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 | ||
| ||
Showing posts with label hep c in prison. Show all posts
Showing posts with label hep c in prison. Show all posts
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.
Besides, this has useful info for everyone. Check out the links to the professional standards. Keep in mind when they were written, too.
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[PDF - 1 page]
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 others11:33 PM CDT on Saturday, August 14, 2010
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
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. View larger More photos Photo store
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.
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.”
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
Michael Mabry, 49, sits on his cot in a medical cell at the Denton County Jail on Friday. 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 dfielder@dentonrc.com.
Dear Director Ryan: Writing to Goliath.
The following is an excerpt from an email I sent to Director Charles Ryan at the Arizona Department of Corrections this weekend. I offered to meet him in his office to discuss a few things, so don't expect me to post a written response from him - they aren't often forthcoming, as emails have their way of making it to court.
My side was a long letter, though - this part of which was a complaint about the phone call I witnessed Friday between Julie and Ryan's people. I still can't figure out how to get the video of that call posted and distributed, but will leave those links here once I do. That recording is as real as it gets, and everyone who's advocated on Davon's behalf needs to see it. Keep acting up out there.
"...By the way, your doctor was really cruel and condescending to Julie Acklin and owes her an apology - at the minimum - as far as I'm concerned. If you all taped that conversation from your end, you'd better play it back. I hope you weren't there condoning his behavior. I also hope you know more about Hep C in prisons than he does - and more about your high profile prisoners, too. He didn't even know if the patient he swore was in no mortal danger had been tested yet for HIV - yet he seemed to think that Davon hadn't asked for an HIV test, either (which was by way of justifying why he wouldn 't have had an HIV test. He knows that kid wouldn't have known to ask before all this.).
That's inexcusable. Furthermore, it's a standard Hep C practice guideline, even in prison, for the physician to automatically test for other forms of hepatitis and HIV whenever a lab comes back HCV+. He should have had some certainty that Davon had been tested if he knew his patient was so healthy that he wouldn't even evaluate him further at this time.
He's full of it. This guy is either strategically trying stall and ridicule Julie, or he really hasn't been keeping up with his profession, so you might want to check him out again. Even I know more about current treatment recommendations than he does. And medical ethics, apparently.
My report of how that conversation went will be in my blogs, whether or not we plan to meet this week - there's no damage control to be done to head off that one. It exemplifies the stone wall your administrators maintain when you're really into denying a problem that everyone else out here can already see - like security in the private prisons...we've been screaming about a lot of this stuff for awhile. Funny how it's ending up an election issue. It still looks a lot like you're waiting Marcia out - as if you're hoping we collapse from the heat or fatigue and shut up already. I guess your doctors are pretty much the same...
...Regarding Davon - whether it takes five months or 15 years to kill that kid, I'll figure out how to prove that he could have become virus-free and avoided such a fate if he'd been treated according to current community standards now, before his liver functioning deteriorates any further. You could be responsible for helping spread Hep C through the community, with the shoddy care he's received.
The one good thing the doctor had to say today is that it may still be early enough in the progression of the disease that there's still hope if he gets prompt treatment - even though he refused to admit that's what he was really saying. That part - the hope - I celebrated tonight. But it is good news that Davon isn't in imminent danger of dying only if that is true, and your physician didn't exhibit a lot of knowledge about either Davon or Hep C..."
My side was a long letter, though - this part of which was a complaint about the phone call I witnessed Friday between Julie and Ryan's people. I still can't figure out how to get the video of that call posted and distributed, but will leave those links here once I do. That recording is as real as it gets, and everyone who's advocated on Davon's behalf needs to see it. Keep acting up out there.
-------------------------------------
"...By the way, your doctor was really cruel and condescending to Julie Acklin and owes her an apology - at the minimum - as far as I'm concerned. If you all taped that conversation from your end, you'd better play it back. I hope you weren't there condoning his behavior. I also hope you know more about Hep C in prisons than he does - and more about your high profile prisoners, too. He didn't even know if the patient he swore was in no mortal danger had been tested yet for HIV - yet he seemed to think that Davon hadn't asked for an HIV test, either (which was by way of justifying why he wouldn 't have had an HIV test. He knows that kid wouldn't have known to ask before all this.).
That's inexcusable. Furthermore, it's a standard Hep C practice guideline, even in prison, for the physician to automatically test for other forms of hepatitis and HIV whenever a lab comes back HCV+. He should have had some certainty that Davon had been tested if he knew his patient was so healthy that he wouldn't even evaluate him further at this time.
He's full of it. This guy is either strategically trying stall and ridicule Julie, or he really hasn't been keeping up with his profession, so you might want to check him out again. Even I know more about current treatment recommendations than he does. And medical ethics, apparently.
My report of how that conversation went will be in my blogs, whether or not we plan to meet this week - there's no damage control to be done to head off that one. It exemplifies the stone wall your administrators maintain when you're really into denying a problem that everyone else out here can already see - like security in the private prisons...we've been screaming about a lot of this stuff for awhile. Funny how it's ending up an election issue. It still looks a lot like you're waiting Marcia out - as if you're hoping we collapse from the heat or fatigue and shut up already. I guess your doctors are pretty much the same...
...Regarding Davon - whether it takes five months or 15 years to kill that kid, I'll figure out how to prove that he could have become virus-free and avoided such a fate if he'd been treated according to current community standards now, before his liver functioning deteriorates any further. You could be responsible for helping spread Hep C through the community, with the shoddy care he's received.
The one good thing the doctor had to say today is that it may still be early enough in the progression of the disease that there's still hope if he gets prompt treatment - even though he refused to admit that's what he was really saying. That part - the hope - I celebrated tonight. But it is good news that Davon isn't in imminent danger of dying only if that is true, and your physician didn't exhibit a lot of knowledge about either Davon or Hep C..."
Monday, July 12, 2010
Davon and Goliath: meet Michelle Burrows.
Sorry - this is a really long one, but it's worth it. The Progressive article below tells the story of the HCV-positive prisoners who became part of a successful 2004 class action lawsuit against the Oregon Department of Corrections for failing to provide adequate (or any) medical treatment for their disease. Note the importance of treating such patients before they begin to experience liver damage. Delaying treatment for even six months or a year could dramatically reduce a young man or woman's life expectancy - and that's a hell of a way to go.
Before the background story on Anstett et al v. the State of Oregon, though, I'm posting the links to the actual class action settlement documents. Some things there just sound too familiar. Please contact me if you or a loved one has/had Hepatitis C in prison and are being/were refused treatment by your state's Department of Corrections - especially if that state is Arizona. The best way to get my attention is through the following address or email:
Peggy Plews
Hard Time Alliance - AZ
PO Box 20494
Phoenix, AZ 85036
hardtimehepc@gmail.com
You may also want to hit the Hard Time Alliance blog for more information and links to resources about Hep C in prison. Most of the other links embedded in this post will take you there, too.
