Hepatitis C is flooding California prisons, threatening to overwhelm the state’s inmate medical system.
The serious medical disease is increasing by 300 cases per year in prisons, “indicating an endemic,” says Dr. Tootell, San Quentin’s chief medical officer.
Hepatitis C rates are 60 percent among Reception Centers inmates and 40 percent among General Population inmates, according to a study by California Medical Facility (CMF).
Federal Receiver J. Clark Kelso’s plan to bring the state’s prison health care system into constitutional compliance includes a detailed protocol for Hep-C treatment. The plan was presented to federal Judge Thelton E. Henderson, who appointed Kelso.
The new protocol provides for a team approach, called Team Model Hep-C. When the disease is detected upon the arrival of a prisoner, a registered nurse and lab technician identify the infected person. The Hep-C Clinic coordinator assigns the inmate to a primary care physician or a Hep-C treating clinician. Advanced cases are referred to a hepatologist and radiologist for cancer evaluation. A transplant specialist will assess the liver condition for potential placement on a transplant list.
Kelso’s Hep-C protocol has not been implemented. No Hep-C coordinator exists in any of the 33 California prisons.
Treatment with Ribviran and Pegylated Interferon, the primary treatment, remains expensive with many side effects
“I can’t apply this treatment on a large-scale with a clear conscience. It would be unethical to do so. The harmful effect is way higher than the benefits,” says Dr. Tootell. She said that the severity of the side effect did not preclude staff physicians from prescribing the treatment to selective inmate patients.
California Health and Safety Code Section 103885 (Ken Maddy Cancer Registry) requires reporting of treatment for cancer patients. Liver cirrhosis can develop into liver cancer.
“If a patient doesn’t know he has developed liver cancer, there is no need to refer him to treatment management, and he will not be referred to treatment management until there is proof of cancer,” said Russell “Rusty” Trunzo, 52, a recently released prisoner. “I received treatment, but it was too late. I waited for years to get a liver biopsy, and when it finally happens, I found out I have stage-three cirrhosis.”
“Unlike HIV, Hep-C is a disease that doesn’t have the political and the public support to educate people and make them aware that Hep.C infection is much higher and rapidly spreading in the U.S,” says Dr. Tootell.
She said the four northern California centers equipped for liver transplants are: UC Davis, with over 850 in waiting list (currently closed for intake due to lack of funds), UCSF Medical Center, California Pacific Medical Center, with 450 on waiting list, and Stanford Medical Center, with nearly 440 on a waiting list.
“One donated liver can accommodate the need of two recipients,” says a infectious disease specialist.
The medical centers under contract with CDCR claim that their refusal of intake to inmates transplant cases is due to inconsistency of CDCR follow-ups.
“Stanford would not take inmate patients because they are not sure CDCR would dispense anti-rejection injections and prescribed medication accordingly,” says a treating physician at CDCR.
“There are many surgical procedures we can do to manage liver cirrhosis, but we just don’t perform liver transplant for prisoners,” says Dr. Scott Biggins, a hepatologist at UCSF Medical Center.
Tootell said it’s discriminatory for UCSF to prevent a life from being saved just because it belongs to a prisoner. She said the state has performed poorly in contracting with medical centers, which need CDCR money to bail them financially.
“Once these contracted centers and hospitals are out of financial problems, they no longer need the CDCR money and their service is selectively applied,” says Tootell.
Dr. Tootell said the delay in implementing Kelso’s Hep-C protocol is not due to a money shortage, but the problem with getting the right people in place to make it happen. She said the plan should be in place within six months.