www.wrongfuldeathinstitute.com/links/sickontheinside.htm
I had come precisely to see it, to witness Hannahs disfigurement, the fruit of a long series of medical miscalculations. David stood now to show me the belly and the hernias, the condition his body had arrived at through an utter lack of attention. He pulled his flannel shirt to the side of his waist and lifted his gray T-shirt, and, in spite of myself, I winced. His belly was enormous, taut and pasty, seemingly glued to his gaunt frame. At the front of it, a hot-pink hernia, about the size of a grapefruit, seemed barely attached where the belly button should have been, giving Davids midsection the overall contour of a giant breast and nipple.
By its very nature, medicine is a private matter, and a prisoners medical records are protected by the same confidentiality laws that protect free citizens. This means that a prisoners medical chart is both locked inside a physical fortress and shielded by a battery of privacy restrictions, all of which leaves the field of prison medicine cloistered and nearly impossible to survey. Compounding this is the fact that prison medicine, and, indeed, the principles of medicine itself, are fundamentally at odds with all other facets of prison life. Even the term prison medicine borders on oxymoron: Whereas prison is designed to alienate and punish, medicine exists to nurture and soothe.
Perhaps even more significantly, private companies such as CMS feel no responsibility, and have no legal obligation, to account to the public for what goes on inside their facilities. So, while CMS receives about $550 million of taxpayer money each year, the company chooses not to provide any accounting of how that money is spent or even how much of it is spent-and how much unspent, to be pocketed as profit. And although lawsuits over the years have revealed discredited health-care professionals working in CMS facilities, the company refuses to reveal the names of its doctors and nurses for verification or to provide any account of how many have been disciplined or had their licenses revoked in other states.
F or those of you who have never been personally acquainted with the hepatitis virus, allow me to describe it briefly. In the spring of 1995, I downed the wrong glass of frozen margarita somewhere in the Chihuahua desert and unleashed the disease on my insides. Unaware, I took a bus back to Juarez a few days later, walked across the border, drove home to Albuquerque, and, when the travel itch returned a few weeks later, set out for Glacier National Park, where I intended to spend thirty days in the backcountry, mountaineering. By the time I arrived in Montana, however, the virus had begun to set in, and I found myself overwhelmed by fatigue. Deciding to get some rest before starting out, I found an empty cabin near the boundary of the park, crawled down to the basement, settled into a bed, and, with one last glance at my backpack by the door, passed out. When I woke up several days later, I was lying on my back in a medical facility 120 miles away with an IV in my arm and a sign on the door that said, Warning Take Enteric Precautions Before Entering. Asking around, I learned that I had been delivered to the medical center by a friend who worked in the park. My liver-enzyme levels, upon check-in, had been gauged at more than a hundred times the normal level. The first time I looked in the mirror, I saw that my jaundiced skin was roughly the same color and texture as a dried tangerine. I spent several days lying in place, flitting in and out of consciousness, playing host to an array of curious physicians assistants, nurses, and certified nursing assistants, some of whom ran tests on my urine and blood while the rest mostly stood around marveling at how odd I looked. For the next six months, I was forced to live at my parents house, where my daily priorities became eating healthy food, sleeping at least half of each day, and wishing that my perpetual headache would relent. This was the face of hepatitis A, the least virulent strain of the virus.
It keeps on attacking your liver for the rest of your natural life. That means people with acute hepatitis C can essentially forget about all the wonderful things that livers do, such as fighting infections, filtering toxins, and storing energy. To make matters worse, people with hepatitis C are contagious for the rest of their lives. Even twenty years after their initial infection, even if the virus is in remission and they feel pretty good, they still constitute a walking weapon and had better be careful where they bleed. It is worth noting, then, that somewhere between 20 and 40 percent of American prisoners are, at this very moment, infected with hepatitis C, and therefore quite contagious. It is also worth noting that most of them will eventually be released back into the general population, where the infection rate is, for now, only about 2 percent. The Association of State and Territorial Health Officials noted in a 2000 report that an estimated 14 million HCV-infected persons pass through the correctional system each year. And although the virus is most pervasive in prison because of the high incidence of injected drugs there, it can be transmitted just as easily on the outside through sex, blood, transfusion, or even a nasty fistfight.
The fact that most prison doctors have not seized this opportunity doesnt reflect any inherent challenge to their doing so. On the contrary, a couple of states have developed simple and effective hepatitis programs that test all prisoners upon intake, making the disease relatively easy to track and monitor. One of those states is Texas, and there, not surprisingly, prison health care is managed not by a private company like CMS but by two universities, the University of Texas and Texas Tech University. David Smith, who is the chancellor of Texas Tech and who led the battle to make hepatitis screening mandatory in Texas, assured me that the hepatitis program he created is not very special at all, or anyway that it shouldnt be. We have almost 30 percent of our prison population in Texas infected with hepatitis. Thats not so different from the numbers you see in the Dark Ages with the plague.
I met Larry at the Western Missouri Correctional Center in Cameron, about four hours west of St. He was a gaunt little man with a circular face surrounded by brownish-gray hair, and his thin mustache seemed to weigh on his lips when he spoke. He walked with a silent shuffle, and from the black bruises under his eyes you could see that he hadnt slept well in months, if not years. When I began reading through his medical record, it was easy to see why. Larry had first been diagnosed with hepatitis in the early 1990s, when a prison plasma center rejected him as a donor. The diagnosis had been confirmed by a prison infirmary in June 1994, but even so, between then and the end of 1997, he had managed to wrangle only a half dozen doctors visits. It wasnt until January 2000, a full five and a half years after his diagnosis, that CMS doctors began formally monitoring his condition. As Larry discovered, CMS doctors required him to meet a long checklist of conditions, known as a protocol pathway, before he could receive any treatment for his disease. One of the things he needed, if he wanted treatment, was a liver biopsy. But when Larry went to the prison infirmary to ask for one, he learned that he had to have a psychological evaluation first, then enroll in a drug-abuse awareness class and sign a slew of forms releasing CMS from liability for anything that might happen during the biopsy. So Larry did those things one by one, and he signed the papers, and he went to see the biopsy specialist, who promptly sent him back to his cell because he didnt know his virus genotype. Larry couldnt find anything in the protocol pathway that required him to know his genotype, but to be a good sport he put in a request at the infirmary for a genotype test. Larry argued that it was his decision to make, and that he wanted the treatment, or at least the biopsy that he was entitled to, and maybe afterward, when he had the biopsy results and could take an informed look at them,...
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