• E-mail
• Print
• Comment
• Font Size
• Digg
• del.icio.us
• Discuss article

Infected Inmates Wait for Drugs; Budget Limits Dictate Which State Prisoners With Hepatitis C Get Expensive Treatment

Posted on: Tuesday, 10 January 2006, 18:00 CST

By Sue Reinert; SUE REINERT

The Patriot Ledger

State prisons are rationing medication for inmates infected with hepatitis C, a contagious and deadly liver disease.

Prison physicians have put 150 inmates on a waiting list for treatment. Nearly 1,500 inmates are known to be infected, and the actual number may be double.

Of the 1,472 state prison inmates who have tested positive for the hepatitis C virus, 62 are receiving the recommended combination of two antiviral drugs, interferon and ribavirin. The cost for 48 weeks of care is $18,000 to $25,000. This year's state budget includes about $1 million for hepatitis C drugs for prisoners.

Every month, up to 10 of the most seriously ill prisoners are chosen to be treated for the liver disease. But the number who actually start the drugs is dictated by how much money is available, an internal policy document says.

Officials insist that prisoners will get the expensive drugs when they need them.

The state policy came to light in a federal lawsuit filed by a 41- year-old inmate at the Norfolk prison. Kerry M. Castello, formerly of New Bedford, says prison doctors recommended treatment for him more than two years ago but he is still waiting.

Without the drugs, 10 to 15 percent of infected people may develop severe liver disease that can lead to cancer - the percentage is even higher for men, people infected with HIV and heavy drinkers.

Inmates with the virus could also infect others when they get out of prison.

The University of Massachusetts School of Medicine in Worcester provides medical services in state prisons. University spokesman Mark Shelton says that treatment is never denied for budget reasons.

"Because this is an expensive medication and a commitment to treat can last a year, we pay close attention to monitoring the use of an expensive resource," Shelton said.

Leslie Walker, director of Massachusetts Correctional Legal Services, a non-profit legal advocate for prisoners, said the group receives many calls from prisoners seeking treatment.

"It would be a real step forward to treat these men and women while they're incarcerated," she said.

Michelle R. Burrows, a Portland, Ore., lawyer who represented prisoners with hepatitis C in a class action lawsuit in Oregon, said a Supreme Court decision bars authorities from denying needed treatment for financial reasons.

"Prisoners are vulnerable and they do not have any choices," Burrows said. "The standard has to be - what would a person get in the community? What if you went to your doctor and he says, 'You need treatment but I'm putting you on a waiting list'?"

Not everyone who is infected requires weekly injections of anti- viral drugs. The medicine works for only about half of patients with the most common type of the virus.

Hepatitis C leaves many patients with no damage and can take years to worsen. Treatment exposes people to dangerous side effects, including depression, suicidal behavior, blood problems and flu- like symptoms.

The standard recommendation, which the state says it follows, is to wait until patients have moderate to severe liver damage before treating them. But some doctors urge treatment while the disease is mild, saying the drugs are more effective then.

The virus is spread mainly through blood exposure, mainly from shared needles, and very rarely from sexual contact.

Because so many prisoners have used needles to inject illegal drugs, inmates are three to five times more likely than the general population to be infected with the virus, the Centers for Disease Control and Prevention says.

Health officials estimate that 30 percent of the 10,000 state prisoners are probably infected with the disease, but only half have been diagnosed.

Even less is known about the 14,000 county prisoners in Massachusetts. They are rarely tested and almost never treated in jail because most will get out before they can complete 48 weeks of medicine, officials say.

Public health officials view prison as a chance to treat people who rarely get medical care outside.

"It's much easier to take care of people in prison than on the street," said Dr. Alfred DeMaria, director of communicable diseases at the state Department of Public Health. "The more people we treat in prison the better off we would be, if we had the resources."

DeMaria, who helped develop the state prison protocol for treating hepatitis C, said prison authorities and the University of Massachusetts Medical School are making a good-faith effort to provide inmates with the care they need.

"Most people can wait for treatment," he said.

Castello, the Norfolk inmate who sued over the delay in receiving treatment, was placed on the waiting list for medicine in October 2003.

Prison doctors found the hepatitis C virus in his blood in 2001, court papers filed in his suit say. In 2003, blood tests showed abnormal levels of a liver enzyme, and a liver biopsy found inflammation but no scarring. He says he suffers from fatigue and joint pain and faces permanent liver damage.

Castello, who is representing himself, sued Feb. 7, claiming that the failure to treat his infection constitutes cruel and unusual punishment. The state replied that Castello has only mild liver disease and other prisoners with more damage should get drugs first.

"While there are many patients with Hepatitis C currently awaiting treatment ... due to the Massachusetts Department of Corrections finite resources, combination therapy is offered first to inmates with the greatest medical need," a state brief said.

A federal judge is considering motions by both sides to decide the case without a trial.

Castello is serving two consecutive sentences of 13 to 15 years for attacking an 81-year-old Mattapoisett woman who caught him burglarizing her home in 1993.

Sue Reinert may be reached at sreinert@ledger.com.

Source: Patriot Ledger, The; Quincy, Mass.

More News in this Category