For those of you following what's happening with Davon Acklin: we're still hitting a wall at the AZ Department of Corrections. His mom, Julie, can't get them to do the lab tests, take him to a specialist, or provide the treatment he needs to clear this virus before it does more damage; his liver and kidney function tests are already abnormal now. She can't even get them to find out the genotype he has to determine his vulnerability and the likeliness that he'll respond to treatment.
The dentist who serves as the Interim Medical Director for ADC said that the Hep C committee (which I believe he has a voice in) determined that Davon doesn't meet the criteria for treatment, emphasizing that he's not a good candidate for treatment and is less than a year from his release (the ADC doesn't want to start treatment if they can't be sure it will be finished. Julie would make sure it was finished). They have about 25 other hurdles prisoners with Hep C have to clear before they qualify for treatment, though (it's what they call an algorithm, which I can no longer find on their website). I guess that's one way to keep down their medical costs, since they could shell out a hundred grand on his medical care before he's through there. The medical profession - especially in corrections - is also generally against treating people with serious mental illness with interferon, because we'd have to go off our psychotropic meds - which could destabilize us - and the interferon can make you pretty sick and crazy even if you're relatively well and sane. That means that if I get Hep C, too, I may well be refused treatment as a free woman - most certainly if I was a prisoner of the state of Arizona.
There are new drug trials going on now, though, with less toxic antivirals that people with psychiatric disabilities can tolerate better. The ADC could be looking into how to get patients like Davon into such trials. In any event, I think Davon and I should both have the right to decide what to risk ourselves - which may come down to a choice between a long, slow, painful death (during which time most of our meds would have to be stopped anyway, because our failing livers couldn't handle them anymore), or a year or more of chemotherapy for Hep C (which may or may not work, and could aggravate our respective psychiatric disorders, resulting in psychosis, mind-numbing depression, and/or suicide). It's kind of a tough choice, really - especially if the misery of cirrhosis is just a maybe in the distant future - for Davon the future is now, though.
As many of you know, Davon's mom has petitions and a Facebook cause page set up for him, and I threw together that Hard Time Hep C blog to be a resource as well as an outreach and organizing tool - this has never just been about him. He talks a lot about the men around him who are sick and dying, and is always asking Julie to help them, too. That's why we formed an alliance with other families, ex-prisoners, and community members concerned about people having access to health care in prison.
We didn't know how sick Davon was at first (Julie has his medical records now and we've both been doing our homework); we're trying desperately to get him treatment or a compassionate release, but we're also still trying to change the system for others - not just trying to force them into making an exception. There are nearly 6,000 men and women in Arizona's state prisons who are known to be Hep C-positive, and many public health experts believe that most people with Hep C don't even know they have it yet (which means they could be infecting others for years unknowingly). Compare that to the couple hundred people in our state prisons who have AIDS. I find that stunning. Those HCV+ prisoners constitute a pretty large class, and if testing was expanded it would grow considerably.
Davon doesn't have time for a lawsuit himself, though - he'll be too sick to benefit from treatment by the time he gets home at the rate he's been deteriorating. Julie was told by the ADC that Davon's life is not in imminent danger and he doesn't qualify for a recommendation to the Board of Executive Clemency for compassionate release. She saw him this weekend, though - she says he looks like he's dying - and came home even more determined to get him treated there and now or freed. The Executive Director of the Board told her that Davon could apply for a regular pardon, however - but that could take six months to come before them, by which time Davon could be too ill to benefit from interferon. I don't think the Governor can pardon someone without the Board's recommendation to do so - but she can refuse to pardon anyone and everyone she wants - even those the Board has declared are clearly innocent of their crimes. In any event, it apparently doesn't get to her until it goes through them.
So, we're working on a few back-up plans to Julie's petitions and letters and Clemency Board paperwork. As far as I'm concerned, withholding medical care like this is state violence that should be covered by the Civil Rights of Institutionalized Persons Act (CRIPA). I also think the policy or practice of excluding anyone with mental illness from treatment - simply by virtue of their diagnosis - is a violation of the Americans with Disabilities Act. I've already started investigating the implications of those laws for Hep C prisoners, in addition to the possibility of class action.
The consequences of not treating HCV+ prisoners are extremely grave, as you'll read below. Julie won't let her son keep suffering without putting up one hell of a fight. The ADC should immediately step up to their responsibility to help this kid in every way possible if they don't want to let him go on medical grounds. He needs nutritional support, counseling, and medication to rid his body of that virus; it almost seems like they're just stalling in hopes he doesn't cost too much or die before his sentence is up. If Ryan is concerned about saving money - if that's the bottom line - then his staff can recommend Davon for medical/compassionate release and ask the Board and governor to send him home now. That'll save them not only the cost of keeping him alive and confined, but also a fortune in legal fees and settlements down the road.
And it may help save Davon's life. God knows he's already more than paid for his crime of mental illness...
Ryan's a big believer in punishment, though, and of course he wouldn't be in that job if he didn't keep every last prisoner there as long as the courts ordered. I don't know if he's been misinformed by his people (like the dentist who seems to be making clinical recommendations about people with Hep C), or what kind of circumstance he would find extraordinary or moving enough to recommend someone for compassionate release - there are people dying of cancer, liver disease (many from Hep C), and old age. According to Tucson prisoners, one of the yards there is known as the Death Yard. Why aren't people being sent off to hospice to die instead? There are also prisoners who have had strokes or amputations and lost the use of one or more limb - the list goes on.
Children are dying in his prison, too; a boy on the minors unit just suicided in May, and 16-year old Edgar Vega died there last year - he just dropped dead. The paper said it was his heart, but his family said the autopsy wasn't clear. I think his dreams were shattered and his heart broke when he was sent there.
I'm sure most judges would reconsider some of their sentences if they knew what was happening to these folks...or maybe they do and don't think much about it at this point in their careers. Maybe they think of it as some kind of Divine Justice or something - I don't know. I find this all very troubling, but can't just walk away. I think we are all responsible for what is done to people by the state, and no one is more vulnerable to and dependent on the state than those committed to its custody and care. That's why I do what I do with my time.
Anyhow, thanks to all of you who have joined the cause and signed a petition or written a letter on Davon's behalf. Whether or not it matters in the end to the Board of Executive Clemency or the Governor, it makes a big difference to our morale right now. As Davon says, it means a lot to know that there are people out here who care about and believe in him.
