Prisons grapple with hepatitis policy

May 01, 2000|By BRENDAN KIRBY

State prison authorities in Maryland are trying to decide how best to treat inmates who become infected with hepatitis C, a strain of the virus that can cause severe liver damage years after exposure.

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Frankie Ruiz said her son has been diagnosed with the disease but has been unable to get help from the state.

Her son, Dallon Curtis Robertson, 39, is serving a 13-year sentence for carjacking at the Roxbury Correctional Institution south of Hagerstown.

Ruiz, 55, said Robertson believes he became infected with hepatitis C when another inmate gave him a tattoo in prison.

"I cried out," she said.

Ruiz said prison officials have denied her request to pay for a liver biopsy and drug treatment for her son.

"He is dying. I can see it," she said. "And they are denying."

Officials at the Maryland Department of Public Safety and Correctional Services declined to comment on Robertson's case, citing confidentiality concerns. But they said the state has not yet decided how to treat those infected with hepatitis C.


Anthony Swetz, director of inmate medical services, said there is no universally recognized standard of care for hepatitis C patients.

Hepatitis C is similar to hepatitis B, according to medical experts. Both can cause cirrhosis and other liver problems. Both are transmitted through contact with blood and other bodily fluids. And neither can be cured once active symptoms appear.

The main difference is that doctors have developed a vaccine for hepatitis B that can prevent harmful symptoms from developing. Swetz said any prisoner or employee who comes in contact with blood or is otherwise at risk from the virus automatically receives an inoculation.

There is no vaccine for hepatitis C, however.

"It's an insidious thing. It just chugs along," said John Stafford, medical director of the state prison system.

Swetz said experts believe that up to 20 percent of people who become infected with the disease will develop cancer, cirrhosis or other liver problems 20 to 25 years later.

"We don't know how to pick out those 20 percent," he said.

The Department of Public Safety and Correctional Services and the Department of Health and Mental Hygiene have agreed to form a committee to study the issue, Swetz said.

Some doctors treat patients infected with hepatitis C with interferon, a drug used to treat cancer victims.

In the treatment, patients take the drug for six to 18 months. Some doctors believe that may prevent liver complications from occurring decades later.

Nobody knows for sure how effective the treatment is, and the drugs cause flu-like symptoms throughout the course of the treatment. Swetz said the treatment also can cause suicidal tendencies in people with psychological problems.

"It's extremely controversial," he said. "The treatment is extremely toxic. A lot of folks will not be able to tolerate the interferon because of other conditions It really plays havoc with your emotional system."

Swetz said some patients probably would not be eligible for treatment. This group includes those who have a long history of drug use, people who suffer from other strains of hepatitis, and those who already have developed liver problems.

Swetz said three prisoners - all of whom have characteristics that would make them unlikely candidates for the treatment - have asked about it.

"The other part of this, quite frankly, is cost," he said.

Swetz said the treatment costs about $15,000. The state spends $53 million a year on medical care for its 23,000 prisoners.

Swetz posed the hypothetical case of an inmate with a heroin addiction who is due to be released in six months.

"Is it really fair to the taxpayers to spend $15,000 on this guy?" he said.

One doctor not associated with the prison system questioned the use of the interferon treatment for any patient.

Dan McDougal, a doctor at the Robinwood Internal Medicine group, said recent research indicates that the effect of interferon on hepatitis C patients is short-lived.

"It's not a good treatment anyway. I think interferon is a dead duck," said McDougal, who prescribed the treatment in the early and mid-1990s. "If you look at interferon on a cost-benefit ratio, you can't justify it."

McDougal said he now advises hepatitis C patients to make changes in lifestyle such as cutting out alcohol, Tylenol and other over-the-counter medications.

Experts believe as many as 200 million people worldwide are infected with the virus. Most of the victims do not realize they have been infected and likely never will.

That has some public health officials worried. McDougal predicted hepatitis C will be the AIDS of the next decade.

"It is a huge epidemic," McDougal said. "In another 10 to 15 years, you're talking about an epidemic that will rival HIV."

What's more, McDougal said doctors know little about how the disease is spread. The same types of high-risk activity associated with hepatitis B and AIDS - unprotected sex and drug use - increases the chances of exposure to hepatitis C.

But McDougal said he has treated hepatitis C patients who have abused drugs like cocaine that are not injected with a needle.

Stafford, the state prison medical director, predicted research under way will dramatically improve understanding of the disease.

But for now, those who develop liver damage as a result of the virus can be saved only with a liver transplant.

"Therein lies the dilemma. There's no way the transplant centers can meet that demand," Stafford said.

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