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Colorado Denies Hepatitis C Treatment as Too Expensive

While much attention has been paid lately to denying AIDS/HIV treatment as being too expensive for prisoners, little focus has been aimed at those restricting or denying treatment for prisoner's infected with the hepatitis C virus.

Hepatitis is spreading in institutions across this country at a rate far greater than John Q. Public is aware. Hepatitis C infections, also called non-A, non-B hepatitis, may not truely be on the rise but their detections are increasing. New tests, and more widely spread testing, is revealing an alarming amount of prisoners infected with this potentially deadly virus.

The standard treatment for hepatitis C infections is a two-phase treatment. In phase I, the patient is given shots of a protein-based derivative known as Interferon, three times per week for six months to a year. Interferon is also a naturally occurring substance in the body. Only about 15% of patients respond to Interferon treatment. Phase II, if needed, stacks the Interferon shots with Ribavirin, an antiviral drug. Approximately 45% of patients respond to this combination therapy.

While this treatment regimen seems straightforward enough, it becomes difficult when the patient is a prisoner. First, proper detection requires a blood test for elevated liver enzymes to initially identify potential infections. Once identified, a liver biopsy is required to verify an actual infection and to determine the extent of the liver's damage. Finally, the prisoner must actually receive the necessary treatment.

In Colorado, increased medical awareness has brought increased testing for hepatitis C; but, in most instances, it is still up to the prisoner to request the test unless elevated enzyme levels are noticed during initial screening upon intake. Once a blood test is considered positive for hepatitis C, the Colorado Department of Corrections (CDOC) slams on the brakes.

First, the prisoner is forced to sign a contract before any further action is taken. Second, the contract mandates that if the prisoner has not already attended "classes and activities (including AA and NA)" for at least a year, he or she will be required to do so for a full year before even the liver biopsy verification and damage assessment is performed. In the meantime, the hepatitis C infection is running unchecked in the prisoner's body. Finally, when and if treatment begins, if the prisoner skips meetings his or her treatments "will be stopped and not restarted." This statement is echoed throughout the contract. As if life isn't hard enough behind bars.

Untreated, the hepatitis C virus can lead to cirrhosis, liver failure, and liver cancer. It is the leading cause of liver transplantation. Hepatitis C often does not cause symptoms such as high liver enzymes, acute fatigue, aching joints, and eye disorders until years after infection.

It's all a questions of economics say most prisoners. While this is often stated by medical staff as the reason for withholding treatment, officials are reluctant to document this reasoning in the grievance process. This failure to document the CDOC's reasons for treatment failure seriously impedes further action and attempts for judicial relief. But the treatment contract plainly states that "treatment for hepatitis C is expensive" and then states in bold print that the "CDOC does not believe that treatment should be given to patients who are likely to become reinfected."

The CDOC automatically presumes, as stated in the treatment contract, that all infected prisoners were infected by the "sharing of needles and syringes among intravenous drug abusers, sharing of straws among nasal cocaine users, and from tattoos and body piercing using contaminated equipment." This ignores that fact that some individuals may be infected for may years before detection. This infection could have come from blood transfusions before improved blood donor testing (circa 1992), from working in the medical field, kidney dialysis, hemophiliacs, people who've had manicures with contaminated equipment, or from an incongruous lifestyle long since abandoned. One can easily see that even contracting hepatitis C through tattoos, body piercing, or a simple manicure will require a year of AA or NA treatments. Published reports state that "about 40% of people infected with hepatitis C do not appear to belong to any of the above risk groups."

Anyone needing more information on hepatitis C can find numerous sources readily available. A good starting point for those who have access to the internet (or access through someone else) log on to: or search for The Hepatitis Place or the American Liver Foundation on the web.

You can also call the Hep C Connection toll free at 1-800-522-HEPC.

Sources: CDOC treatment contract, The Hepatitis Place, the Hep C Connection, and the American Liver Foundation.

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