Death on the Installment Plan

Medical neglect, chronic disease, a hepatitis epidemic. Some Colorado prisoners pay for their crimes with their lives.

Across the nation, a declining crime rate has slowed prison growth to a crawl. But the DOC's inmate population has increased by a whopping 50 percent in the past five years -- to 18,382 -- and is expected to soar to more than 22,000 in the next five years.

Other state agencies are slashing costs, cutting programs and laying off employees as part of Governor Bill Owens's belt-tightening measures. But the DOC is slated for a 7.5 percent increase in its current $500 million budget.

Longer sentences, an influx of drug offenders, a logjam of nonviolent prisoners that the state refuses to parole and other policy decisions have all contributed to the prison boom. Perhaps the biggest factor has been the increase in parolees being returned to prison for technical violations of their parole, including traffic offenses; close to one out of three people sent to prison last year were "technical returns," coming back to serve time on the same felony for which they were previously incarcerated. Whatever the driving force, the rising population comes with a rising price.

Part of that price is medical. Every time some crackhead, drunk driver, gangbanger or rapist is sent to prison, the taxpayer is also getting sentenced -- to pay for said felon's ulcers or peri-rectal cysts, insulin injections or dialysis for however long the offender is stuck in the system. In 1999, the DOC spent $30.5 million on medical services; this fiscal year, medical expenditures will top $54 million. Medical costs, along with mental-health and drug-treatment programs, are among the department's fastest-growing line items, demanding a greater percentage of the corrections budget than ever before.

Legally, the DOC isn't required to respond to every kind of health complaint a prisoner might raise; it is, however, supposed to address the "serious medical needs" of those in its custody. And thousands of prisoners now in the system have chronic, potentially life-threatening diseases that are devouring the medical budget -- including, most alarmingly, an epidemic of hepatitis C, a blood-borne virus that has infected 20 to 40 percent of the entire U.S. prison population.

The DOC estimates its current level of hep C infection at around 17 percent, well below the rampant spread of the disease in correctional systems on the East Coast. Even so, the virus, which attacks the liver and can cause cirrhosis and organ failure, is now the most common cause of death in Colorado prisons. A Westword review of death certificates, autopsy reports and other records found that at least twenty out of 122 inmate deaths -- roughly one out of six -- over the past three years stemmed from hepatitis-related illnesses. In recent months, hepatitis C has outpaced heart problems, lung cancer and other diseases as the leading killer in the joint.

Critics of the DOC's health-care system -- including inmates such as Ramos, plaintiffs' attorneys and prisoners' families -- insist that the quality of care is shockingly poor, resulting in unnecessary suffering and questionable deaths. The system's defenders insist that it meets and exceeds constitutional standards for inmate care. But the rising tide of deaths and lawsuits is prompting the department to re-examine how it deals with its sickest cases, from revising its controversial treatment policies for hepatitis C to opening a prison at Fort Lyon for geriatric and chronically ill inmates.

Facing a crisis in critical care that is only going to get worse in coming years, the DOC's medical staff is trying to steer a course between two extremes: a degree of compassion that it can't afford and a level of neglect that can be fatal.

"I think the department is acting in a responsible way," says Joseph McGarry, the department's chief medical officer. "We're taking care of 18,000 people. The fact is, being in a correctional system slows down your access to health care. Things don't happen as fast as they can on the street. That's part of the downside of being in prison."

Your name is Clarence Thompson. You are 28 years old, almost six feet tall, a sturdy 225 pounds. You are down for twelve years for theft and stuck in a private lockup in a place called Olney Springs. There is not much to do in the private lockup, but there is marijuana.

You get word that a drug test is coming down with your name on it. This is never good news, but especially not now, when you are higher than the razor-wire-topped fences that surround the place. A positive test means loss of "good time" -- time shaved from your sentence for good behavior. It also means restriction of privileges and a lot of other complications you don't even want to think about.

You've heard that there are special pills a body can take that are supposed to confuse the piss test, but you can't get any of that stuff in here. What you need is something else to clean out your system. Thanks to some very bad advice, or perhaps because your options are desperately limited, you seize on the only cleansing diet available to you.

You swallow Tide detergent and VO5 shampoo, washing the nasty stuff down with huge gulps of water. You follow this up with more and more water, to rinse your system clean. Results are not long in coming. Nausea grips you. Soon you are vomiting. The puking makes you thirsty, so you guzzle more water, then puke some more.

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