Pubdate: Fri, 24 May 2002
Source: Register-Guard, The (OR)
Copyright: 2002 The Register-Guard
Contact:  http://www.registerguard.com/
Details: http://www.mapinc.org/media/362
Author: Tim Christie, Register-Guard
Bookmark: http://www.mapinc.org/prison.htm (Incarceration)
Bookmark: http://www.mapinc.org/find?143 (Hepatitis)

DISEASE RAGES BEHIND BARS

SALEM - On Dec. 1, 1998, health officials at the Oregon State Penitentiary 
learned that inmate Rodger Anstett had elevated liver enzymes, an 
indication that he might be infected with hepatitis C, according to a 
lawsuit against the Department of Corrections.

It took two more years until prison doctors ordered a blood test that 
confirmed Anstett had the viral disease. To date, Anstett has received no 
treatment for the disease, and his health is failing.

"They won't treat the hepatitis C. They're dragging their feet," said 
Anstett, who is serving a 20-year sentence for multiple counts of arson and 
attempted murder out of Washington County. "The problem in prisons is, they 
really want to look the other way. They have an intentional policy to 
misdiagnose consistently until you leave."

Or die.

That's the central allegation in the $17.5 million lawsuit, filed last fall 
by Portland lawyer Michelle Burrows on behalf of 10 inmates, including 
Anstett, and one former inmate.

"The state of Oregon, through the DOC, has a de facto policy of not 
treating hepatitis C," Burrows said. "I've had four inmate clients die from 
hepatitis C-related issues."

Anstett is one of three plaintiffs whose disease has reached an advanced 
stage and could die at any time, Burrows said.

Burrows is trying to get the suit, filed last fall, certified as a class 
action complaint. Attorneys for the state are preparing to fight the class 
action request.

Although state lawyers won't discuss the merits of the case, the 
Corrections Department's top medical official contends that most people who 
get the disease suffer few serious health problems and that it's 
appropriate for the department to take a cautious approach to treatment.

But the sheer numbers of prisoners with the disease shows that the state 
has a growing, costly health problem on its hands.

An estimated one in three Oregon prisoners is infected with hepatitis C, a 
chronic, potentially deadly disease that's costly to treat. Although the 
numbers are startling, they're similar to numbers found in prisons across 
the country, said Phyllis Beck, director of the Eugene-based National 
Hepatitis C Prison Coalition.

"In essence, our state prisons have become a state-sponsored incubator for 
HCV, by default," Beck told Hepatitis magazine.

Prison officials said about 30 percent of the nearly 11,000 inmates in the 
14 Oregon prisons, work camps and release centers - 3,300 prisoners - have 
hepatitis C. Burrows believes that the number could be closer to 40 percent.

Hepatitis C is the fourth-leading cause of death in Oregon prisons, after 
heart disease, cancer and suicide, Burrows said, citing Corrections 
Department death reports.

About 4 million Americans are infected with the hepatitis C virus, many of 
whom don't know they have the disease. Hepatitis C is spread through 
blood-to-blood contact, often through injection drug use and from needles 
used to inscribe tattoos. Some people got the disease through blood 
transfusions or organ transplant before 1992 when better testing of the 
blood supply became available.

The virus can lurk in a body for years without detection, slowly wrecking 
the liver. Federal health officials report that 10,000 people die each year 
from hepatitis C, a number expected to triple by 2010.

The Department of Corrections won't say how many inmates are being treated 
for hepatitis C. Burrows said she's aware of eight inmates who are 
receiving treatment.

Burrows alleges that treatment decisions are being made for financial, not 
medical reasons. The disease is expensive to treat, with a single course of 
the recommended combination therapy, interferon and ribavirin, costing 
$17,000 to $20,000, she said. One course of treatment can take 25 to 45 
weeks. The expense doesn't include liver biopsies, which are required to 
assess the amount of liver damage and cost several thousand dollars.

Measure 11, which mandated tough sentences for violent offenders, has 
exacerbated the problem, Burrows said.

"We put people in prison for a very long time, and we expect that to be the 
end of it," she said. "We don't want to deal with it. ... The unfortunate 
thing is, you have to take care of them. These are captive, vulnerable people."

However, Corrections Department medical director Dr. Steve Shelton said the 
state adequately cares for inmates who have hepatitis C, most of whom 
probably won't experience serious health problems.

"Over 80 percent of the people with hepatitis C will not show evidence of 
health problems during the course of their full lifetime," he said.

Knowledge about hepatitis C has evolved rapidly in recent years and doctors 
have not settled on a single standard of evaluation and treatment, Shelton 
said.

"It is reasonable to take a very careful, reasonable medical evaluation, 
though some people want it to move faster," he said.

Treatment decisions are based on medical evaluations that seek to identify 
patients for whom it appears to be a progressive disease, he said.

"For those people for whom it is not a progressive disease, is it a 
problem? I think you'd probably have to say it is not a problem for those 
people," he said. "Everyone who has chest pain doesn't get taken to open 
heart surgery."

Hepatitis C attacks different bodies in different ways, depending on the 
strain of the virus and the strength of the person's immune system, 
according to the National Institutes of Health.

According to the federal Centers for Disease Control and Infection, 70 
percent of hepatitis C patients suffer chronic liver disease and 15 percent 
may develop cirrhosis of the liver over a period of 20 to 30 years. The 
risk is greater for people who have abused alcohol.

Dr. Hugo Rosen is a liver specialist at the Veterans Affairs Medical Center 
and Oregon Health & Science University in Portland. He said for the "vast 
majority of patients," hepatitis C is a progressive disease, albeit one 
that progresses slowly.

"If you follow patients, many will develop progressive liver disease," he 
said. "The ultimate progression is a point where they die or need a 
transplant."

He favors treatment in most cases, though not for patients with psychiatric 
problems because the combination therapy can cause side effects, including 
depression, anxiety and flulike symptoms.

In some cases, the combination therapy can cause the virus to go into 
remission.

"If you treat someone with less degree of injury you may prevent them from 
developing cirrhosis," he said.

For Anstett, it may be too late to treat his disease. If he has cirrhosis, 
as Burrows suspects, drug therapy may do more harm than good.

Anstett said he's never injected drugs and believes that he contracted the 
virus while serving in Vietnam.

He said the disease has given him a skin rash that feels "like acid coming 
up from under my skin," leaves him constantly achy and fatigued, and fogs 
his brain so it's hard to think clearly or carry on coherent conversations.

"I do not consider any of the treatment I have received to be responsible 
or responsive," he wrote in an affidavit prepared for the lawsuit. "I 
believe the various delays and denials are simply calculated to see whether 
I die or am released first."
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MAP posted-by: Jay Bergstrom