---------------------From the National HCV Prison Coalition------------------
HCV Treatment Guidelines - OREGON
Oregon Department of Corrections Guidelines for
Evaluation and Treatment of Hepatitis C (7/28/2003)
oregon 1.02 Mb
HCV Treatment Guidelines for Oregon (no date)
oregon_bak 99.01 Kb
Documents for the April 6, 2004 settlement concerning Oregon Department of Corrections (ODOC) treatment of inmates with Hepatitis C (HCV).
[ posted Oct. 26, 2005 ]
Letter from Michelle R. Burrows, attorney, to clients regarding class action lawsuit, Anstett et al v. State of Oregon, USDC No. CV01-1619BR, May 26, 2004
burrows_letter_052604 87.11 Kb
Anstett et seq. v. State of Oregon et seq., USDC Case No. 01-1619BR, Plaintiff's Settlement Proffer: Part I and Part II "As Applied" Policy, 40 pages
or_settlement 1.95 Mb
Supplemental Release and Settlement Agreement, April 15, 2004, 8 pages
or_settlement_suppl_041504 318.23 Kb
State of Oregon Hepatitis C Strategic Plan, Recommendations
of the Statewide Viral Hepatitis Planning Group, Prepared by
Ann Shindo, Ph.D., and Ann Thomas, M.D.
OR_strategic_plan 879.73 Kb
----------------------------The Progressive, March 2006------------------------
Rodger Anstett's death in 2003 was neither sudden nor inevitable. The symptoms started back in 1998: the abdominal pain around his kidneys and liver, the achy joints, the debilitating fatigue. Blood tests later that year showed that his liver enzymes were far above normal--one of them was eight times higher than it should have been. It all pointed to advanced hepatitis C infection, but Anstett's doctor waited another two full years before giving him a test to confirm the presence of the disease. It was another year before the doctors for Oregon's corrections system, where Anstett had been locked up for twelve years, treated him, just a month before his release. At that point, his liver was far too damaged for the drugs to do much good, and he died a year and a half later.
Thousands of hepatitis C-positive prisoners around the country are today facing Anstett's dilemma--barreling towards a preventable death because they are at the mercy of corrections health systems that are refusing to treat them. Moreover, say an increasing number of public health watchers, the unchecked hepatitis C epidemic inside the nation's prisons is undermining efforts to bring it under control in the broader community.
"No matter what you're in prison for," says Rodney Anstett, who watched his brother Rodger wither away from liver failure, "you deserve basic human rights." Rodger was the lead plaintiff in a lawsuit making just that assertion. Two days before his death, Anstett recorded a deposition for a case that would be the first successful class-action challenge to a state prison system's hepatitis C treatment policies. Last year, the state settled the suit, agreeing to open up treatment, and a federal judge is now monitoring its compliance with that settlement.
But Oregon's case is unique only in that the courts have intervened. Hepatitis C infection rates in some incarcerated populations are as high as 42 percent, according to an article in the Clinical Infectious Diseases journal, and anywhere from 15 to 30 percent of all prisoners are believed to carry the blood-borne virus. More precise counts are unavailable because few systems have come up with effective ways to screen for it-indeed, few even tried until federal health officials prodded them into action in recent years.
"Most prison systems are purposely not testing for hep C," charges civil rights lawyer Michelle Burrows, who led the Oregon lawsuit, "so they can say 'we don't know who's got it,' and don't have to treat it."
Science didn't identify hepatitis C until 1989, and it has been overshadowed by its more prominent viral sister, HIV. But the U.S. Centers for Disease Control and Prevention (CDC) estimates at least three million people nationwide now have chronic hepatitis C infections-triple the HIV caseload. Most are injection drug users, since unlike HIV the hepatitis C virus spreads less easily through sex than through direct blood-to-blood contact--which explains the epidemic's intensity among people who cycle through prison.
Hepatitis C is emerging as a leading cause of death in several state prison systems, according to Scott Allen, the medical director of Rhode Island's corrections department. It's also the number one reason for liver transplants in America. The disease has overwhelmed the market, creating a waiting list of more than 15,000 people.
As with most diseases, early treatment separates the well from the ill. But hepatitis C-positive prisoners around the country testify that prison health care providers are delaying treatment as long as possible.
Many prisons insist that anyone with a history of drug or alcohol use--no matter how long ago--complete a rehab course before beginning treatment. And they usually add a requirement that inmates be far enough away from any potential release date to guarantee that they will complete the year-long treatment regimen while still locked up. Finally, many systems also bar anyone with potential mental health problems from getting care. Oregon denied Anstett's repeated requests for treatment based on his need for a psych evaluation, which he never got, and the requirement that he take a drug abuse class, which, he testified, he had previously completed.
There are few national or even state-by-state numbers on how many prisoners actually get medical care under these policies. But Oregon had treated just a dozen of its at least 3,500 hepatitis C-positive inmates when Burrows filed suit.
A Justice Department census in 2000 tried to uncover how many inmates are tested and treated nationwide. It found that around 57,000 hepatitis C tests were conducted in the preceding year (a quarter of which were in California), and a whopping 31 percent came back positive. But of these nearly 18,000 people, only 4,750 were being treated (and 40 percent of those were in California alone). In New York State, which has about 10,000 hepatitis C-positive inmates, the highest in the nation, only about 300 were being treated, according to the Justice Department's census.
In August, New York civil rights lawyers filed a class-action suit challenging that system's policy. The lead plaintiff, Robert Hilton, had begun treatment at a New York City public hospital for his hepatitis C and subsequent liver disease in 2002. A few months after starting, he became homeless, and his treatment was interrupted. In August of 2004, Hilton was incarcerated on a parole violation and, after a few days in a downtown holding cell, shipped to a facility upstate. Upon intake there, he underwent a routine exam, and he told doctors about his infection, his liver disease, and his treatment history. Court records show that the doctors received copies of a May 2004 medical record confirming Hilton's report and recommending that his treatment resume.
But the medical staff allegedly waited two months to conduct its own screening, and a full seven months to recommend him for treatment--a process that would have taken weeks at best on the outside. By May 2005, an outside specialist had also recommended treatment for him, he'd been cleared by a mental health evaluation, and he'd signed the necessary consent form. Then, according to the suit, state Chief Medical Officer Lester Wright stepped in and shut the process down by demanding Hilton first take drug addiction classes, even though no previous doctor inside or out of the system had suggested it, and even though Hilton professed to not having used drugs in thirteen years.
