Hepatitis C Rates Rise Among Inmates But Few Get Treatment

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By Salem Statesman Journal

Published: 06/04/2003

Steve Meljado says his life was saved when he became the first Oregon inmate to receive drug treatment to combat hepatitis C.
During a six-month blitz of interferon injections and anti-viral pills, Meljado endured horrendous side-effects, including bouts of suicidal depression. But the results made it all worthwhile.
'I'm considered cured or in remission,' Meljado said recently at the Oregon State Correctional Institution in Salem. He pointed to post-treatment blood tests that detected no sign of the virus.
Recently freed after completing a nearly six-year prison term for robbery, Meljado, 47, was part of a tiny minority of prisoners to be treated for hepatitis C. Corrections officials estimate that about 30 percent of all Oregon inmates - roughly 3,500 - are infected with hepatitis C. Inmate advocates say that is a conservative estimate.
Only a small fraction of infected prisoners have received expensive treatment for the disease, which can cause liver damage, cirrhosis and cancer.
Costs range from $18,000 to $30,000 per inmate.
Even as overall inmate health-care surpasses what is provided to many ailing Oregonians, lack of treatment for prisoners with hepatitis C is a massive, sometimes fatal, flaw in prison medical care, critics say.
Oregon inmates allege in a pending class-action lawsuit that treatment for hepatitis C is so woefully inadequate in the state's 12-prison, 11,800-inmate system that it violates the constitutional ban on cruel and unusual punishment. Prisoners say health-care managers systematically deny treatment to hold down costs.
The federal lawsuit seeks $17.5 million for inmate medical expenses, including drug therapy, chemotherapy and potential liver transplants.
No trial date has been set for the suit, pending in U.S. District Court in Portland. Meanwhile, anger and frustration run high among prisoners and advocates, who maintain that a prison sentence can turn into a death sentence for infected inmates.
'It's just unconscionable what's going on,' said Phyllis Beck, director of the hepatitis C Awareness Project in Eugene. 'They're letting prisoners die of hepatitis C. It's happening here. It's happening in every state.'
Beck charged that Oregon corrections officials are ignoring the crisis.
Since the federal lawsuit was filed, Beck said corrections officials haven't been open to talking with inmate advocates about their concerns.
District Court Judge Anna Brown recently granted a motion to expand the suit into a class action. All Oregon inmates with hepatitis C now are considered plaintiffs.
In addition to expanded testing and treatment, the suit asks the court to order a new panel of experts to oversee care for infected inmates.
Shelton, who oversees the prison system's management of hepatitis C, declined to provide complete data on the number of prisoners given medication for the infection. In response to a Statesman Journal request for full disclosure, Shelton said through an intermediary that he didn't have time to compile the information.
Responding to the inmate lawsuit in a court affidavit, Shelton defends the prison system's handling of hepatitis C. He describes the overall approach as 'medically reasonable, consistent, albeit conservative.'
Lynne Rennick, an assistant state attorney general representing the Corrections Department in the case, suggests in court papers that a conservative approach makes sense because most people infected with hepatitis C never develop serious health problems.
Rennick also notes that drug therapy often fails to clear the virus, and she points out that the medication can cause serious side effects.
The legal fight over treatment for inmates with hepatitis C may carry significant public-safety implications.
Hepatitis C disproportionately affects prisoners, prompting some experts to say that prisons and jails essentially act as 'incubators' for the disease.
The worry is that infected people who leave prison will pass the blood-borne virus to others.
The cost of treatment is also a hurdle.
In Oregon, corrections officials put the cost of treatment at anywhere from $18,000 to $30,000 per inmate for medications, lab work, liver biopsies and related expenses.
Medications alone cost from $11,000 for a six-month regimen to $22,000 for a full year of treatment.
Treatment clears the virus in just half of all cases, some experts say.
Dr. Bennet Cecil, medical director at the hepatitis C Treatment Centers in Louisville, Ky. He was hired by the inmates' lawyer to examine how the Oregon prison system provided care for the initial 11 plaintiffs.
His case-by-case review resulted in scathing criticism. 'The treatment of all of these patients is a serious and intentional violation of the standard of care which, at least for liver disease, has been well established for years,' Cecil asserted in an affidavit.
Shelton provided a far rosier assessment of care for the core group of initial plaintiffs.
'In my opinion, these plaintiffs demonstrate that testing is available, individual and individualized medical evaluation is done, work-up is determined by the individual medical findings, specialty consultation is available and utilized, and medication treatment is available and started as medically indicated.'
But it's a bleak situation for infected inmates and the general public, says Cecil, who augments his medical center duties by serving as an assistant clinical professor at the University of Louisville School of Medicine.
He raised concerns about serious public health risks arising from the DOC's lack of treatment for inmates with hepatitis C.
The prison system's protocols for managing the disease 'appear to be intentionally and deliberately designed to avoid treatment for most, if not all, inmates in the system,' Cecil wrote, 'thus creating a much greater risk of a medical crisis in the community when infected inmates are released untreated and ignorant of their disease and its dangers.'
Meljado suspects that he caught the virus while shooting drugs as a teenager. In 1969, he said, he shared a needle with an older brother, who contracted hepatitis C during military service in Vietnam.
The disease recently claimed his brother's life, Meljado said.
Meljado didn't find out that he was infected until 1991. A blood donation test revealed that he had the virus.
After Meljado was sent to prison in 1997 for a Washington County robbery conviction, he became a persistent, strong-willed advocate for his own treatment. Assisted by Beck, Meljado immersed himself in hepatitis C medical reports. He painstakingly documented every aspect of his care and condition.
'I created a detailed paper trail that would have been irrefutable in a court of law,' he said. 'I wrote them into a corner.'
After what he described as a three-year battle with prison officials, Meljado finally got the drug therapy he wanted. And it worked.
Looking back, Meljado said he still has hard feelings about his struggle to get treatment.
'In their final attempt, they told me that I was too far gone for treatment, that my liver was too damaged for treatment to be of any benefit,' he said, referring to prison doctors. 'Today, I sit here virus-free with a promising future ahead. I'm glad I put all my fears and frustrations aside and didn't listen to them.'
Meljado's chief ally said his tenacity paid off.
'Steve was lucky,' Beck said. 'He had cirrhosis, and they weren't doing anything for him. He could have been dead. Now he's got a new chance at life.'
Meljado completed his prison sentence March 27. The first Oregon inmate to receive hepatitis C treatment is back in the free world.
Meljado plans to remain a vocal advocate, working with Beck to educate inmates and the general public about hepatitis C.
'I've done bad all my life. Now I have a chance to rectify that,' he said. 'I'm going to give back some of what the state has given me. This is my calling.'
Beck expects him to make a big impact by sharing his story in videos and brochures that can be distributed across the country.
As Meljado tells it, people who don't care about inmate health problems stand to benefit from expanded treatment for prisoners with hepatitis C.
'We're coming out, and we're coming out infected,' Meljado said, bluntly summing up the threat to public health. 'People need to understand that we're going to be infecting their sons and daughters and families.
'You have to put a stop to it somewhere,' he said. 'Prison would be the place.'

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