The Needle and the Damage Done

In prison, getting hepatitis C is easy. Getting treatment isn't.

Terry Akers feels like death warmed over.

His back throbs. His testicles ache. His gut -- dude, don't even ask. It's like he's living in an old Road Runner cartoon, and someone just shoved a keg of nails down his swollen throat. He's got a bad case of cottonmouth and a fierce need to urinate, thanks to the painkillers, which don't seem to be doing...anything...about the pain.

Sitting in a glass-and-steel booth in the Colorado State Penitentiary, the state's highest-security prison, he fingers the murky blue tattoos that cover his spindly arms -- wizards, demons, naked nymphs, the phrase WINNER TAKES ALL arching across his left bicep -- and tries to focus. What was the question? How long has he been inside?

Twenty-three of his 42 years, plus a few months in juvie. The last ten years in solitary confinement. The last seven in 23-hour-a-day lockdown at CSP. "I've been in one kind of cage or another since I was a kid," he says.

In a cage, or trying to get out. Fact is, this Terrance Joel Akers, underweight and pasty-skinned and hurting, is merely a ghost of the badass he used to be. Go back twenty years, to the 21-year-old hothead, recently escaped from a Virginia prison, who knocked over a Taco Bell in Arvada for dope money and wound up killing a teenager who tried to stop him.

Or fifteen years, when the tattoos were still fresh, to the inmate known as "Smiley," who iced another prisoner because he thought the dude was planning to do him.Not long after that, Smiley Akers went to court to be sentenced for one of his many escape attempts, used a zip gun to hijack a prison van, and fled through the streets of Cañon City.

Go back even ten years, when six lifers with nothing to lose busted out of Centennial, a maximum-security prison, shooting a guard in the process. Wearing an officer's uniform and armed with a handgun of mysterious origin, Terry Akers was the last of the bunch to be captured.

That Terry Akers was a desperado, all right-- and a real escape artist. But this one? A ghost, a wisp, humbled by a cage even he can't escape. He's trapped not just in CSP, which was built for men like him, but in his own ravaged body, a funhouse of failing organs and bad chemistry and the pain of the damned.

Akers knows he is going to die in prison. He'd have to live to 133 to see parole. His doctors say he might still be alive for his 45th birthday, three years away, but fifty is probably out of the question. He is dying of cirrhosis, a particularly nasty liver disease that announced itself a few months ago by pumping fluid into his abdomen and rupturing veins in his esophagus.

Cirrhosis is often the result of chronic alcohol abuse, but Akers is no boozer. Having spent almost his entire adult life in stir, he's had little opportunity to imbibe; wine tastings are hard to come by at CSP. He blames his condition on another culprit. Two years ago he was diagnosed with hepatitis C, a bloodborne virus that, depending on whose figures you believe, has infected 20 to 40 percent of the entire U.S. prison population.

Hepatitis C is one of the most common causes of chronic liver disease. The virus can be transmitted a number of ways, including exposure to blood products or blood transfusions given before 1992, when better screening methods emerged; unlike AIDS, it's not easily acquired through sexual contact. These days hepatitis C is spread primarily through intravenous drug use, amateur tattooing or what health-care workers call "needle-stick accidents." Although the virus can lurk in the system for years with no visible symptoms, most hepatitis C infections ultimately become chronic, with the potential for cirrhosis, liver cancer and organ failure.

Akers hasn't had access to tattoo work or hard drugs in more than a decade. He speculates that the virus might have found him through a shaving nick -- a few years ago, CSP banned disposable razors and required prisoners to share electric shavers, a practice since abandoned. ("They said they sterilized those shavers, but when you cracked one open, there was enough hair to build a toupee, so you know they didn't clean them," he says.) But the most likely explanation, he concedes, is bad behavior of long ago: "I would have to say it was probably drugs or tattoos."

An estimated 4 million Americans, in all walks of life, carry the hepatitis C antibody, indicating ongoing or past infection by the virus. But the link to dirty needles makes hepatitis C particularly well-suited for transmission among convicts. The combination of a criminal lifestyle and the disease's ability to lie dormant for decades --during which a carrier may drift from prison to the street and back again, passing along the disease in cellhouse tattoo parlors and shooting galleries -- has produced a corrections health crisis of staggering dimensions.

Keeping that crisis contained within prison walls is a formidable challenge. A cutting-edge regimen of drugs has proven effective in treating up to 40 percent of hepatitis C patients in this country. But the drugs are expensive, as much as $25,000 per patient, and prisoners say they face an obstacle course of procedures, delays and bureaucracy that effectively denies treatment to many of them. At issue is not simply whether murderers, rapists and other felons deserve such costly treatment -- court cases have generally held prison medical providers to a "standard of care" comparable to that of the surrounding community -- but whether budget-conscious corrections officials can set conditions for treatment that seem designed to keep the pool of patients on drug therapy at a minimum, regardless of the medical need.

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