most pernicious way, that people should get what they deserve. What a sea change it might be in our public discourse and our civic life if we focused instead upon mercy and forgiveness. A merciful and forgiving culture might find itself with less anger, less social disruption, and even less crime. If we liberated only half of our prisoners, we could spend the billions of dollars saved educating children, or providing substance-abuse treatment to addicts, or training mental health workers -- breaking the cycle of neglect that sets future prisoners on their initial trajectory toward misconduct.


I am not naive enough to believe that all of our prisoners should be freed. Some individuals are truly unfit for reintegration into society. No reasonable person would argue that Charles Manson or Scott Roeder or admitted Al Qaeda terrorists should be sent home for the holidays. Fortunately, the majority of our more than two million prisoners are not fanatics and sociopaths. Many are good people who have exercised poor judgment. They have the same hopes and dreams as ordinary, free Americans, but they now squander their lives behind bars because our prison-industrial complex has gone haywire. They are, in short, the meek and wretched who the Biblical Jesus -- whether literal or figurative -- would want us to remember in our holiday prayers.


Will the White House read this column and decide upon a mass clemency? Unlikely. Such a bold step might make President Obama truly worthy of his Nobel Prize, and win him the praise of history, but political leaders of all stripes think in terms of poll numbers. I suspect that a mass clemency could be sold to the American public -- particularly as more and more Americans find their own loved ones imprisoned -- but I understand that to attempt such a courageous step requires a leap of considerable faith. I am more optimistic that, if enough people clamor for a mass clemency, one inspired state governor -- possibly a lame-duck chief executive without a political future -- will consider such a dramatic and compassionate act. If that happens, and the social order does not crumble, other political leaders may have the courage to follow. In the interim, I can only hope that the government lawyers assembling last-minute pardons lists, possibly as I write this, remember that each name they add to their clemency register is another flesh-and-blood human being who will be able to spent the Christmas holiday with his or her family.

from the Syracuse Cultural Workers

Arizona: Mercy, Mercy Me...

Davon's clemency board hearing was yesterday - the decision to turn him down was clearly made before we walked into the room, however. The chair made only passing reference to the thick stack of mail that had arrived in support of Davon's application, and cut me off when I was speaking on his behalf. He made a special point of reading things into the record to justify their determination against him. The county attorney's office can be expected to oppose such applications, but they went out of their way, it seems, to damn him - which was precisely what the board needed and asked for. Not that I'm accusing them of any impropriety - I'm sure they did what they felt was right - just as I'm doing. We just come from different places, and they don't know Davon like I do. As evidenced by their decision yesterday, They don't know him at all.


Pardons in Arizona have nothing to do with mercy or grace, by the way - or even justice for that matter, even when sincere people try to deliver it. Look at what our good governor did to Bill Macumber, the innocent man who has already spent 35 years in prison for murder and may well die there. Convinced beyond any doubt that his conviction was based on perjured testimony and manufactured evidence, the Arizona Board of Executive Clemency unanimously recommended him for a full pardon, which would have gone into effect if Brewer had simply left it alone for 90 days. Instead she quashed it, in the interest of her kind of "justice". Affirming Bill's innocence would have implied his ex-wife's guilt. As she worked for the Maricopa County Sheriff's office at the time she framed him, I suspect Brewer was doing someone with history there a favor. But what do I know?



Sadly, despite his story saturating the media across the country before November 2, the voters in Arizona elected that woman anyway.



As for Davon: the outcome of his hearing was no surprise, really - probably least of all to him - but it was still a disappointment; his little sister left the room abruptly in tears. We did, however, raise awareness about the prosecution of the seriously, mentally ill for their symptoms rather than their criminality, and built a network for prisoners with Hep C and their families. We also entered our objections to the prison industrial complex into the public record (that was the part I think they didn't want to hear). One of our legislators even turned out to corroborate Davon's mom's assertion that Arizona's prisoners aren't getting the medical care they need in there - and that came from a self-described "conservative Republican". I suspect he will pay a price for having done that, which is why I won't name him here. I doubt he would endorse my own take on the system, but he's still one of the few politicians I've ever met with real integrity. I can't think of a single Democrat in this state who would put themselves on the line like that for a convicted violent, crazed felon seeking mercy - much less another Republican.



