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Tough Punishment



On his first day as a free man in two decades, convicted murderer Malcolm Price didn't rush to take a shower, grab a beer or reunite with family. Instead, he went straight to a local health clinic to seek treatment for the disease he'd been diagnosed with five years earlier.

At the clinic, his medical file in hand, Price told a nurse that in 2000 he'd tested positive in prison for Hepatitis C. Physicians at Augusta State Medical Prison had monitored his condition, he explained, through blood tests every three months. But they never treated him for the contagious and potentially fatal virus. Price says that despite repeated requests -- as well a prison doctor's suggestion -- he never received Hepatitis C care, which includes injections and pills at a cost upward of $16,000 per year.

Currently, an estimated 2,500 Georgia inmates have been diagnosed with Hepatitis C, an infection that causes inflammation of the liver and can lead to liver failure and cancer. And that number might be low, considering that many people with Hepatitis C don't show symptoms for years, or choose to forgo a voluntary blood test that detects the disease.

Department of Corrections spokeswoman Peggy Chapman failed to comment on the suspected number of Hepatitis C inmates who aren't receiving treatment.

Being denied treatment for such a disease -- particularly if a prisoner forcibly contracts it in prison -- could be construed as cruel and unusual punishment, according to Sarah Geraghty, an attorney with the Southern Center for Human Rights, a prisoner rights advocacy group. Under the Eighth Amendment, being denied inadequate medical care while in prison violates a person's civil rights and creates excessive punishment, Geraghty points out.

She says it's one thing for inmates to be incarcerated for their mistakes -- and something else entirely for them to helplessly suffer the complete ravaging of their health.

On the other hand, there's no way state prisons can afford to treat every Hepatitis C patient behind bars, says Madie Lamarre, a former Department of Corrections health care administrator.

In the face of a $30 million budget gap, which grew wider after the last legislative budget cuts, inmate health care services have been stripped to the bone, according to Rep. Alan Powell, D-Hartwell. And it's tough to convince lawmakers to place a higher priority on inmate care, Powell adds, when non-prisoners are struggling to obtain adequate health care.

Lamarre points out that, as a result, prison officials must prioritize who gets Hepatitis C treatment. And that can be problematic with a disease that rapidly takes a turn for the worse, causing many prisoners in dire need of treatment to slip through the cracks.

What's more, a typical inmate is at a higher risk of contracting Hepatitis C than the general population. Prison conditions -- in which violent fights, consensual sex without condoms, rape and shared tattoo needles are prevalent -- serve as fertile grounds for the spread of the blood-borne disease.

Price says he could have contracted the virus from sharing needles during IV drug use before entering prison, though he also believes he might have contracted the virus by coming into contact with blood while working, in prison, as a first responder to the facility's medical emergencies.

It's difficult to determine when the disease is contracted because symptoms of Hepatitis C don't immediately surface. Approximately 80 percent of Hepatitis C victims become chronically infected.

But regardless of when and how a prisoner gets the disease, Geraghty says, it shouldn't end with the denial of treatment in prison -- which can amount to a virtual death sentence.

In an e-mail to CL, Department of Corrections spokeswoman Chapman wrote that the department is delivering a "constitutional level of service" to each inmate in Georgia's prison system at a total cost of approximately $150 million per year.

Some take issue with Chapman's assessment. Last month, an 11th U.S. Circuit Court of Appeals judge moved forward in a lawsuit that alleges the state failed to treat a prisoner's worsening Hepatitis C condition. Winston Goforth, an inmate serving a 10-year drug sentence at Scott State Prison, filed a pauper's lawsuit in March 2002 in federal court in Macon after failing to receive treatment for the disease for more than a year. His complaint went nowhere until January, when the Southern Center for Human Rights took on his case.

"Mr. Goforth's main priority is to be treated for this disease," says Geraghty, one of Goforth's lawyers. "It shouldn't take almost four years of litigation to be treated for a contagious and potentially life-threatening infection."

Goforth tested positive for Hepatitis C in April 2001. Two years later, a liver biopsy revealed his disease had progressed to cirrhosis. The complaint alleges that officials denied Goforth treatment despite a doctor's repeated requests for care. According to Federal Bureau of Prisons guidelines, inmates with severe liver disease, including cirrhosis, should be "priority candidates for treatment."

On Nov. 7, Geraghty received word that prison officials authorized Hepatitis C treatment for Goforth. Despite the good news, the lawsuit will continue in an attempt to find out why Goforth's treatment was delayed for so long -- and how to prevent similar delays in the future.

In the midst of the Hepatitis C challenge, the recent resignation of the Department of Corrections' longtime director of health services signals that medical treatment in Georgia's prisons might get worse before it gets better.

"The medical division over at the [Department of Corrections] is virtually abandoned," Powell says. "The morale factor among DOC employees is very low, and people are leaving left and right."

Currently, there are more than 1,700 vacant DOC positions statewide.

Though changes to inmate health care come slow -- it took more than four years, as well as a lawsuit, for the DeKalb County Jail to remedy its substandard inmate health care system -- simple solutions could help, according to Powell and Lamarre. They claim that hiring more security officers, distributing condoms and providing sterile conditions for tattooing could prevent at least the spread of Hepatitis C.

Without more attention to the near epidemic, prisoners will continue to spread the disease -- not just among themselves, but to the general population.

"Ninety-nine percent of inmates see freedom," says Powell. "When they come out with Hepatitis C that's untreated, they're infecting a whole new crowd."

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