The Needle and the Damage Done

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"The disease takes so long to manifest itself, it's difficult to have the medical trials to show the drug treatment is effective," he says. "They've never proven that any of the people who get 'cured' are people who were going to develop hypatic failure or liver cancer otherwise. It's possible that the people who respond well to treatment were going to have a benign course anyway and didn't need treatment."

Now that Akers has developed cirrhosis, the DOC considers him a poor candidate for interferon, a position that's supported by many medical authorities. But Akers has a letter from a private doctor who believes he may still benefit from the drug therapy, and other states, including Kentucky, have considered offering the drugs to cirrhosis patients as well.

Akers says he doesn't have any complaints about his nurses, the physician's assistant or Dr. Neufeld; despite his violent history, they've treated him well, and he understands their hands are tied by department policy. The real issue, he says, is that the DOC treats so few of the people who have hepatitis C. Several of his buddies at CSP scrambled to get into the drug-education classes after they saw what happened to him, but as far as Akers knows, none are receiving interferon yet.

In Colorado prisons, McGarry estimates, around 2,000 hepatitis C patients have cases serious enough to make them candidates for treatment. But because of the various requirements for treatment, including the one-year waiting period, currently there are no more than ten to twenty inmates on interferon, he says.

Even with that small percentage, Colorado still ranks as one of the more progressive states in attacking the problem. Several states offer no treatment programs at all.

To become a candidate for drug therapy while in the care of the DOC, a prisoner who's tested positive for hepatitis C must first sign a contract. The contract states that the supplicant will take a year of substance-abuse classes, submit to random urine testing four times during that year, and commit to further tests and classes throughout the course of treatment. It's a straightforward document, one that seems to make perfect sense. After all, a patient who continues to shoot up is probably going to get reinfected anyway, so why bother to offer him a costly and futile program?

"Since you're using expensive and somewhat experimental treatment," says McGarry, "you want to make sure you have a highly motivated group of people who are taking part in this."

Yet fulfilling the contract can be a complicated matter. Prisoners aren't very good at following rules -- that's why they're in prison. And the contracts actually involve prohibitions that have little or nothing to do with the medical requirements for successful drug therapy. Consequently, patients who commit what might be considered in another setting a minor infraction -- such as sneaking a cigarette -- could wind up being denied lifesaving medical treatment.

"They're making it a privilege to get interferon," notes inmate Grant Brown, a resident of the Kit Carson Correctional Center in Burlington. "If they think you're a bad boy, you can't get medical treatment, basically."

Brown is a 33-year-old offender serving two consecutive sixteen-year sentences for burglary, courtesy of former Denver judge Lynne "Hang 'em High" Hufnagel. He admits to having dabbled in drugs during his past dozen years behind bars. He also has what prisoners call a "shirt": arms, back and chest covered in tattoos. He was diagnosed with hepatitis C eight years ago. Last spring, while he was staying in a halfway house in Denver, tests showed a dramatic rise in the levels of his liver enzymes, making him a candidate for interferon therapy. But before his own doctor could put him on the drugs, he was yanked out of community corrections for marijuana use and returned to prison.

Since then, Brown has been shuffled from one prison to another, with little attention to his medical problem. One doctor prescribed a low-fat diet that the prison kitchen had trouble accommodating; in the meantime, he's continued to lose weight and battle fatigue and other symptoms. He says he only learned of the requirement that he take a year of substance-abuse classes when he arrived at Kit Carson a few weeks ago; the months of classes he took during his prior prison stay didn't count, he was told, because he'd tested positive for drugs. Brown contended that he ought to get at least some credit for the classes he took at the halfway house -- but then he was told he could be bumped from eligibility because a recent urine test came back positive for a drug that, outside prison walls, is still legal.

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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