Michigan's prisons incubator for Hep C

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By Lansing State Journal

Published: 09/30/2003

A deadly hepatitis C epidemic is raging largely unchecked inside Michigan's prisons, threatening the lives of inmates and the public as prisoners are released to spread it to their friends, families and strangers.

Between 12,000 and 18,000 of the state's 48,800 prisoners are believed to harbor the blood-borne liver infection, which by 2010 will cause more deaths in the United States than AIDS, according to the Centers for Disease Control and Prevention.
The state says medical care is too expensive and the drugs are ineffective.
So Michigan is treating just 55 inmates for what is considered the greatest infectious threat to public health in modern times.
Compared to the state's tracking of AIDs, prison record keeping is so incomplete Michigan doesn't know the extent of its hepatitis C problem in the prisons.
And the state's handling of the disease - designed to avoid the expense of treatment - has discouraged testing and prevented prisoners from knowing they are infected. As a result, some inmates unwittingly spread it to their families, sex partners and others when they leave prison.
Michigan's decision to ignore the prevalence and the consequences of hepatitis C contrasts with the approach in some other states and by the federal prison system, where officials actively promote testing, treatment and education.
'If this epidemic is not stemmed in prisons, it will become an epidemic on the outside, and the people will pay,' said Michael Steinberg, legal director of the Michigan chapter of the American Civil Liberties Union.
Michigan's reluctance to test, treat and track hepatitis C at its 42 prisons is a threat:
- To sick inmates, who can develop liver disease or cancer from the virus.
- To prison officers who may be exposed to the virus.
- To the public, at risk of contracting the virus from the hundreds of prisoners released each year.
- To taxpayers facing big medical bills when inmates get sicker and need more costly cancer treatment or liver transplants, which can cost $250,000 per patient.
- And to the state, exposed to lawsuits from inmates being denied treatment.
Corrections officials say they're overwhelmed by hepatitis C and can't afford to treat it amid the largest budget shortfall since World War II. They estimate it will take $130 million a year to treat infected inmates.
'There's no way we could treat every infected inmate with the resources available,' said Dr. George Pramstaller, chief medical officer of the Michigan Department of Corrections' Bureau of Health Care Services.
Prisoner advocates and health experts accuse the state of grossly overinflating the cost. They say many inmates wouldn't want the drugs, which are toxic and cause side effects while treating the virus. And only the sickest would need help.
Pennsylvania, which has the most aggressive treatment program, is treating 548 of 8,030 inmates.
The tab: $8.8 million.
'Every time a department doesn't want to do something, they throw out ... outrageous price tags,' said Michigan Rep. Mickey Mortimer, R-Horton. 'It's a scare tactic.'
Between 20 percent to 40 percent of the nation's two million prisoners are believed to harbor the virus. Experts say treating them will prevent an epidemic in the general public.
'That's going to protect me and everyone else,' said Ed Harrison, president of the National Commission on Correctional Health Care.
The nation's prisons are the greatest repository of the virus with an infection rate at least 10 times higher than the general public. Experts believe most inmates already have it when they get to prison.
Once in prison, inmates incubate the disease and accelerate its spread through sex and sharing toothbrushes, razors and other items. Up to 3 percent of infected inmates picked up the virus in prison, according to the CDC. And most prisoners eventually get out.
In 1996, 1.3 million of the more than 11.5 million prisoners released from jails and prisons nationwide had hepatitis C, according to the Denver-based National Commission on Correctional Health Care.
They leave their lockups to join children, husbands, wives, lovers, prostitutes and fellow drug addicts and share everything from nail clippers to needles. They also share their hepatitis C, which kills 8,000 to 10,000 people every year. It's expected to kill 30,000 a year by 2010.
HIV, by comparison, takes 15,000 lives each year.

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