The Needle and the Damage Done

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Colorado was one of the states Kentucky officials contacted for advice in revising their plan. The DOC has its own elaborate protocol for deciding who will receive interferon or ribavirin -- one that's not as restrictive as the old Kentucky policy but has a few inflexible requirements of its own. For example, patients who are less than two years away from their discharge date, older than 65 or have a life expectancy of less than twenty years are not eligible for the drugs; nor are those who have already acquired cirrhosis, are still using illicit drugs or drinking, or have demonstrated "an established pattern of refusing to comply with medication contracts."

Medical chief McGarry says his department revised the protocol extensively last year in order to mount a more aggressive response to the virus. In the past, when a prisoner's medical tests revealed abnormally high liver enzymes, the agency used to wait six months to see if the levels persisted before running specific tests to detect the presence of hepatitis C. Now the hepatitis screening is done right away. "We're doing it sooner, and that streamlines how fast we're able to know if someone has hepatitis C," McGarry says.

But diagnosis is no guarantee of treatment, as Terry Akers discovered. He says he was told he had hepatitis C when his liver enzymes came back "high" two years ago. But he was also told to check back in six months so that his doctor could determine if he had a chronic case. (Eighty-five percent of all hep C cases develop into chronic infections.) Six months later he was put off for another six months; his case wasn't drastic enough to fit the treatment criteria, he was told, and department policy at the time required that liver enzymes be elevated for at least one year before drug therapy would be considered.

In the fall of 1999, after a full year of delay, Akers's case was finally certified as chronic hepatitis C. According to his medical records, the levels of key liver enyzmes had increased significantly during that year. But in the DOC medical staff's opinion, Akers's body was "fighting the infection adequately," and the lab results reflected no need for immediate treatment.

"Medical evidence supports the fact that this is a lifetime disease, with terminal illness from this being very remote," medical officer Orville Neufeld wrote in a memo to Akers. "Statistically, 95 percent of individuals with hepatitis C will die from other natural causes."

Akers filed formal grievances complaining about the lack of treatment, only to discover another catch: The DOC requires that hepatitis C patients complete a year of substance-abuse classes, complete with random drug testing, before being considered for interferon. Akers wondered why no one had told him about the requirement earlier so that he could get started on the classes; he also wondered how he was supposed to get access to such a program within CSP, which only offered much shorter drug-education programs on video.

McGarry says he isn't sure when CSP began to offer the one-year substance-abuse classes; more than a dozen inmates there are now enrolled in them. The classes became a requirement for treatment only a year ago, and other inmates besides Akers have complained of getting a runaround about them at CSP. (Calls to the prison's warden, Gene Atherton, were not returned.) In any event, Akers's condition soon began to defy the cheery assessment the prison's medical professionals had given him.

Last spring his stomach became grossly distended, as if he were carrying a beach ball under his shirt. At first the doctors suspected a bacterial infection, but it was ascites, an accumulation of fluid that is one of the common symptoms of cirrhosis. The veins in his esophagus also became painfully swollen. The DOC's internal medicine specialist said he'd seen worse.

After dinner a couple of months ago, Akers began to vomit blood. A physician's assistant responded to his distress call, looked in his toilet and decided, yep, that was a lot of blood. He was rushed to one hospital, then another, as he continued to throw up "mouthfuls of blood like it was cheap beer," Akers recalls. His esophogeal varices had ruptured in five places, requiring surgery.

Neufeld's statistics aside, researchers estimate that one in five chronic hepatitis C patients will develop cirrhosis. But the process can take ten or twenty years, and McGarry says there's no evidence that earlier treatment with interferon would have any positive result in the most serious cases. Although the DOC's own literature describes interferon as "potentially curative treatment," McGarry is wary of overstating its benefits.

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Alan Prendergast has been writing for Westword for over thirty years. He teaches journalism at Colorado College; his stories about the justice system, historic crimes, high-security prisons and death by misadventure have won numerous awards and appeared in a wide range of magazines and anthologies.
Contact: Alan Prendergast