The hepatitis C virus (HCV) has surpassed AIDS as the next stealth epidemic, and no demographic has been hit harder by HCV than California prisoners, who have a previously unimaginable infection rate of 40 percent. A disease of slow progression, chronic HCV is projected to affect 85 percent of inmates who remain incarcerated over a period of 10 to 40 years.
These conditions are fueling an institutional health crisis of monumental proportions, because correctional healthcare administrators are unable to provide even basic medical treatment, falling well below the bare minimum constitutional requisites.
One of the inmates the California Department of Corrections and Rehabilitation (CDCR) is failing to treat is Larry Gilmore, now serving a life sentence at the Susanville California Correctional Center for armed robbery. Gilmore, 60, contracted hepatitis C many years ago. Since being diagnosed with this fatal ailment, he has had no choice but to stave off the inevitable through diet and exercise.
"Right now, I am being refused treatment," Gilmore says. "It is the CDCR's policy not to treat a patient until his liver has sustained considerable damage from the virus. Instead of early treatment, when a patient is healthy and able to tolerate the interferon and ribavirin, they insist on waiting until the liver is malfunctioning."
Due to his age and the fact that his viral load counts are within an acceptable range, Gilmore is barred from treatment under prison guidelines. Hepatitis C protocols implemented by the CDCR in 2005 automatically exclude anyone over 60 from receiving the combination drug therapy that begins at $10,000 a year. Gilmore feels that prison officials implemented these exclusions as a short-sighted, cost-cutting measure--without considering the consequences.
"I believe that a person should be treated upon request. We are not talking about heroic measures here," he says. "We are talking about an easily available drug-treatment therapy."
According to San Francisco District Court Judge Thelton Henderson, hepatitis C is concentrated in a system responsible for roughly 60 preventable deaths a year. In the landmark 1995 case Madrid v. Gomez, Henderson found that the inadequacies of the prison healthcare system violated the Eighth Amendment rights of inmates. After officials in charge of the CDCR failed to enact a myriad of medical reforms, the judge found "incompetence and indifference" were so "deeply entrenched" in California's prison system that he appointed a correctional medical receiver answerable only to him. Together they will try and bring the CDCR out of the penological Dark Ages.
When Steve Silvera from Vallejo came to the California Correctional Center with a five-year sentence for drug possession in late 2003, he knew little about hepatitis C. Silvera, 41, couldn't believe that nearly every other inmate has the virus.
"I had no idea so many had [HCV]. I thought it was a rare occurrence," says Silvera, who has lived in the North Bay since the early '90s. "On the streets, I never knew anyone to have it."
Silvera's epiphany didn't have anything to do with a hepatitis awareness campaign; instead, the death of Robert "Freddy" Hagenson brought it to his attention. Hagenson had chronic HCV that led to his death last December at age 54, when his liver failed due to advanced cirrhosis. Many at the California Correctional Center witnessed Hagenson's excruciating demise.
"It scares me that this disease can destroy a human being like it did to Freddy," says Silvera. "But by the same token, preventative measures can be taken. One foolish decision in prison, like injecting drugs or using a dirty tattoo needle, can end up a death sentence. Luckily, I've done neither."
Hepatitis C is a blood-borne pathogen and can spread quickly in a community of intravenous drug users. High-risk behavior like tattooing and unprotected sex can lead to transmission. But the fact that 80 percent of prisoners have histories of substance abuse--and continue to share tainted needles while incarcerated--explains why HCV is transmitted so efficiently in correctional facilities. By concentrating so many drug addicts together without substance-abuse management or education about the dangers of contagious diseases, the death of inmates like Hagenson will grow in frequency as the natural progression of the liver disorder takes its toll on the afflicted.
"It was a shock to see [Hagenson] deteriorate that fast. That was the first time I ever seen someone die in prison, and I didn't like it," Silvera says. "I feel like I am serving two sentences: one the judge gave me; and the other, the death sentence the CDCR might or might not have given me by surrounding me with so many with the disease."
Silvera, whose drug of choice was methamphetamine, is dismayed by the casual attitude toward the affliction, even though nearly "everyone here has [HCV]." With a release date set for this month and plans to go back to work with the roofers' union, Silvera is just trying to make it through some very deadly territory.
"[I'm close] to the finish line, but it only takes one microscopic virus to beat me there; it's like I'm running for my life. Freddy's death made me feel like I'm walking through a minefield, and I only have [a short amount of time] to make it to the other side safely," Silvera says.
Hepatitis C is considered an incurable disease. However, if the combination of interferon and ribavirin are administered before severe cirrhosis develops and damages the liver beyond repair, 50 percent to 60 percent of patients respond favorably and clear the virus. Yet since the CDCR's medical system is plagued, as Judge Henderson says, by "incompetence and indifference," Gilmore suspects negligence is at the root of Hagenson's death.
"It really shook me up because Freddy had been pressing for medical treatment for a year or more before he died. Freddy told me that all he got was the runaround--lost blood tests, first they treat him and then they wouldn't. While all this was going on, his liver worsened to the point of total failure. I can't help but wonder if I will meet the same end in here," Gilmore says.
With no other recourse, Gilmore is challenging his exclusion from combination therapy by filing an administrative appeal, a likely precursor to a lawsuit. Gilmore hopes to force the CDCR to abandon protocols that deny him treatment based solely on age. In the statistical likelihood his condition develops into chronic HCV, he would simply be allowed to die.
Judge Henderson recently appointed Robert Sillen as the court's receiver. For inmates like Gilmore, Sillen's success is a matter of life and death. The judge gave Sillen, a respected healthcare manager, six months to implement life-saving measures. Already considered a national disgrace, the beleaguered agency has fallen into an unprecedented downward spiral since the resignation of corrections secretary Rod Hickman this March.
Some CDCR critics suggest that the governor should appoint an outsider with the political clout and wherewithal to transcend decades of bureaucratic ineptitude. Others want the judge to place the entire agency under federal control. Gilmore just wants the CDCR to provide treatment for those afflicted with this deadly disease.
"If the politicians and voters think it is such a great idea to build this huge, overbloated prison system and pass out life sentences like candy, then they should be willing to pay the price of decent healthcare," Gilmore says. "HCV care is an example of short-term thinking. There will come a day when there will be an aging prison population, half of which will be HCV-infected. Treatment now is far cheaper than down the road, when thousands will require more expensive measures in the end stages of liver disease."
Serving a life sentence for a nonviolent drug conviction under the 'three strikes' law, writer Eugene Dey is an inmate at the California Correctional Center in Susanville.