Wanting his treatment resumed, Hilton acquiesced and signed up for the class--only to be put on a lengthy waiting list, since the facility at which he was incarcerated didn't have enough classes to accommodate the demand. He was then transferred to another facility, where counseling staff again tried to enroll him in a drug addiction class. This time, his enrollment was denied because he would be eligible for parole before the class finished. "As antiretroviral treatment continues to be denied on the basis of this Catch-22," the class action complaint notes, "Mr. Hilton's liver continues to deteriorate."
The state declined to comment on this and other suits it now faces related to its treatment policy. It did, however, file court papers in November asking that the suit be dismissed because, it said, it had just changed its treatment policy to ensure that "programmatic needs for alcohol and substance abuse treatment do not interfere with medical requirement" for hepatitis C treatment.
But Alex Reinert, who is representing the plaintiffs for the firm Koob & Magoolaghan, charges that he has already received at least one complaint from a prisoner who says he was denied treatment for not going to rehab, even though that policy was supposedly repealed.
"What Dr. Wright is saying is, 'Trust us, you don't have to be involved anymore,' " Reinert says. "But our experience is, the only time an individual gets treated is when an attorney has stepped in."
Coincidentally or not, treating hepatitis C is one of the more expensive tasks in medicine. Unlike HIV, doctors believe it can be permanently eradicated from a patient's body. But doing so can cost as much as $35,000 per person. Even evaluation can be an expensive process.
Corrections officials around the country, however, say they're just following federal health agencies' guidelines. In 2002 and 2003, in response to growing concern about the hepatitis C epidemic, the National Institutes of Health (NIH) and the CDC each issued recommendations for treating the virus. Around that time, state correctional officials gathered in San Antonio to share their experiences and compare ideas. They came away agreeing that each system should come up with firm criteria for both screening and treatment decisions, according to people in attendance. The rehab, time-remaining-on-sentence, and psych evaluation requirements fast became national standards.
Corrections health officials do face a complicated set of considerations. Because hepatitis C is a slow-progressing virus and because medicine is still learning how it works, just how fatal it is remains unclear. Currently, the CDC estimates that 5 percent to 20 percent of those infected with hepatitis C might develop cirrhosis over two or three decades. When and how to treat those who may not progress to that stage is a difficult question, and not just because of the costs. Hepatitis C treatment is brutal. Even the most advanced therapies involve regular injections. Side effects include psychiatric problems, particularly depression, and flu-like symptoms similar to heroin withdrawal--taxing circumstances for someone trying to stay sober. Both the CDC and NIH guidelines urge caution in treating active users, because failed adherence can jeopardize treatment success.
But the prison systems' policies are far inferior to the standard of care on the outside. Both the CDC and NIH stress that even active drug use should not automatically rule someone out for treatment. And at least one study--conducted by Rhode Island's corrections department--found that pre-existing mental health problems don't get in the way of treatment. As a result, class-action suits have been lodged in at least four states since 2001.
Oregon's case has been the most watched. The settlement was unprecedented. Outside specialists crafted a treatment policy that Burrows calls "the Cadillac standard." Doctors can still demand drug rehab classes and delay treatment if there's not enough time left on the sentence to finish a course of medicines, but those judgments must be made case by case, and everyone who tests positive must get at least a full medical workup to determine whether immediate treatment is needed.
Since the agreement, Burrows estimates, the state has begun treatment on around 1,000 inmates. But the legal fight continues, as several inmates and families--including the Anstetts--filed a wrongful death and damage civil claim in May. A spokesperson for the Oregon Department of Corrections declined to comment on the case or the department's hepatitis C treatment policies.
While states are failing to provide adequate treatment for hepatitis C-positive inmates, they are doing even less to prevent further spread of the disease. In many places, prisoners receive no information whatsoever about how to live healthy lives with the virus and how to prevent passing it on.
Prisoners nationwide testify that the sorts of behaviors hepatitis C thrives upon are widespread behind bars. While locked-up users more often sniff or smoke heroin than shoot it, plenty inject it as well. Some fish used syringes out of hazardous waste buckets in the infirmary and sell them on the black market. Others fashion makeshift "works" out of an eyedropper and a needle.
"I actually made a syringe out of a Bic pen," says Greg, who spent seventeen years in New Jersey prisons and requested anonymity. "If you get one set of works, the whole wing's using it. And that's how HIV and hepatitis C are spread. That's where I believe I got it."
New Jersey faces at least one lawsuit challenging its hepatitis C treatment policy. New Jersey Department of Corrections spokesperson Matthew Schuman refuses to comment on the case or the state's hepatitis C policies. While he acknowledges that injection drug use through shared syringes takes place, he stresses the department has a "zero tolerance" policy and has made strides cutting out drugs of all sorts in recent years. "When you're dealing with inmates," he says, "it's always going to be a cat and mouse game."
Widespread tattooing inside prison offers a similarly efficient way to contract hepatitis C. Tattoo machines are as easy to make as syringes--just pull a motor out of an old Walkman and hook it up to anything sharpened into a point. The problem is the ink, which prisons ban. So jailhouse artists shave down lead pencils or burn checkers and use the ash. Because they go to such extremes to get this valuable commodity, the artists do not dream of making a new pool each time they have a new customer, as those on the outside do. Hepatitis C can live for a few days outside the body.
And then there's sex. In an informal survey by the Latino Commission on AIDS of just over 100 New York State prisoners and ex-offenders in 1999, 63 percent of respondents reported having witnessed other inmates having sex. Nearly a fifth acknowledged having had sex themselves. And more than 30 percent said they knew someone who had contracted HIV while in prison due to unprotected sex.
University of North Carolina researcher James Thomas says all of this raises questions about the relationship between the hepatitis C and HIV epidemics in prisons and in neighborhoods--particularly African American ones. His research suggests "incarceration is leading to STDs," he says, adding that there appears to be a dynamic interaction between sexually transmitted disease patterns in the street and in the jailhouse. An estimated 1.4 million hepatitis C-positive inmates are released from America's prisons and jails each year, according to the Clinical Infectious Diseases journal.
Greg doesn't know if he infected his wife or not. She left him after his last prison term and now refuses to tell him if she's hep C- or HIV-positive. But the possibility that he brought the virus outside the prison walls is one that America's corrections health care system doesn't seem to grasp.
"They really don't care," scoffs Greg. "They figure we're criminals, so we're going to die anyway one way or the other."
Kai Wright is a writer in Brooklyn, New York, and editor of BlackAIDS.org. You can read more of his work at KaiWright.com.
