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The Other Prison Health Crisis

Hepatitis C is common behind bars, but sick prisoners aren’t getting treatment.
(Photo: Michael Coghlan/Flickr)

(Photo: Michael Coghlan/Flickr)

New York City’s Rikers Island has made national headlines a lot lately, and none of them good. But city officials took steps toward progress in one important area—health care—when Mayor Bill DeBlasio announced that the city would not renew its contract with Corizon when it expires this year. An investigation by the city had found that employees of the for-profit health care provider had often neglected sick inmates, directly leading to at least two deaths.

Rikers isn’t alone in having to face difficult truths about the health and safety of the people detained under its roof. Earlier this month, the American Civil Liberties Union and the Public Justice Center filed a suit against the Baltimore City Detention Center for inadequate health care of its short-term inmates—negligence that lawyers say is to blame for seven deaths there. The suit alleges that inmates lack basic health necessities, from diabetes medication to working plumbing. Separately, a woman formerly incarcerated at a Connecticut prison also wrote in the Guardian recently about the lack of sanitary products there, and how creative she and her fellow inmates had to get while doing without them.

All of these failings could come down to the question of funding, or of the profit motive that leads health care providers to pinch pennies. But there’s another health crisis in American prisons that could be a bit more political—when a prison suffers an outbreak of a type of disease that only spreads when inmates are doing things that prison administrators don’t want to admit happen there.

"By not assuming the financial cost of treatment, defendants are imposing a human cost on the prisoners as well as on the population which will be at risk when these prisoners will be released."

Hepatitis C is a persistent problem in prisons. The virus is spread most frequently through shared drug syringes and unsafe tattooing methods. If left untreated, it can lead to liver failure and death. Recent figures suggest that about two percent of the American population suffers from hepatitis C, but the Centers for Disease Control and Prevention estimates that one in three incarcerated people have it. (Figures are fuzzy, however, which is part of the problem.)

Last week, prisoner advocacy groups filed a class-action lawsuit in federal court in Boston, accusing the Massachusetts Department of Correction of denying medical treatment to inmates infected with hepatitis C. Despite the fact that it's contagious, potentially deadly, and has recently become easily treatable, the suit alleges, only three of the approximately 1,500 state prisoners infected with the disease are currently being treated for it.

The rest of the sick prisoners have been told again and again that their cases are “under review,” the lawyers argue, and the inmates’ livers get more and more damaged because of the “foot-dragging” of the prison officials and doctors. The complaint cites the Eighth Amendment, which protects Americans from cruel and unusual punishment.

“By not assuming the financial cost of hepatitis C treatment, defendants are imposing a human cost on the prisoners in their care as well as on the population which will be at risk when these prisoners will be released,” wrote attorneys for the National Lawyers Guild and Prisoners’ Legal Services in their complaint.

Hepatitis C is spread even more efficiently than HIV, and it now has a higher death rate than AIDS in the United States. Inmates’ own accounts to researchers in Australia show that a lack of access to clean syringes, plus widespread addiction, means that “equipment becomes commodified and circulates for long periods ... [and] it appears impossible not to share injecting equipment and, hence, produce elevated risks of HCV transmission.” They are aware of the risks, but they say that they trust the people they share their needles with to tell them if they have the disease.

The problem with this trust, of course, is that it is often misplaced; many people do not know that they are infected. That’s why, after studying Philadelphia’s prisons for the Journal of Urban Health, a group of epidemiologists concluded that universal screening of new inmates was the most important improvement prison health systems could make toward controlling hepatitis C. Others suggest continuing to monitor and treat hepatitis sufferers even after they are released from prison.

There are some more progressive ideas out there as well. Australian researchers have suggested that prisons bring in licensed tattoo artists to stop inmates from inking themselves. And as for the illicit injection drug use, needle exchanges and supervised injection clinics have been shown to reduce infection in places like Vancouver and Indiana recently; could prisons be next?

In the meantime, prisoners’ advocates are cheering a new hepatitis C drug that just got Food and Drug Administration approval last year. It has a hefty price tag—about $1,000 per pill—but supporters told the New York Times back in 2014 that it would save patients and providers money in the long term by treating the disease quickly.

Likewise, as the class action complaint in Massachusetts points out, the short-term impact of sick inmates inside jails and prisons should be considered in the context of their wider impact on entire communities. Just as new research has shown how methadone treatment behind bars can prevent overdoses when addicts get out of jail, hepatitis medicine in prisons can prevent the disease from spreading when those inmates return home.

Or, as a Canadian analysis of prison needle exchange initiatives put it, even more succinctly, “prisoner health is public health.”

True Crime is Lauren Kirchner's weekly column about crime and criminal justice issues.