Medical Epidemics

I assure you that this disease is a dreaded silent killer that kills many more than are executed. It is an alternate death sentence. This death sentence is not adjudged by a jury, rather by the indifference of the prison system. The prison system is complicit in keeping prisoners ignorant that they may have HCV because when you enter the prison system, they do not expend the funds to perform the necessary tests. Almost always, a prisoner has to request an HCV test. It is not always approved. In an article in the Arizona Republic newspaper, dated February 10, 2001, it stated "Of Arizona's 26,800 inmates in the prison system, an estimated 6,000 have Hepatitis C Virus. Of these, an estimated 700-1,000 meet the criteria making them eligible for treatment."

Today, there are over 31,000 prisoners in Arizona. In my prison unit, there are a total of two people receiving treatment. The reason being is that it costs an average of over $8,000 per year per prisoner. It would run into millions of dollars to begin treatment to tackle the problem. It is easier to turn a cold shoulder.

Over the years, the protocol for treatment has constantly changed. One has often spent years on a specific protocol toward treatment. After you have jumped through all the hoops, you come to learn a new protocol is in effect. You must start over from the beginning.

A case in point is a man diagnosed over 15 years ago with HCV. It was new then, and not much was known about treatment. He was told that it may never develop into a serious condition. That he may just be a carrier and never develop any of the symptoms. He was told there was no treatment. He had to wait. As the years passed, his HCV numbers increased, still with no treatment. A few years ago Interferon was becoming standard treatment for HCV. The prison would not authorize it. Next, Ribavirin was developed and it was combined with the Interferon. He requested this treatment and was denied. Finally, a more effective Interferon called Pegylated Interferon combined with Ribavirin became the federal government approved treatment called Rebetron.

When he requested this treatment, he was told there was a new protocol. After a year of more blood tests he finally reached the point where he would have a liver biopsy. This took about a year to approve. At long last, he had the biopsy. After waiting 15 years, the biopsy confirmed his disease. He was told he has Stage 2 - Chronic Active Hepatitis C with Fibrosis, which involved inflammation and early scaring (fibrosis) in one zone (portal) of the liver. The family nurse practitioner asked him if he wanted treatment or it he wanted to wait for a future treatment. He was told that the Rebetron treatment was only 15-25% effective. He told her that after 15 years of waiting, he would take the treatment now.

After an hour of signing release forms and waiting as the medical provider filled out the paperwork, she said there was a problem. Apparently, there is an enzyme called ALT and a normal reading is 40. The department requires that at least double, 80, must appear in three blood tests over a two-year period. His last two tests were 82 and 78. She told him he could not be considered until he produces more tests of 80 or higher in the next year. She asked him how old he was. Almost 57, he told her. She said that once he reached 60, treatment is not authorized. He couldn't believe how depressed he felt.

He was beside himself and told me in confidence that now that he knows he has the terminal illness, and they continue to deny treatment, he feels as if he has been given a second death sentence. The big question is which one will kill him first: execution or liver failure?

The bill surely will come due. Since most prisoners are released back into society, they simply take the disease with them. It is transmitted through sex, blood transfusions or a minor fist fight. It is wiser to treat it now rather than later when the cost is ten times more expensive when liver transplants are considered. The HCV is a ticking time bomb for prisoners across the nation. There is a terrible sense of helplessness inside these prison walls. Because we are prisoners, especially those on death row, we are looked upon as less than human and not worthy of proper medical treatment to save our lives. The HCV is no longer new and unknown, but until we can lift the veil of secrecy surrounding these negligent practices behind prison walls and are willing to acknowledge the abuse and additional punishment we are placing on our prisoners, many more will suffer and die silently in a haze of denial.