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November 13, 2006 - Detroit Free Press (MI)

Editorial: Prisons Make Unhealthy Cuts On Hepatitis Testing

By Jeff Gerritt, Free Press editorial writer

Return to Drug War News: Don't Miss Archive

Depending whether you believe the state or outside experts, Michigan prisons hold 7,000 to 18,000 inmates infected with hepatitis C. That's 14-40% -- and most of them don't even know they have the disease.

Contagious and potentially fatal, hepatitis C attacks the liver. The prison epidemic affects everyone. Practically all of those infected - -- more than 95% -- will go home, carrying their infections and health problems with them, and in some cases spreading them. As a public health problem, the level of hepatitis C in the prison system demands the attention of not only the Department of Corrections but also the Department of Community Health and the Legislature.

Lawmakers, however, have made a bad problem even worse. They cut most of the $5.9 million that Gov. Jennifer Granholm requested in 2004 to test and treat hepatitis C in prisons, and this year whacked the funding altogether. By not routinely testing for hepatitis C, the state is failing to meet U.S. Centers for Disease Control guidelines.

"They don't test regularly enough to find people before they have a permanently damaged liver," said David Santacroce, a University of Michigan law professor who filed a class action suit in 2003 on behalf of infected inmates. "We're seeing more and more cases of people who are too sick to be treated, and they're going to die.

"It's A Death Sentence."

Up to 40% of the nation's prisoners have hepatitis C, compared to 2% of the general population. The infection is spread through blood, and can be passed by needles shared to inject drugs or in tattooing, through unprotected sex and, before blood screenings began in 1992, by transfusions.

Truth be told, prison administrators don't want to know everyone who has hepatitis C, because that would pressure them to treat more inmates. Drug therapies with interferon and ribavirin cost more than $10,000 for each patient, though not every infected prisoner needs them. Still, the number of inmates getting drug therapies in Michigan prisons is ridiculously low -- only 125 inmates enrolled this year. Hundreds, possibly thousands, more need it. Left untreated, the only option is a liver transplant, which costs about $250,000 and is not done in Michigan prisons.

Prison officials say they treat everyone identified as needing it. The department regularly evaluates 2,500 inmates known to have hepatitis C, said spokesman Russ Marlan. Still, medical records and lawsuits show dozens of cases where inmates were denied testing or treatment or not even notified that they had the disease.

In one case handled by Santacroce, inmate Jeffrey Muller, now dead, was taken off a liver transplant list in 2001, after he supposedly tested positive for marijuana. But law students tracked down Muller's urine sample and, using DNA, found that the sample was not Muller's.

Inmate Lionel Stewart, 54, serving 35-75 years for armed robbery, is another example of the oke-doke inmates say they get when trying to get treated. A college graduate, Stewart never made it to law school because he got hooked on heroin and robbed to feed his habit. He's up for parole in two years. Stewart said that his levels of ALT -- an enzyme produced in higher amounts when the liver is inflamed -- were high enough early this year to qualify for drug therapies, but then the department stopped testing him. Another prison doctor, he said, is trying to get him in treatment.

"She said that, if I don't get it, I'll die," Stewart told me last week in the visiting room of Deerfield Correctional Facility in Ionia.

Another Ionia inmate, Randy Rodgers, 46, who's serving 7 to 20 years for home invasion and breaking and entering, said doctors predict he will die in two years from hepatitis C, which he may have contracted from injecting drugs or tattooing more than 20 years ago. Rodgers has been in and out of jail and prison six times, all for nonviolent offenses related to alcohol and drug abuse.

Rodgers has undergone two unsuccessful treatments in Michigan prisons for hepatitis C and wants to try a low-dosage drug therapy, but he said prison administrators wouldn't permit it.

"I've got nothing to lose," Rodgers said. "If I die, I die."

Rodgers is also trying to get a medical parole and ought to get it, especially considering his nonviolent record.

No doubt, prison medical administrators have a tough job, trying to contain an epidemic without enough money. Still, Michigan's prison system should at least routinely test all high-risk inmates, especially injection drug users, and treat those with life-threatening symptoms. Blood tests for hepatitis C cost only $35.

"Thousands of people in prisons are left to die without treatment," said Dr. Bennett Cecil of Louisville, Ky., a national expert on hepatitis C in prisons. "Cirrhosis of the liver is just as deadly as breast cancer, and we don't say we're not going to pay for that."

The prison system could be the spot where the state starts to get a handle on hepatitis C by testing and treating inmates before they get out and return to their communities. But that's not going to happen with policies that are more focused on hiding than healing.

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