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Massachusetts Prisoners Battle MRSA, Untreated Hepatitis C

Kerry M. Castello is infected with hepatitis C, a disease that is slowly destroying his liver. But because Massachusetts prison officials are short on funds, he cant get the treatment he desperately needs.

Castello, 41, was first diagnosed with hepatitis C by prison doctors in 2001. In 2003 doctors placed him on a waiting list for treatment after blood tests found abnormally high levels of a liver enzyme and a biopsy revealed, liver inflammation. He was still waiting in February 2006 when he filed his pro se lawsuit against the Massachusetts Department of Corrections (MDOC). He was later placed on a treatment list.   Castello is just one of thousands of Massachusetts prisoners whose lives are threatened by hepatitis C and another potentially fatal infection, Methicillin Resistant Staphylococus Aureus, or MRSA.

Currently 1,472 Massachusetts prisoners are known to be infected with the hepatitis C virus, though the actual number is probably much higher. Health officials believe about 30% of the state's 10,000 prisoners may be infected.
Yet only 150 prisoners are on the waiting list to receive treatment, and even fewer are getting it. As of December 27, 2005, only 62 prisoners were receiving the recommended combination of interferon injections and ribavarin capsules.  The reason is cost. The price tag for the standard 48 weeks of treatment with the two drugs is $18,000 to $25,000. In 2005 about $1 million was budgeted for hepatitis C treatment. But it's not enough. By the state's own admission, the number of prisoners who get treated is determined by how much money is available.

While there are many patients with hepatitis C currently awaiting treatment ... due, to the Massachusetts Department of Corrections finite resources, combination therapy is offered first to inmates with the greatest medical need, a state brief said.  Michelle R. Burrows, a Portland attorney who represented Oregon prisoners with hepatitis C said the Supreme Court has held that cost cannot be considered when deciding who gets treatment. Prisoners are vulnerable and they do not have any choices, Burrows said. The standard has to be: What would a person get in the community? What if you went to your doctor and he says, You need treatment but Im putting you on a waiting list?

Because hepatitis C is spread primarily through the blood, prisoners--many of whom have histories of IV drug use--are five times more likely to be infected than the general population. Years of living in close quarters with infected individuals may also increase the risk, as does receiving tattoos with unsterile equipment.  Hepatitis C is known as the silent epidemic because it progresses over 10 to 30 years, often with no initial symptoms. But, if left untreated, the disease can lead to cirrhosis, liver failure, liver cancer, and death. Males, people infected with HIV, and heavy drinkers are at an increased risk for serious complications.

The combination therapy is effective in about half the patients who complete the treatment regimen. But many discontinue treatment due to side effects, which can include depression, suicide, headaches, irritability, and sleeplessness. A newer version of the interferon, known as pegylated interferon, may reduce side effects and increase effectiveness.  Prisoners are also at risk in the states county jails, which hold about 14,000 prisoners. These prisoners are rarely tested and even fewer receive treatment. The Norfolk County House of Corrections, for instance, tests prisoners only if they show symptoms of possible infection or come to jail already taking medication for the disease, said David Falcone, a spokesman for the Norfolk sheriffs department.

At the Hamden County Correctional Center, where jail officials reportedly encourage testing for those who show elevated levels of a particular liver enzyme, about 200 of the jails 2,000 prisoners have been diagnosed with hepatitis C, said the jail's medical director, Dr. Thomas Lincoln. But like other jails, Hamden County treats only a tiny fraction of those with the disease--just 2 were receiving treatment in December 2005. The jail does, however, have doctors and nurses from community health centers spend time at the jail, said Lincoln. When the prisoners are released, theyre referred to the center for follow-up care, he said.

Like other penal facilities across the nation, Massachusetts prisons are facing another epidemic--Methicillin Resistant Staphylococus Aureus, a particularly virulent strain of staph bacteria [See PLN, September 2005]. As the name implies, MRSA is resistant to most antibiotics, including penicillin and methicillin. It can lead to pneumonia and various infections. It is sometimes fatal. MRSA can even lead to a painful and potentially deadly form of flesh-eating bacteria, according to Dr. Alfred DeMaria, director of communicable disease control at the state Department of Public Health.

Prisons and jails are particularly susceptible to MSRA outbreaks because the bacteria is transmitted through skin contact, contaminated items, poor hygiene, and institutional living conditions. In 2005 the MDOC dealt with a serious outbreak of MRSA. From January 1, 2005, to December 1, 2005, prison health officials treated 68 prisoners infected with the bacteria.

MRSA can generally be treated using a variety of antibiotics, said DeMaria. But he stressed the importance of using antibiotics appropriately. Whenever an infection is treated with an antibiotic, he explained, there is a risk the bacteria will mutate and become resistant to the antibiotic. Its pure Darwinian natural selection, he said. All 68 prisoners were treated for the infection.

The prisoners infected with hepatitis C havent been so lucky. In his lawsuit, filed on February 7, 2005, Castello claimed the MDOC's failure to treat his infection constitutes cruel and unusual punishment. Castello says he suffers from joint pain and fatigue and is facing permanent liver damage. The court dismissed the lawsuit on February 1, 2006, finding the DOC employees had not shown deliberate indifference to Castellos medical needs. Castello has appealed.


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