Pubdate: Tue, 28 Jan 2003 Source: New York Times (NY) Copyright: 2003 The New York Times Company Contact: http://www.nytimes.com/ Details: http://www.mapinc.org/media/298 Author: Fox Butterfield INFECTIONS IN NEWLY RELEASED INMATES ARE RISING CONCERN MOUNT PLEASANT, Mich., Jan. 27 - Marva Johnson was thrilled when her longtime boyfriend, Randy Vallad, was paroled from prison in 1999. They went back to living together, and once when he had a bad cut on his head, she took care of him. She was splattered with his blood, but the couple did not think anything of it at the time. It was not until Mr. Vallad was sent back to prison in 2001 for a parole violation that he was accidentally shown his Michigan Department of Corrections medical records. They reported that Mr. Vallad had tested positive for hepatitis C, a blood-borne virus that can cause potentially fatal liver disease, when he was first admitted to prison years before. "They knew and didn't tell him," Ms. Johnson, 33, said today in this small city in central Michigan. "As a result, they also let him infect me." For the past 11 months she has been taking a powerful, enervating course of drugs for hepatitis C. Such cases are becoming increasingly common across the nation, as jails and prisons have become giant incubators for some of the worst infectious diseases. According to a study released today at a conference sponsored by the federal Centers for Disease Control and Prevention, at least 1.3 million inmates released from jail or prison in 1996 were infected with hepatitis C. That was 29 percent of the 4.5 million cases nationwide. Similarly, newly released inmates accounted for 35 percent of the 34,000 Americans with tuberculosis in 1996, the study found. And newly released inmates accounted for 13 to 17 percent of Americans infected with H.I.V. or AIDS, the study estimated. The problem has become so acute that health care officials and prisoner rights groups are calling for widespread testing of prison populations for hepatitis C and faster treatment of prisoners. "This is a public health problem that has been growing and growing, but we are reluctant to do anything about it because these are bad guys," said Dr. Robert Greifinger, a former chief medical officer for the New York State Department of Correctional Services and the author of the study, which was commissioned by Congress and prepared for the Justice Department. The Centers for Disease Control held a conference of prison medical officers in San Antonio devoted to the issue last weekend. During the conference, the centers said that public vaccination efforts to prevent hepatitis outbreaks should be extended to prisons. The centers also issued new guidelines urging states to test all prisoners with a history of intravenous drug use and other risky behavior for hepatitis C. Sharing needles and unprotected sex are common ways the virus is spread. The problem is not that large numbers of prisoners are contracting hepatitis C while incarcerated, experts say. Most were infected years before. The experts say the high rate of communicable diseases among inmates is a critical issue for two reasons: the danger inmates pose of infecting others when they are released, and the opportunity to treat them that is largely being wasted. Dr. Greifinger said that Americans tended to forget that most inmates eventually return home. In 2000, about nine million people were released from jail and prison, according to Allen J. Beck, of the Bureau of Justice Statistics, the statistical arm of the Justice Department. In a sign that the problem is getting more attention, the C.D.C. made public Dr. Greifinger's report today. It had been given to the Justice Department in March 2001, Dr. Greifinger said, but never before released to the public. In a separate action, the American Civil Liberties Union and two dozen other organizations interested in prison conditions issued a call today for a Congressional investigation into the state of medical care in jails and prisons. "Correctional systems have buried their heads in the sand because they don't want to know how many prisoners have hepatitis C," said Eric Balaban, a staff lawyer with the National Prison Project of the A.C.L.U. Russ Marlin, a spokesman for the Michigan Department of Corrections, said, "We are treating hepatitis C in accordance with federal guidelines." He said that Michigan did not do blood tests of all incoming inmates or all those who engage in risky behavior. "Our position is that indiscriminate testing is not useful," he said. In addition, it would cost $200 million to test and treat all suspected cases of hepatitis C among Michigan inmates, he said. Even more important, he said, is that the drug treatment - a combination of interferon and ribarvin given over a 6 to 12 month period - is very toxic. Mr. Marlin said he had no information on why Mr. Vallad was not told he had tested positive for hepatitis C and could not release it even if he did because of the confidentiality of prisoners' medical records. Mr. Vallad, was originally convicted for fleeing the police when he was stopped for driving with a suspended license. It was not the last of his problems. Today, the police raided the trailer where he lives with his sister and brother, looking for drugs. It was a bad tip from an informant, the police later said, and they found no drugs. But they detained Mr. Vallad anyway. Steven Croley, a lawyer for Mr. Vallad and Ms. Johnson, said Mr. Vallad had stumbled on the information that he had tested positive for hepatitis C when he asked to see some of his private medical records compiled by doctors while he was out of prison. At the time, in 2001, Mr. Vallad had just been sent back to prison because of a urine test that showed evidence of drug use, a violation of his parole. But the records he received accidentally included pages of his prison medical file reporting on a blood test he had been given during his first admission in 1998. At the bottom of one page was the notation "Hepatitis C - Positive." "I said, wait a minute, what's this?" Mr. Vallad recalled. He called Ms. Johnson, who went for a test and discovered she was also infected. Mr. Vallad, now 42, was never offered any treatment inside prison for hepatitis C. His level of infection has steadily gone up and his health has deteriorated, Mr. Croley said. Mr. Croley said he will soon bring suits against the Michigan Department of Corrections on behalf of Mr. Vallad and Ms. Johnson. - --- MAP posted-by: Jo-D