I'm convinced that clemency boards exist largely to reinforce the illusion that the system we have of doling out punishment in our country is a "just" one that serves the best interests of society at large. By allowing room for pardons and commutations, we suggest that the legal system we live under, as a rule, delivers justice to criminals and victims alike, and that any abuse of power or injustice perpetrated by the state in the process is an exception that needs to be dealt with on a case-by-case basis. If that was the reality, however, our prisons would not be packed almost exclusively with the poor - most of whom have the least ability to do great harm. In a truly just and morally evolved society it is the money-lenders, warmongers and rogue sheriffs of this land who would be doing time for exploitation, mass murder, and kidnapping - not making the rules the rest of us have to live by. They certainly wouldn't be retiring with honors and drawing down our collective dime.



But ours is neither a just nor a moral society - it isn't even a democracy. It is a capitalist republic in which the wealth and power of the few still depends on their ability to co-opt, terrorize, and restrain the many. We literally replaced our plantations with prisons when overt slavery went out of style. America's governments exploit and injure far more innocent and vulnerable people than all our lone criminals combined do. We've even made the perpetuation of victimization and crime an attractive, acceptable industry from which savvy investors can profit.



Thanks, everyone, for all your support through this. Stay with us, please - this fight is much bigger than one young man, and has only just begun. Keep an eye on what's happening with Davon for awhile longer - he went further out on a limb in the interest of prisoner rights and health care than any of the rest of us had to - and risks paying a much higher price now than the one extracted from him at sentencing. We'll see if he's allowed to keep his good time - and make it successfully through the 4 years of probation he has yet to serve -in light of his and his mother's public defiance. I guess we'll also see if the Arizona State Legislature shows any mercy for the honesty and courage of one of their own.

Julie Acklin: Tenacious advocate for prisoner's rights.

Julie Acklin (holding photo of son Davon)
with the Arizona Liver Foundation staff/volunteers.

Anyone who's read more than just a few blurbs on this blog should know who Julie and Davon Acklin are, by now. What follows is just one story of how Julie's touched others' lives for the better. I pulled it off of her Facebook - her friend Verena posted it there to remind her of how much she means to those of us who know her, and to ignore the skeptics and haters who occasionally land on her pages and try to sabotage her efforts to assure decent medical care for her son. I've met Verena and her daughter, and know this story to be true.

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

Sunday, September 6, 2010

Hey Julie,

We love you, and the ones that truly know you know what you are capable of.

Here is my story of my beautiful daughter who almost died at the hands of Texas Prisons. My daughter was 21 and on 9/9/09, first let me tell you she suffers from a mental illness. She had been on suicide watch numerous times; she was in the treatment part of the prison for substance abuse and behavioral health issues. She stands only maximum of 5 foot 2in, and very petite.

A couple of weeks before I received a call, my daughter called me from her counselor's office. I asked my daughter if I could speak to her counselor, my daughter handed the counselor the phone, I tried to give the counselor the information on what my daughter needed to work on and the counselor hid behind the HIPPA law stating that she could not take any information from me regarding my daughter. I informed her I wasn’t seeking information but felt it necessary so my daughter could be treated for these issues. Remember HIPPA Laws state that you can receive information, but the professional can not give it with out a written Release of Information, or verbal permission from the patient. My daughter handed her the phone that was a verbal.

I received a call from the Warden, a few weeks later telling me my daughter is on life support, when I asked what happened she told me she hung herself. I lost it. Now I’ve lost control, and going insane it felt like, the warden told me I needed to get to Texas, ASAP. So I contacted my Mother and we left for Texas. I had to see my daughter on what they call a High Five ventilator. I guess it shoots 300 breaths in to the patient; my understanding was they said it’s the most intense ventilator they had.

While at the hospital the Dr. told me that my daughter had a 9 % chance to live. I had to leave Tx and come back home. I had not heard of Julie until I got back - I think one of my friends called her or knew of her. When I got back from Tx, I received a call from Julie telling me she is a prisoner rights advocate for the National Alliance for the Mentally Ill (NAMI). She asked me what happened and all I could do is cry.

Julie was so patient with me, and so understanding with me, she provided me with hope, which I lost in Tx. Julie kept in touch to see how I’m doing on a daily bases. Julie jumped in to action and started calling everybody, God only knows who, Julie did something and the charges were dropped on my daughter and she got better and was sent to the prison psych ward, while being released.

The prison told Julie that I could call and talk to my daughter, so I tried to, but the prison would not let me talk to her. They stated that she was still in custody, I explain to them she has been released, needless to say I was not successful, so I called Julie and was crying again and explained to her what happened.Julie got back on the phone and next thing you know I received a phone call the staff at the prison, and they put my daughter on the phone. She didn’t sound like she was all there yet, she wasn’t fully back to being her.