Before the background story on Anstett et al v. the State of Oregon, though, I'm posting the links to the actual class action settlement documents. Some things there just sound too familiar. Please contact me if you or a loved one has/had Hepatitis C in prison and are being/were refused treatment by your state's Department of Corrections - especially if that state is Arizona. The best way to get my attention is through the following address or email:
Peggy Plews
Hard Time Alliance - AZ
PO Box 20494
Phoenix, AZ 85036
hardtimehepc@gmail.com
You may also want to hit the Hard Time Alliance blog for more information and links to resources about Hep C in prison. Most of the other links embedded in this post will take you there, too.
For those of you following what's happening with Davon Acklin: we're still hitting a wall at the AZ Department of Corrections. His mom, Julie, can't get them to do the lab tests, take him to a specialist, or provide the treatment he needs to clear this virus before it does more damage; his liver and kidney function tests are already abnormal now. She can't even get them to find out the genotype he has to determine his vulnerability and the likeliness that he'll respond to treatment.
The dentist who serves as the Interim Medical Director for ADC said that the Hep C committee (which I believe he has a voice in) determined that Davon doesn't meet the criteria for treatment, emphasizing that he's not a good candidate for treatment and is less than a year from his release (the ADC doesn't want to start treatment if they can't be sure it will be finished. Julie would make sure it was finished). They have about 25 other hurdles prisoners with Hep C have to clear before they qualify for treatment, though (it's what they call an algorithm, which I can no longer find on their website). I guess that's one way to keep down their medical costs, since they could shell out a hundred grand on his medical care before he's through there. The medical profession - especially in corrections - is also generally against treating people with serious mental illness with interferon, because we'd have to go off our psychotropic meds - which could destabilize us - and the interferon can make you pretty sick and crazy even if you're relatively well and sane. That means that if I get Hep C, too, I may well be refused treatment as a free woman - most certainly if I was a prisoner of the state of Arizona.
There are new drug trials going on now, though, with less toxic antivirals that people with psychiatric disabilities can tolerate better. The ADC could be looking into how to get patients like Davon into such trials. In any event, I think Davon and I should both have the right to decide what to risk ourselves - which may come down to a choice between a long, slow, painful death (during which time most of our meds would have to be stopped anyway, because our failing livers couldn't handle them anymore), or a year or more of chemotherapy for Hep C (which may or may not work, and could aggravate our respective psychiatric disorders, resulting in psychosis, mind-numbing depression, and/or suicide). It's kind of a tough choice, really - especially if the misery of cirrhosis is just a maybe in the distant future - for Davon the future is now, though.
As many of you know, Davon's mom has petitions and a Facebook cause page set up for him, and I threw together that Hard Time Hep C blog to be a resource as well as an outreach and organizing tool - this has never just been about him. He talks a lot about the men around him who are sick and dying, and is always asking Julie to help them, too. That's why we formed an alliance with other families, ex-prisoners, and community members concerned about people having access to health care in prison.
We didn't know how sick Davon was at first (Julie has his medical records now and we've both been doing our homework); we're trying desperately to get him treatment or a compassionate release, but we're also still trying to change the system for others - not just trying to force them into making an exception. There are nearly 6,000 men and women in Arizona's state prisons who are known to be Hep C-positive, and many public health experts believe that most people with Hep C don't even know they have it yet (which means they could be infecting others for years unknowingly). Compare that to the couple hundred people in our state prisons who have AIDS. I find that stunning. Those HCV+ prisoners constitute a pretty large class, and if testing was expanded it would grow considerably.
Davon doesn't have time for a lawsuit himself, though - he'll be too sick to benefit from treatment by the time he gets home at the rate he's been deteriorating. Julie was told by the ADC that Davon's life is not in imminent danger and he doesn't qualify for a recommendation to the Board of Executive Clemency for compassionate release. She saw him this weekend, though - she says he looks like he's dying - and came home even more determined to get him treated there and now or freed. The Executive Director of the Board told her that Davon could apply for a regular pardon, however - but that could take six months to come before them, by which time Davon could be too ill to benefit from interferon. I don't think the Governor can pardon someone without the Board's recommendation to do so - but she can refuse to pardon anyone and everyone she wants - even those the Board has declared are clearly innocent of their crimes. In any event, it apparently doesn't get to her until it goes through them.
So, we're working on a few back-up plans to Julie's petitions and letters and Clemency Board paperwork. As far as I'm concerned, withholding medical care like this is state violence that should be covered by the Civil Rights of Institutionalized Persons Act (CRIPA). I also think the policy or practice of excluding anyone with mental illness from treatment - simply by virtue of their diagnosis - is a violation of the Americans with Disabilities Act. I've already started investigating the implications of those laws for Hep C prisoners, in addition to the possibility of class action.
The consequences of not treating HCV+ prisoners are extremely grave, as you'll read below. Julie won't let her son keep suffering without putting up one hell of a fight. The ADC should immediately step up to their responsibility to help this kid in every way possible if they don't want to let him go on medical grounds. He needs nutritional support, counseling, and medication to rid his body of that virus; it almost seems like they're just stalling in hopes he doesn't cost too much or die before his sentence is up. If Ryan is concerned about saving money - if that's the bottom line - then his staff can recommend Davon for medical/compassionate release and ask the Board and governor to send him home now. That'll save them not only the cost of keeping him alive and confined, but also a fortune in legal fees and settlements down the road.
And it may help save Davon's life. God knows he's already more than paid for his crime of mental illness...
Ryan's a big believer in punishment, though, and of course he wouldn't be in that job if he didn't keep every last prisoner there as long as the courts ordered. I don't know if he's been misinformed by his people (like the dentist who seems to be making clinical recommendations about people with Hep C), or what kind of circumstance he would find extraordinary or moving enough to recommend someone for compassionate release - there are people dying of cancer, liver disease (many from Hep C), and old age. According to Tucson prisoners, one of the yards there is known as the Death Yard. Why aren't people being sent off to hospice to die instead? There are also prisoners who have had strokes or amputations and lost the use of one or more limb - the list goes on.
Children are dying in his prison, too; a boy on the minors unit just suicided in May, and 16-year old Edgar Vega died there last year - he just dropped dead. The paper said it was his heart, but his family said the autopsy wasn't clear. I think his dreams were shattered and his heart broke when he was sent there.
I'm sure most judges would reconsider some of their sentences if they knew what was happening to these folks...or maybe they do and don't think much about it at this point in their careers. Maybe they think of it as some kind of Divine Justice or something - I don't know. I find this all very troubling, but can't just walk away. I think we are all responsible for what is done to people by the state, and no one is more vulnerable to and dependent on the state than those committed to its custody and care. That's why I do what I do with my time.
