Corky Maurer has less than a year to go on his assault sentence at the Stillwater Correctional Facility. But when he is released next September, he'll leave prison with more than he brought in: His latest blood test reveals that he has contracted hepatitis C.
Much like the AIDS virus, hepatitis C is commonly transmitted via sexual contact or contaminated needles. The virus can incubate for decades, gnawing on the liver unimpeded while the unwitting host goes about his or her business (and perhaps infects others). Though there's no cure for hepatitis C, treatment can slow its course, but the drugs are expensive. At present the federal Centers for Disease Control (CDC) estimate that 4 million Americans are infected with hepatitis C--four times as many as carry HIV.
According to the CDC, 60 percent of hep C infections are the result of shared needles, 20 percent take place through sexual contact, and the remainder come from blood transfusions or accidental needle sticks. Statistics indicate that the population at greatest risk for infection is the one least likely to receive treatment: The majority of people now identified as having hep C are poor, most are African American or Hispanic, and 60 percent have used intravenous drugs.
The same groups are also disproportionately likely to be incarcerated. At a national medical conference last year, Harold Margolis, chief of the hepatitis branch of the CDC, called hepatitis C "an epidemic within the correctional setting." Margolis and other public health officials contend that anywhere between 40 and 70 percent of the nation's 1 million inmates are infected with the virus.
Maurer, who turned 40 in September, says he entered Stillwater in December 1995 with a clean bill of health. According to DoC protocol, all new inmates are required to have a thorough physical (which includes blood tests for sexually transmitted diseases) and to attend an orientation class about communicable diseases. All of his tests were negative upon intake, says Maurer, and a test the following year came out clean as well.
This February Maurer once again submitted to the needle. But it wasn't until August, he says, that he was summoned to the infectious-disease nurse's office. Maurer had hepatitis C, the nurse told him; the virus "was running rampant" through the facility. (Dodge has since quit her position and City Pages' efforts to contact her were unsuccessful.) "She asked me if I'd gotten a tattoo while I was in or if I was an IV drug user," Maurer says. When he said he hadn't engaged in either behavior, "the best we could come up with is that I contracted it through my [prison] job." Maurer works as a machinist, and says that his hands are continually nicked and cut, thus clearing a pathway for the pathogen.
Aside from that initial conversation with Dodge, says Maurer, he hasn't received any medical attention or education about his condition. "It takes weeks to get to see the doctor, and when you do, they don't do anything for you," he maintains. Maurer speculates that since chances are he won't develop symptoms while in prison, "they're basically just blowing me off. They know that I'm out in less than a year, so the doctor's just been telling me to come back in another six months." (It can take up to 20 years for a person infected with hep C to experience symptoms, which can include bloating of the abdomen, internal bleeding, jaundice, and delirium. The disease is considered fatal, though many patients die of other causes before the liver dysfunction kills them.)
What's more, claims Maurer, neither the Department of Corrections (DOC) nor its health-care provider, Correctional Medical Services (CMS) seems very interested in preventing the spread of the disease in prison. "They aren't educating or warning the inmates," he maintains. "I can think of six or seven guys off the top of my head who have it, and I know there's guys working in the kitchen who have it."
State epidemiologist Michael Osterholm says he doesn't know how many inmates in Minnesota's prisons have hepatitis C (statewide, he estimates, between 40,000 and 50,000 people carry the virus). He says the DoC has been "far ahead of the curve" in preventing the spread of the disease. "A lot of testing and follow-up was being done," he explains, then pauses and adds, "at least before the company took over. I can't say what the situation is currently or what kind of treatment program is [now] in place. You'll have to ask the DoC or the company."
Neither CMS nor Carol Sheehan, director of DoC health services, returned City Pages' calls for this story. But CMS has drawn scrutiny in other states, most recently in a five-month investigation by the St. Louis Post-Dispatch. The company operates more than 340 sites in 30 states; according to the Post-Dispatch, there have been at least 20 inmate deaths under its management, many of which have resulted in costly lawsuits.
If Maurer has its way, CMS could soon face its first Minnesota lawsuit: He's planning to sue the company for denying him interferon, the drug most commonly used to treat hepatitis C. Maurer says he found out about the drug from TV and from other inmates, but when he asked his physicians about it, he was told that "Interferon is too costly and it doesn't work on many patients. The last one I asked about it said that I don't have [hep C] bad enough to warrant treatment."
According to the National Institutes of Health, interferon--a naturally occurring protein which boosts the body's immune response--restores regular liver function in about 50 percent of patients, and half of those see the virus levels in their blood drop to undetectable levels. Patients often experience flulike symptoms; some become depressed, and in a few the drug causes thyroid dysfunction and arthritis. "It's clearly not for everyone," says a local hepatologist who asked not to be named for fear of criticism from superiors in his health-maintenance organization. "But there are definitely people who should be treated [with interferon], and everyone should at least be informed about it." Doctors can't predict who will respond to the medication, he continues, so he frequently recommends that patients try the drug for between three and 12 months to see if it has any impact.
But that, says a veteran correctional medical staffer who also requested anonymity, is not CMS's policy. "Before CMS took over, inmates were getting interferon treatments," she maintains. And while she believes those patients are still getting the drug, she says newly diagnosed inmates "aren't getting anything. They are just told that they have hep C. That's it." Mary McComb, the media liaison for Stillwater, says that she "doesn't know that the approach has changed, and it's my understanding [CMS] will follow the recommended protocol by the CDC."
But that in itself doesn't mean much, says the hepatologist. "There isn't a straightforward set of guidelines," he explains, "and without some kind of hard algorithm to force people's hands [into providing treatment], its easy for doctors or HMOs to not do anything."
Not only is the company failing to treat infected inmates, says the Stillwater staffer, it's also falling behind on prevention. "I used to teach classes about infectious diseases to the inmates, but it's been months since I taught one," she says. The hallways leading to the infirmary used to be filled with educational pamphlets about communicable diseases and high-risk behaviors, she adds, but those ran out months ago and haven't been replenished. CMS is continuing the practice of offering blood tests to inmates, she says, but the tests are voluntary, and inmates wanting to be screened for hep C must specifically request it. "If you don't know what it is," the staffer wonders, "how in the world are you going to ask to be tested for it?"
Maurer says he has contacted an attorney to discuss the possibility of suing CMS and the DoC. Last February, a federal judge ruled that a similar lawsuit by an inmate in a Wisconsin state prison could proceed to trial. The inmate, Christopher Neal, was released in June, but plans to go ahead with the suit.
"[Nurse] Dodge told me that the sooner I got treatment the better," says Maurer. "I don't want this thing to screw up my job on the outside." Maurer recently completed his 18-month machinist training course and has started on the accompanying computer classes. He's worked his way up the prison pay scale from 25 cents to $1 an hour, and says that when he leaves Stillwater next fall he should be able to make between $16 and $18 an hour. He feels fine, he says, but is worried about what the future may hold for him and his girlfriend. "I still don't know too much about [hepatitis C] other than it's blood-borne. Does that mean I can pass it along through sex?" He can--though no one at Stillwater appears to have told him.
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