Death on the Installment Plan

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

You persist. In October, you are given the test. A nurse tells you that your enzyme levels are not high enough to warrant drug treatment. You have been reading up on the disease, and the levels seem pretty high to you. You ask to review your medical file. When you finally get access to it, you realize that you have been misled.

According to the file, your enzyme levels have been increasing steadily for years, while DOC staffers told you merely that your counts were within the "acceptable" range. Actually, your enzyme levels were unacceptably high, by the department's own standards, as far back as 1999. But at some point, the medical staff hiked the values for the "acceptable" range by ten points without explanation, making you a borderline candidate, at best, for interferon therapy.

You apply for treatment. You are handed a contract that states you must first complete a year of substance-abuse counseling and random drug testing before you are eligible for interferon. No one told you about the classes before, and you wished you'd heard about them three years earlier. You sign the contract under protest. You do the classes and complete them in November 2001.

Mark Andresen
Roderic Gottula devised the DOC's first hepatitis treatment policies a decade ago.
Brett Amole
Roderic Gottula devised the DOC's first hepatitis treatment policies a decade ago.

Now can you have the damn drugs? Of course not. The next step is a liver biopsy, which will give the doctors a better idea of how much damage the virus has already done. The biopsy is ordered in February but not scheduled until August 2002. "Budget constraints," you are told.

It's been five years since your diagnosis. You file numerous grievances, to no effect, and join several other prisoners who've been denied treatment for hepatitis C in a lawsuit against the state.

The doctor performing the biopsy is one of the defendants in your lawsuit. You wait in line with other prisoners until he calls you into his office. He explains that he'll "do a couple of passes," and if he can't hit the liver, he'll try again at a later date, with more sophisticated imaging equipment. He makes pointed reference to the fact that you are suing him.

You say little. You don't want to provoke someone who will soon be slicing into you.

You are given an anesthetic. You hear later that the doctor stuck you five or six times. Two months go by. You learn that the procedure failed to yield a single analyzable sample of liver tissue. You await another biopsy.

Your gut is swollen and achy, and you are fighting chronic symptoms of fatigue and nausea, as if you're getting the flu over and over again. The drug therapy is supposed to have close to a 50 percent success rate, but you are not close to getting the drugs. You file more grievances, write to your lawyer, compare notes with other prisoners on the insidious progress of the virus and the lack of progress in your treatment.

Mostly, you wait.

Prisoners die in all sorts of ways. Increasingly, though, they die from hepatitis C.

Last March, the virus claimed Frank Rodriguez, who'd been on Colorado's death row for sixteen years for the kidnapping, rape and murder of bookkeeper Lorraine Martelli. Rodriguez's death from liver failure saved the state the expense of an execution, but the disease's impact on the system is costing taxpayers millions.

The DOC has screened its inmate population for liver abnormalities since the 1970s, long before hepatitis C was identified as a specific threat. Over the years, as more has become known about the virus, the department has refined its treatment program and now offers a costly regimen of interferon and ribavirin, drugs that have proven successful in ridding the body of detectable levels of hepatitis C in up to half the patients treated.

But critics of the DOC's treatment policies say that out of hundreds who may need them, only a fortunate few actually receive the drugs. The system now has roughly 3,000 inmates who've tested positive for hep C; in the current fiscal year, 34 are receiving drug therapy. Even according to the DOC's own conservative estimates, which project that 4 percent of its hepatitis cases will end in liver failure, the number of cases getting treatment is abysmally low. And studies indicate that up to 20 percent of hepatitis C patients will develop cirrhosis; that's 600 potential candidates in the system right now.

The problem, says McGarry, is determining which inmates are the best candidates. "Do you treat 25 people in order to get the one who's at greatest risk?" he asks. "Undoubtedly, you're going to have to treat more than 4 percent. Our ability to identify and target those people isn't good enough."

But inmates say the department is trying to avoid treating anyone. They accuse administrators of loading the hep C program with hurdles and foot-dragging tactics -- the required year of substance-abuse classes, the delays in getting biopsies, restrictions that bar you from the program if you're too old, too close to your parole date or caught using tobacco -- in order to keep to a bare minimum the number of inmates receiving some very expensive drugs. Interferon therapy usually runs between 24 and 48 weeks, at an average cost of $25,000 per inmate. In some cases, the drugs' side effects require additional countermeasures, such as a series of injections to stimulate red and white blood cell production, bringing the total cost for each of those patients to as much as $75,000.

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