Joint Interim Committee on Health and Human Services, Nov. 29, 2000
by Phyllis Beck, Director, Hepatitis C Awareness Project
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Thank You Members of the Joint Interim Committee on Health and Human Services.
Introduction
My name is Phyllis Beck, Director of the Hepatitis C Awareness Project based out of Eugene, Oregon. We are a grassroots membership organization dedicated to Hepatitis C prevention, education and outreach support.
First of all I would like to thank this committee for your interest and persistence regarding Hepatitis C in our prisons.
Background
Nationwide, 4 million Americans suffer from HCV or roughly 2% of our population. Over 10,000 people die each year from HCV.
Last February I was here before you to address the ever-increasing problem of Hepatitis C in our prison population. At that time you also received a report from the Oregon Department of Corrections on Hepatitis C. It was at that time that you as a committee had the opportunity to hear first hand that we have a serious Hepatitis C epidemic in our State Prison system.
The DOC report informed you that at least 30% of their inmate population were infected with HCV based on an intake survey they did last fall. To put that into real numbers, that is close to 3,000 inmates!
It was at that time the DOC informed you that they were unprepared for what they found and that a "campaign" would be developed to begin addressing this serious issue.
Ten months later we are here to get a progress report.
My Own Experience
Since I was last before you I have had the opportunity to visit several of the state prisons as part of the Hepatitis C Awareness Project "Prison Outreach Program" and speak with many of the inmates regarding what was being done to address this issue. I also had a couple of meetings with Dr. Shelton as well.
My goal was to attempt to gain first hand knowledge on what was being done about HCV in prisons and identify what the main issues confronting our inmate population. I began by asking questions about HCV prevention education, counseling opportunities as well as testing and treatment options. I also asked to see copies of what material was being given to them on Hepatitis C. According to the inmates I spoke with, it still appeared that very little was being done to address HCV. In an attempt to gain a broader perspective on this issue, I conducted surveys and have received a number of letters from individual inmates that detail the problems the inmates are experiencing relative to HCV. These problems included barriers to medical attention, testing, treatment and lack of adequate follow-up care after a positive diagnosis is made. They also tell me there is lack of prevention education information. You each have copies of the letters and survey in your packets.
Is There a Doctor in the House?
But the real story here as told by these letters and in my survey is that many of these inmates are very sick. Some of these inmates have developed cirrhosis of the liver. Usually cirrhosis develops in about 20% of HCV cases. They are looking for help from the DOC, from me, from you and some have even told me that they have or will soon be initiating legal action against the state.
From a public health policy perspective, this is a serious issue. You have inmates who are released into the community on a daily basis. They have no clue they have HCV, or have any understanding how it is contracted. Therefore, they continue the cycle and spread it to someone else in the community. In essence our state prisons have become a state sponsored incubator for HCV by default. You also have inmates who are not serving life sentences, but who very well may die in prison from HCV.
From a DOC perspective I understand that they are a large agency with a number of important issues on their plate. I understand that it may take them awhile to get a program ramped up to address this issue. But I think it is important that you the legislature after one year at the very least understand what their game plan is to address this issue. What are the timelines? Is there going to be an agency budget request for dollars from the Governor? Have they or when are they going to hire the HCV/HIV coordinator they promised? Where are the educational materials we were supposed to be seeing? How many inmates have been tested? How many inmates are being treated? How many inmates have progressed to cirrhosis? How many liver biopsies have been given? What special precautions is the DOC taking to prevent the spread of HCV to inmates during incarceration? For example, inmates have reported that when barbers come into the prison to give shaves or haircuts that the only precaution they are using after each inmate is taking a toothbrush and dipping it into barbasol and then quickly brushing the hair out of the sheers on the clippers. They then move on to the next inmate. Inmates have also reported that many times when using the electric razor that there is still hair left in the razorheads from previous inmates. Personal care items such as these should not only be rinsed under water before using, but also washed manually with hot soapy water and then disinfected appropriately. The fourth letter in your packet will describe one inmateâs experiences with this problem. Why is so little being done after so much was promised last February?
I am not here to tell you that inmates need special treatment. I am not ignorant to the fact that these individuals have broken the law and have in essence made their own bed. They have all made some serious mistakes to end up where they are. Some of these mistakes not only ended in a prison sentence for these inmates, but for at least 30% who have HCV, these mistakes will have a life long impression that will haunt them long after they have served their time.
An Inmates Story
I know of one inmate that received treatment this year. His name is Steve. And he asked me to give you a copy of a letter he wrote that tells a story of a 2-year battle with the DOC to get treated for HCV. He tells of his frustrations, the barriers and hurdles he overcame to eventually get treated. He credits you the legislature for saving his life. Once the legislature became interested in this issue he got the treatment he needed. I am happy to say that after six months of treatment he cleared the virus. He never gave up!
Conclusion
But it should not be a fight! Let us not forget that these inmates are under the care of the state of Oregon. You the legislature are the ones ultimately held responsible for the care these inmates receive. They have some basic human rights that need to be met; adequate health care is one of them. There are many other Steveâs in our state prisons facing the same frustrations, but getting no where fast.
You in your wisdom asked DOC to identify the problem. They have and it is not a pretty picture. HCV the silent epidemic is upon us. It is alive and well in the Oregon prison system. Absent careful attention by you, it will continue to spread into our communities as inmates go home. Now let's get down to business and finish what you started by aggressively moving forward on HCV Prevention, Education, Testing and Treatment for our inmate population. We owe it to the citizens of Oregon. They have a right to know.
Thank You!
I would be happy to respond to any questions you might have.
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