Anyhow, thanks to all of you who have joined the cause and signed a petition or written a letter on Davon's behalf. Whether or not it matters in the end to the Board of Executive Clemency or the Governor, it makes a big difference to our morale right now. As Davon says, it means a lot to know that there are people out here who care about and believe in him.
---------------------From the National HCV Prison Coalition------------------
HCV Treatment Guidelines - OREGON
Oregon Department of Corrections Guidelines for
Evaluation and Treatment of Hepatitis C (7/28/2003)
oregon 1.02 MbHCV Treatment Guidelines for Oregon (no date)
oregon_bak 99.01 KbDocuments for the April 6, 2004 settlement concerning Oregon Department of Corrections (ODOC) treatment of inmates with Hepatitis C (HCV).
[ posted Oct. 26, 2005 ]
Letter from Michelle R. Burrows, attorney, to clients regarding class action lawsuit, Anstett et al v. State of Oregon, USDC No. CV01-1619BR, May 26, 2004
burrows_letter_052604 87.11 KbAnstett et seq. v. State of Oregon et seq., USDC Case No. 01-1619BR, Plaintiff's Settlement Proffer: Part I and Part II "As Applied" Policy, 40 pages
or_settlement 1.95 MbSupplemental Release and Settlement Agreement, April 15, 2004, 8 pages
or_settlement_suppl_041504 318.23 KbState of Oregon Hepatitis C Strategic Plan, Recommendations
of the Statewide Viral Hepatitis Planning Group, Prepared by
Ann Shindo, Ph.D., and Ann Thomas, M.D.
OR_strategic_plan 879.73 Kb----------------------------The Progressive, March 2006------------------------
Rodger Anstett's death in 2003 was neither sudden nor inevitable. The symptoms started back in 1998: the abdominal pain around his kidneys and liver, the achy joints, the debilitating fatigue. Blood tests later that year showed that his liver enzymes were far above normal--one of them was eight times higher than it should have been. It all pointed to advanced hepatitis C infection, but Anstett's doctor waited another two full years before giving him a test to confirm the presence of the disease. It was another year before the doctors for Oregon's corrections system, where Anstett had been locked up for twelve years, treated him, just a month before his release. At that point, his liver was far too damaged for the drugs to do much good, and he died a year and a half later.
Thousands of hepatitis C-positive prisoners around the country are today facing Anstett's dilemma--barreling towards a preventable death because they are at the mercy of corrections health systems that are refusing to treat them. Moreover, say an increasing number of public health watchers, the unchecked hepatitis C epidemic inside the nation's prisons is undermining efforts to bring it under control in the broader community.
"No matter what you're in prison for," says Rodney Anstett, who watched his brother Rodger wither away from liver failure, "you deserve basic human rights." Rodger was the lead plaintiff in a lawsuit making just that assertion. Two days before his death, Anstett recorded a deposition for a case that would be the first successful class-action challenge to a state prison system's hepatitis C treatment policies. Last year, the state settled the suit, agreeing to open up treatment, and a federal judge is now monitoring its compliance with that settlement.
But Oregon's case is unique only in that the courts have intervened. Hepatitis C infection rates in some incarcerated populations are as high as 42 percent, according to an article in the Clinical Infectious Diseases journal, and anywhere from 15 to 30 percent of all prisoners are believed to carry the blood-borne virus. More precise counts are unavailable because few systems have come up with effective ways to screen for it-indeed, few even tried until federal health officials prodded them into action in recent years.
"Most prison systems are purposely not testing for hep C," charges civil rights lawyer Michelle Burrows, who led the Oregon lawsuit, "so they can say 'we don't know who's got it,' and don't have to treat it."
Science didn't identify hepatitis C until 1989, and it has been overshadowed by its more prominent viral sister, HIV. But the U.S. Centers for Disease Control and Prevention (CDC) estimates at least three million people nationwide now have chronic hepatitis C infections-triple the HIV caseload. Most are injection drug users, since unlike HIV the hepatitis C virus spreads less easily through sex than through direct blood-to-blood contact--which explains the epidemic's intensity among people who cycle through prison.
Hepatitis C is emerging as a leading cause of death in several state prison systems, according to Scott Allen, the medical director of Rhode Island's corrections department. It's also the number one reason for liver transplants in America. The disease has overwhelmed the market, creating a waiting list of more than 15,000 people.
As with most diseases, early treatment separates the well from the ill. But hepatitis C-positive prisoners around the country testify that prison health care providers are delaying treatment as long as possible.
Many prisons insist that anyone with a history of drug or alcohol use--no matter how long ago--complete a rehab course before beginning treatment. And they usually add a requirement that inmates be far enough away from any potential release date to guarantee that they will complete the year-long treatment regimen while still locked up. Finally, many systems also bar anyone with potential mental health problems from getting care. Oregon denied Anstett's repeated requests for treatment based on his need for a psych evaluation, which he never got, and the requirement that he take a drug abuse class, which, he testified, he had previously completed.
There are few national or even state-by-state numbers on how many prisoners actually get medical care under these policies. But Oregon had treated just a dozen of its at least 3,500 hepatitis C-positive inmates when Burrows filed suit.
A Justice Department census in 2000 tried to uncover how many inmates are tested and treated nationwide. It found that around 57,000 hepatitis C tests were conducted in the preceding year (a quarter of which were in California), and a whopping 31 percent came back positive. But of these nearly 18,000 people, only 4,750 were being treated (and 40 percent of those were in California alone). In New York State, which has about 10,000 hepatitis C-positive inmates, the highest in the nation, only about 300 were being treated, according to the Justice Department's census.
In August, New York civil rights lawyers filed a class-action suit challenging that system's policy. The lead plaintiff, Robert Hilton, had begun treatment at a New York City public hospital for his hepatitis C and subsequent liver disease in 2002. A few months after starting, he became homeless, and his treatment was interrupted. In August of 2004, Hilton was incarcerated on a parole violation and, after a few days in a downtown holding cell, shipped to a facility upstate. Upon intake there, he underwent a routine exam, and he told doctors about his infection, his liver disease, and his treatment history. Court records show that the doctors received copies of a May 2004 medical record confirming Hilton's report and recommending that his treatment resume.
But the medical staff allegedly waited two months to conduct its own screening, and a full seven months to recommend him for treatment--a process that would have taken weeks at best on the outside. By May 2005, an outside specialist had also recommended treatment for him, he'd been cleared by a mental health evaluation, and he'd signed the necessary consent form. Then, according to the suit, state Chief Medical Officer Lester Wright stepped in and shut the process down by demanding Hilton first take drug addiction classes, even though no previous doctor inside or out of the system had suggested it, and even though Hilton professed to not having used drugs in thirteen years.