When I went back to Texas to get my daughter and bring her home to AZ, we had to pick her up from the psych prison ward. My daughter had MERSA (staph infection) on the back of her head, she couldn’t walk, she over enunciated her speech, and had traumatic brain injury. She had memory loss, too. My daughter had not had a bath in 4 days, was left to defecate and urinate on herself. She was unable to walk or stand; she needed help with every thing. My daughter would still be there in prison or dead if it hadn’t been for Julie.

Julie fought day and night for my family; she is a blessing to have. If Julie went to bat for you she fights with all she has. Not all situations will turn out the way this one did, but it’s not from a lack of trying on her part. Julie is my friend and she has a heart for justice for our loved ones in prison.

If you all don’t believe me I have pictures of my daughter on life support , and you can meet my daughter get a hold of me on Facebook and leave me your # and I will be more than happy to meet you in public. Julie saved my daughter's life. Thank God my daughter turned 22 this yr.

Verena and her daughter, with Julie's daughter Kirsten, at the 2010 Liver Life Walk raising awareness about prisoners with Hepatitis C. They're holding up a birthday card for Davon, Julie's imprisoned son, for whom we were all walking that day.

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
To: cryan kklausner
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. ------------------------------- CDC HCV FAQs: 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 http://www.cdc.gov/hepatitis/HCV/PDFs/hcv_graph.pdf [PDF - 1 page]. Is an algorithm for HCV diagnosis available? A flow chart on HCV infection testing for diagnosis is available at http://www.cdc.gov/hepatitis/HCV/PDFs/hcv_flow.pdf [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? The American Association for the Study of Liver Diseases: AASLD Practice Guideline: Diagnosis, Management, and Treatment of Hepatitis C . The National Institute of Diabetes and Digestive and Kidney Diseases: Chronic Hepatitis C Current Disease Management. -- Arizona Prison Watch http://arizonaprisonwatch.blogspot.com 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)

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.

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

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   ELEVENTH ANNUAL ACADEMIC EXCELLENCE DAY WEDNESDAY, MAY 2, 2007 ...

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   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 ...
   azmec.med.arizona.edu/.../AED%20Program%20Book%202007%20Final.pdf - Similar

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

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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 ...
   www.hcvets.com/nih/PressRelease/0904.asp - 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 ...
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   Hepatitis C Virus (HCV)

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   The focus of this paper is on the Hepatitis C virus (HCV), ..... William Remak, Chairman, California Hepatitis C Task Force (Phone interview Nov. 2008) ...
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   CALIFORNIA HEPATITIS C TASK FORCE Little Hoover Commission Stuart ...

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   Chairman, California Hepatitis C Task Force, Inc. Chairman, National Association of Hepatitis Task Forces. 2X Liver Transplant Patient, Cancer survivor. ...
   www.lhc.ca.gov/studies/198/cirm/CHCTFNov08.pdf

5. Bill Remak - Email, Address, Phone numbers, everything! 123people.com

   Bill Remak is Chairman of California Hepatitis C Task Force ... 04 Continued from Segment .... William Remak Santa Rosa, US. William Remak West Warwick, US ...
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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, ...
   www.cdc.gov/hepatitis/resources/mtgsconf/natvhprevconf2005.htm - Cached

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He also goes by "Bill".

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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. ...
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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 ...
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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 ...
   www.wsradio.com/wsradio-player.cfm/type/...with.../24727.html - 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... http://fb.me/AYjYIxVP 1:54 ...
   twitter.com/wmremak - 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. (wmremak@pacbell.net ) Chair, National Association of Hepatitis Task Forces and ...
   hardtimehepc.blogspot.com/2010/05/remak-scandal-of-hep-c.html - 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.

Sincerely,


Peggy Plews
480-580-6807


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

- Fyodor Dostoyevsky (1821-1881)

Prison Abolitionist
http://prisonabolitionist.blogspot.com
Arizona Prison Watch
http://arizonaprisonwatch.blogspot.com
Arizona Juvenile Prison Watch
http://azjuvenileprisonwatch.blogspot.com
Hard Time: Hep C in AZ Jails and Prisons
http://hardtimehepc.blogspot.com
Free Marcia Powell
http://freemarciapowell.blogspot.com

¡El pueblo unido, jamás será vencido!