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Going Viral

New Mexico has one of the worst Hepatitis C problems in the nation—for now

April 27, 2011, 12:05 am

These injectable antiviral drugs, known as peginterferon, may eventually be totally replaced by a pill form of hepatitis C treatment.
Credits: Wren Abbot

While patients outside of prison sometimes need to be coaxed into treatment, inside the Penitentiary of New Mexico, they’re often desperate to get on it, according to Jenny Martinez, a current PNM nurse who, concerned she could lose her job, spoke to SFR on condition her real name not be used.

“They always ask the nurses about hepatitis treatment, if they’re going to get treated, if they’re going to get [lab testing], and they just have to wait in line until they get an appointment. And then, when they do get an appointment, [treatment] is not done anyway,” Martinez says. “[Correctional Medical Services, the private health care provider contracted with the Department of Corrections to provide inmates’ medical care is] really, really, really slow on the process of getting inmates started on the treatment, and I don’t know what the reason is.” 

Nationwide, approximately 26 percent of HCV-infected inmates were being treated with antiviral drugs at the time of a 2000 US Department of Justice study. According to state Department of Corrections Health Services Director Stephen Vaughn, 22 inmates in the New Mexico corrections system are currently receiving treatment. Since a conservative estimate of the total number of inmates carrying the disease is 2,520, that means that the state corrections department with the highest reported rate of HCV infection nationwide also has one of the lowest treatment rates, at less than 1 percent.

Martinez claims only one patient in the whole PNM is being treated with antiviral drugs, though she believes the facility is supposed to treat between nine and 12 at any one time. She says she sees many HCV-positive inmates who have high levels of the liver enzymes that correlate strongly with cirrhosis and liver cancer, yet aren’t being treated. 

Patricia Clark, a source who worked closely with the HCV program in the state prison system until 2008 and spoke on condition that her real name not be used, says CMS obstructed Project ECHO’s efforts to treat HCV. The state not only fully funds HCV treatment, but pays the salary of an infectious disease nurse at each facility who is charged with treating inmates’ HCV. 

Clark says that, at the facility where she worked, the infectious disease nurse instead tended to other duties on the state’s dime. Meanwhile, Clark saw files on hundreds of patients who needed treatment for HCV, some with evidence of “very advanced fibrosis” from liver biopsies done before they entered the prison system. Over a two-year period, Clark saw only six inmates start treatment.

“I was told on probably six different occasions, ‘CMS is not interested in treating hepatitis C patients. It is not a priority. You need to back off,’” Clark says. 

In an email, CMS spokesman Ken Fields attributes low prisoner-treatment rates to the prisoners’ own reluctance about treatment, and denies that CMS screens inmates before presenting them to Project ECHO.

“If a patient requests medication therapy, that request is evaluated through a multi-disciplinary process established by the University of New Mexico…The Treatment Review Committee takes into consideration each patient’s overall health status, the likelihood that [the] patient will benefit from medication therapy and other issues that may affect the patient’s future health status,” Fields writes.

Neither Thornton nor Arora acknowledged any problems with CMS when they spoke to SFR, emphasizing that they are grateful to be treating patient prisoners and to have access to the prisons for the Peer Education Program. Thornton says they don’t see barriers to patient treatment on their end.

“We don’t want to put our relationship with the corrections department in jeopardy because, if we did, it just wouldn’t work out,” Thornton says. “They trust us and we have this relationship, and we’re treating people and we’re educating people, which is what we really want to do.”

Maria Romero, a former PNM and Central New Mexico Correctional Facility nurse who recently resigned but also requested SFR withhold her real name, says inmates had to have a certain viral load to even be considered for treatment by the DOC, even though Thornton tells SFR that there is no minimum viral load required for participation in Project ECHO—in fact, lower viral loads make a cure more likely.

“There was one guy—he was pretty close to end-stage [liver disease],” Romero says. “He wasn’t on interferon or anything because they said it was already too late for him—I doubt it, though. One other guy, he just lived to the end on medication to control his ammonia levels. He ended up dying in the clinic there at Los Lunas.”

Jacob Miller, an ex-con who spoke on condition of anonymity because he’s still on parole, says he tried to get on HCV treatment at PNM without success.

“They really discourage it,” Miller says. “I had hepatitis C when I went into prison, and I tried to get on the treatment and they kept putting me off and putting me off…My experience and some people that I talked to, was that the medical people would put them off, being like, ‘Your [virus antibody] levels aren’t that high; it looks like you’re doing fine right now.’”

Jeffrey Holland, 42, an ex-con turned social worker and entrepreneur who now directs a sober living center in Albuquerque, did time at CNMCF and Southern New Mexico Correctional Facility in Las Cruces. Holland had HCV when he was in prison, but didn’t undergo treatment until after he was released. He tells SFR that, based on his experience of the prison health care system in general, he knew better than to expect treatment for HCV.

“Unless you’re at death’s doorstep, you’re not going to get that treatment,” Holland says. “There’s people in there dealing with cirrhosis and there’s people in there who are yellow, have yellow eyes, and jaundice and all that stuff. Do I know for a fact that they’re being purposely neglected? I can’t say that, but let’s put it this way: If you see someone like that and you’re a staff member, whether they’re asking for treatment or not, wouldn’t you say, ‘Hey, you need to go to the infirmary and get this checked out’?”

Although Project ECHO PEP Coordinator Miranda Haynes acknowledges to SFR that some DOC prisons have “long, extensive waiting lists” to get on HCV treatment, DOC spokesman Shannon McReynolds contends that there are no waiting lists, and that DOC’s low percentage of patient treatment doesn’t prove that the department is violating patients’ rights to be free of “cruel and unusual punishment” by being denied medical care.

“The standard for measuring the Department’s performance is not some statistical average but the Constitution and it is the Department’s position that the NMCD is in full compliance with the Eighth Amendment,” McReynolds writes SFR in an email.

McReynolds adds that, if only one PNM inmate is receiving antiviral medication, that does not mean the other inmates are being denied “treatment,” which, according to McReynolds, is broadly defined to include “testing.” 

“Treatment also includes monitoring. So if an inmate were not receiving medication but was receiving regular testing, that would fall within the parameters of treatment,” McReynolds writes.

Holland says he appreciates the public’s negative perception of inmates and reluctance to provide them good medical care, but points out that, in the case of an infectious disease like HCV, prisoners’ medical care also has an effect on the general public. 

“You have a child molester in prison; most people are going to say, ‘Yeah, so what? Let him die.’ And to an extent, I can sympathize,” Holland says. “But it’s a cyclical thing where it’s infecting people on the outside, it’s infecting people on the inside. When [prisoners] get out, they’re overloading the treatment out here and, when they go in, there’s not enough treatment in there.”

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