Wanting his treatment resumed, Hilton acquiesced and signed up for the class--only to be put on a lengthy waiting list, since the facility at which he was incarcerated didn't have enough classes to accommodate the demand. He was then transferred to another facility, where counseling staff again tried to enroll him in a drug addiction class. This time, his enrollment was denied because he would be eligible for parole before the class finished. "As antiretroviral treatment continues to be denied on the basis of this Catch-22," the class action complaint notes, "Mr. Hilton's liver continues to deteriorate."
The state declined to comment on this and other suits it now faces related to its treatment policy. It did, however, file court papers in November asking that the suit be dismissed because, it said, it had just changed its treatment policy to ensure that "programmatic needs for alcohol and substance abuse treatment do not interfere with medical requirement" for hepatitis C treatment.
But Alex Reinert, who is representing the plaintiffs for the firm Koob & Magoolaghan, charges that he has already received at least one complaint from a prisoner who says he was denied treatment for not going to rehab, even though that policy was supposedly repealed.
"What Dr. Wright is saying is, 'Trust us, you don't have to be involved anymore,' " Reinert says. "But our experience is, the only time an individual gets treated is when an attorney has stepped in."
Coincidentally or not, treating hepatitis C is one of the more expensive tasks in medicine. Unlike HIV, doctors believe it can be permanently eradicated from a patient's body. But doing so can cost as much as $35,000 per person. Even evaluation can be an expensive process.
Corrections officials around the country, however, say they're just following federal health agencies' guidelines. In 2002 and 2003, in response to growing concern about the hepatitis C epidemic, the National Institutes of Health (NIH) and the CDC each issued recommendations for treating the virus. Around that time, state correctional officials gathered in San Antonio to share their experiences and compare ideas. They came away agreeing that each system should come up with firm criteria for both screening and treatment decisions, according to people in attendance. The rehab, time-remaining-on-sentence, and psych evaluation requirements fast became national standards.
Corrections health officials do face a complicated set of considerations. Because hepatitis C is a slow-progressing virus and because medicine is still learning how it works, just how fatal it is remains unclear. Currently, the CDC estimates that 5 percent to 20 percent of those infected with hepatitis C might develop cirrhosis over two or three decades. When and how to treat those who may not progress to that stage is a difficult question, and not just because of the costs. Hepatitis C treatment is brutal. Even the most advanced therapies involve regular injections. Side effects include psychiatric problems, particularly depression, and flu-like symptoms similar to heroin withdrawal--taxing circumstances for someone trying to stay sober. Both the CDC and NIH guidelines urge caution in treating active users, because failed adherence can jeopardize treatment success.
But the prison systems' policies are far inferior to the standard of care on the outside. Both the CDC and NIH stress that even active drug use should not automatically rule someone out for treatment. And at least one study--conducted by Rhode Island's corrections department--found that pre-existing mental health problems don't get in the way of treatment. As a result, class-action suits have been lodged in at least four states since 2001.
Oregon's case has been the most watched. The settlement was unprecedented. Outside specialists crafted a treatment policy that Burrows calls "the Cadillac standard." Doctors can still demand drug rehab classes and delay treatment if there's not enough time left on the sentence to finish a course of medicines, but those judgments must be made case by case, and everyone who tests positive must get at least a full medical workup to determine whether immediate treatment is needed.
Since the agreement, Burrows estimates, the state has begun treatment on around 1,000 inmates. But the legal fight continues, as several inmates and families--including the Anstetts--filed a wrongful death and damage civil claim in May. A spokesperson for the Oregon Department of Corrections declined to comment on the case or the department's hepatitis C treatment policies.
While states are failing to provide adequate treatment for hepatitis C-positive inmates, they are doing even less to prevent further spread of the disease. In many places, prisoners receive no information whatsoever about how to live healthy lives with the virus and how to prevent passing it on.
Prisoners nationwide testify that the sorts of behaviors hepatitis C thrives upon are widespread behind bars. While locked-up users more often sniff or smoke heroin than shoot it, plenty inject it as well. Some fish used syringes out of hazardous waste buckets in the infirmary and sell them on the black market. Others fashion makeshift "works" out of an eyedropper and a needle.
"I actually made a syringe out of a Bic pen," says Greg, who spent seventeen years in New Jersey prisons and requested anonymity. "If you get one set of works, the whole wing's using it. And that's how HIV and hepatitis C are spread. That's where I believe I got it."
New Jersey faces at least one lawsuit challenging its hepatitis C treatment policy. New Jersey Department of Corrections spokesperson Matthew Schuman refuses to comment on the case or the state's hepatitis C policies. While he acknowledges that injection drug use through shared syringes takes place, he stresses the department has a "zero tolerance" policy and has made strides cutting out drugs of all sorts in recent years. "When you're dealing with inmates," he says, "it's always going to be a cat and mouse game."
Widespread tattooing inside prison offers a similarly efficient way to contract hepatitis C. Tattoo machines are as easy to make as syringes--just pull a motor out of an old Walkman and hook it up to anything sharpened into a point. The problem is the ink, which prisons ban. So jailhouse artists shave down lead pencils or burn checkers and use the ash. Because they go to such extremes to get this valuable commodity, the artists do not dream of making a new pool each time they have a new customer, as those on the outside do. Hepatitis C can live for a few days outside the body.
And then there's sex. In an informal survey by the Latino Commission on AIDS of just over 100 New York State prisoners and ex-offenders in 1999, 63 percent of respondents reported having witnessed other inmates having sex. Nearly a fifth acknowledged having had sex themselves. And more than 30 percent said they knew someone who had contracted HIV while in prison due to unprotected sex.
University of North Carolina researcher James Thomas says all of this raises questions about the relationship between the hepatitis C and HIV epidemics in prisons and in neighborhoods--particularly African American ones. His research suggests "incarceration is leading to STDs," he says, adding that there appears to be a dynamic interaction between sexually transmitted disease patterns in the street and in the jailhouse. An estimated 1.4 million hepatitis C-positive inmates are released from America's prisons and jails each year, according to the Clinical Infectious Diseases journal.
Greg doesn't know if he infected his wife or not. She left him after his last prison term and now refuses to tell him if she's hep C- or HIV-positive. But the possibility that he brought the virus outside the prison walls is one that America's corrections health care system doesn't seem to grasp.
"They really don't care," scoffs Greg. "They figure we're criminals, so we're going to die anyway one way or the other."
Kai Wright is a writer in Brooklyn, New York, and editor of BlackAIDS.org. You can read more of his work at KaiWright.com.
Tuesday, May 4, 2010
Prisoner Health is Public Health
Prison's deadliest inmate, hepatitis C, escaping
Public-health workers warn of looming epidemic of ‘silent killer’
The Associated Press / MSNBC.com
March. 14, 2007
Nobody knows how many inmates have the disease; by some estimates, around 40 percent of the 2.2 million in jail and prison are infected, compared with just 2 percent of the general population.
Eventually, when they are released, medical experts predict they will be a crushing burden on the health care system, perhaps killing as many people as AIDS in years to come. At the same time, they will be carriers, spreading the disease.
Hepatitis C can be treated, but many prisons do not test for it. Among the reasons: Budgets are tight, and treatment is expensive. So prison officials close their eyes to the gathering emergency and pass it along to the outside world.
“Right now there’s a golden opportunity to bring solutions to this problem before it hits,” said Dr. John Ward, director of viral hepatitis at the
Hepatitis C is already the most common disease of its sort in the
'Silent killer'
What makes this virus particularly insidious is that as many as half of the people who have hepatitis C don’t even know they have it. The “silent killer,” already considered epidemic by the World Health Organization, often remains dormant for decades.
Some of the infected are lucky: One in five people who get hepatitis C will clear it out of their system naturally. But without treatment, one in four will suffer liver failure or develop liver cancer. Last year liver cancer was the only one of the top 10 fatal cancers in this country to increase, in large part because of hepatitis C.
More than $1 billion is already spent each year on this country on hepatitis C, and those costs are expected to soar unless prevention and treatment are expanded.
Without those changes, researchers project that liver-related deaths will triple from around 13,000 in 2000 to 39,000 by 2030. It’s also estimated that 375,000 Americans with hepatitis C will develop cirrhosis by the year 2015.
Anita Taylor, 48, is already there, in end-stage liver disease.
'Doctor gave me a death sentence'
A mother of two and former heroin addict,
“They tested me and told me I had hepatitis C. They didn’t tell me there was a treatment and a cure,” she said. “And I didn’t know to ask.”
“The doctor gave me a death sentence, recalls Leslie Czirr, a 36-year-old parolee. “He told me, ’There’s no cure for this and you will die from it unless you are hit by a truck first,”’
Czirr learned she had hepatitis C during a prenatal examination in 1996, at a time when she wasn’t in prison. Czirr has been arrested 10 times for drug possession and served almost eight years in prison on various drug possession and dealing charges.
She has started to suffer exhaustion, brain fog and aches. She recently enrolled in a county program to be treated — treatment, she said, she was denied at
“I asked and asked, but they barely want to give you a Motrin,” she said. “I really want to get well, not just for myself, but so I’m not putting anyone else at risk.”
Limited studies indicate that fewer than 10 percent of prisoners who have contracted hepatitis C are treated. The reason vary. Medical staff have other priorities, and not all are well-informed about the disease. Prisoners with short sentences are often excluded because they won’t be able to complete treatment, and drug addicts who are inclined to return to risky behavior are often turned away because it is assumed they will simply reinfect themselves.
No funding for treatment
Usually, though, it comes down to money. Prison officials say that even if they wanted to provide the treatment, it is extremely expensive — about $9,500 per patient per year — and no federal funds have been earmarked to pay for it.
“It’s a hard sell to convince taxpayers why additional resources should be spent on the health care of the incarcerated when there are a lot of people who aren’t incarcerated who don’t have adequate health care,” said Dr. Joseph Bick, chief medical officer at the California Medical Facility at Vacaville.
Many of the inmates in
“I’m pretty sure this is how I got it,” said Anthony Harris, an inmate at
Harris, 51, is a former barber serving a life sentence for second-degree murder. In 2003, a doctor at another prison told him he had Hepatitis C; he researched the disease in the prison library and has sought treatment ever since.
“They gave me shots for Hep A and B, got rid of them. I’d like to get rid of the C too,” he said. “I’m entitled to that. But some docs will give you the treatment and others won’t. I keep making appointments. I keep asking.”
The course of treatment can take a year, and involves taking pills twice a day and weekly injections. Side effects are like those associated with chemotherapy — nausea, exhaustion, depression, debilitating aches and pains — and the cure only works about half the time.
But Bick said the high cost of treating prisoners for hepatitis C is a bargain compared to the bill that would come due if these cases are left untreated. “It’s a tremendous opportunity for us to have an impact on the larger health of the community,” he said.
Dr. Lynn Taylor, an assistant professor of medicine at
'Window of opportunity' for public-health efforts
“Prison can be a window of opportunity to reduce the reservoir of infection,” she said.
But there are no federal rules about testing and treating hepatitis C. Federal guidelines, issued by the CDC in 2003, said correctional facilities should “become part of prevention and control efforts in the broader community.” But they don’t recommend screening for all inmates.
Instead, the CDC urged medical staff to ask new inmates about their risk factors, and only those prisoners who seem likely to be exposed should undergo screening, which costs $5 to $10.
The CDC guidelines fell short, said Dr. Josiah Rich, a professor at Brown who directs the university’s Center for Prisoner and Human Rights. Rich’s studies confirm that convicted criminals are almost always willing to be tested for hepatitis C, but will often lie to prison authorities about their past drug use.
“We already know that more than one in three people coming through corrections has Hep C, so by definition everyone coming in is high risk. It’s absurd that they’re not testing everyone,” he said.
Rich concedes that testing every inmate will “jack up costs” for prisons.
“An individual is going to say, ’Hey, you tested me, you said I was positive, and now I want to be treated, and I’m going to sue you if I don’t get treated,”’ he said.
Lawsuits on the rise
Lawsuits are, indeed, on the rise.
The first significant case came in 1999, when officials at the Luther Luckett Correctional Complex in
But the treatment came late and he died in 2004, the year he would have been eligible for parole. The litigation prompted broader testing and treatment in
“I think it’s immoral if a country, a state a society is going to incarcerate somebody and then deny them necessary medical care. I think that’s an outrage,” he said.
Prisons in at least a dozen states —
But it’s tough going, said
5-year wait
“It’s appalling, horrendous, horrifying. Prisoners wait five years just to be evaluated,” she said.
Rep. Barbara Lee, D-Calif., recently reintroduced legislation that would mandate prison testing and treatment of hepatitis C. Earlier similar proposals in recent years have failed.
“The plain fact is that prisoners do not stay in prison. With more than 90 percent of incarcerated persons returning to their communities, it is clear that when a prisoner is infected, we are all affected,” Lee said.
In
“It became obvious to me that these people are going to cost the state a lot of money if we don’t do something about it,” she said.
“We look at this as a huge public health initiative,” she said.
© 2009 The Associated Press.
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