A HEALTH DANGER FROM A NEEDLE BECOMES A SCOURGE BEHIND BARS

Prison officials say that nearly 10,000 inmates in New York and
thousands more across the country are infected with hepatitis C, an
insidious liver infection that is difficult to treat, has no definite
cure and, over many years, kills 5 percent of those who contract it.

Prison and public health officials are wrestling with how to respond to
the surprisingly high rates of infection, trying to figure out how to
contain its spread, and how and when to provide expensive treatment that
in most cases does not work. Some states are treating hundreds of
prisoners infected with hepatitis C, while others are treating none.

And beyond concerns about how to manage the problem inside the prisons
- -- guards, for instance, fear being infected through contact with
inmates' blood -- health officials worry that prisoners may spread
hepatitis C through intravenous drug use when they are released.

A study to be submitted to Congress this fall estimates that 18 percent
of state prisoners nationwide -- or about 360,000 inmates -- are
infected with the virus.

"There are still legitimate scientific questions about who the treatment
will ultimately benefit," said Dr. Robert Greifinger, a senior fellow
for the Centers for Disease Control and Prevention in Atlanta, who
conducted the study for the Justice Department. "On the other hand, the
infection rates are very, very high. I just don't think it's very clear
yet how to manage the problem."

Dr. Greifinger based his study on projections from several state
studies. Many states are just starting to survey inmates for the
infection.

In New York, a first-ever survey recently estimated that 14 percent of
the state's 69,000 prisoners have hepatitis C. In Pennsylvania, about 17
percent of the state's 36,500 prisoners are infected. In Connecticut,
the rate is believed to be 15 percent of 17,500 inmates. New Jersey has
not broadly tested for the virus.

The Northeast is hardly alone in grappling with the problem. In
California, officials estimate that 33 percent of the state's 161,000
prisoners have hepatitis C. In Texas, 28 percent of the state's 157,000
prisoners are believed to be infected.

"It's simmering and brewing and if it boils over, the medical costs will
be catastrophic," said Dr. Frederick R. Maue, chief of clinical services
for Pennsylvania's Department of Corrections, which is actively treating
infected inmates. "There will be liver transplants, multiple
hospitalizations to treat liver failures, and increased numbers of
deaths."

Doctors say the problem is not that large numbers of prisoners are
contracting hepatitis C while incarcerated; most were infected through
intravenous drug use and shared needles years ago. It is that the
infection's breadth and power are only now becoming clear.

New screening tests developed in the early 1990's have found that far
more people are infected than was ever expected, although many people
who contract it suffer few ill effects. But some people who were
infected as long ago as the 1960's are dying today, underscoring the
fact that the disease can prove fatal over the course of 20 to 30 years.

Hepatitis C causes liver disease in 20 percent of its victims, and
eventually kills 5 percent of those infected. Doctors describe the
infection as more of a potential medical time bomb than an immediate
public health threat. Roughly 2.7 million people in the United States
have the infection, which is responsible for 8,000 deaths a year.

Hepatitis C is a blood-borne virus that can linger for years without
symptoms. Aside from intravenous drugs users, hundreds of thousands of
other people are thought to have contracted the virus from blood
transfusions before better screening began in the early 1990's.

Vaccines exist for two other hepatitis viruses. Hepatitis A, which can
be transmitted by food, food handlers and water, rarely kills those it
infects. Hepatitis B is a sexually transmitted disease that kills 5,000
people a year.

The infection rate among the general population for hepatitis C is far
lower -- 1.8 percent -- than in prisons. Doctors believe that the
infections are concentrated among inmates because of their high rate of
intravenous drug use before being jailed.

The infection may also be gradually spreading in prisons. Studies show
that 3 percent to 21 percent of inmates say they engage in intravenous
drug use behind bars. Forty-four percent of those who reported drug use
said they shared needles.

The infection's death toll is rising and is expected to grow steadily
over the next 10 to 20 years. In New York prisons last year, where $71
million was spent to treat roughly 1,400 inmates with AIDS, eight
inmates died of that disease. Nine died of illnesses related to
hepatitis C.

The question of how best to treat the infection has provoked debate in
medical circles. Expensive new drug treatments, costing $10,000 to
$25,000 per patient annually, show signs of curbing the infection, but
are effective in only 15 percent to 45 percent of cases, and sometimes
make patients sicker. States are responding differently to the problem.
In New Jersey, for instance, no prisoners are currently being treated,
but in Pennsylvania, 417 prisoners are. New York is treating 95
prisoners at a cost of about $6 million a year.

Inmates in various states, including at least five in New York, are
suing prison systems and claiming that they are being denied treatment.
Last year, a federal judge in Kentucky ordered prison officials to treat
an inmate at a cost of $25,000 a year. Kentucky prison officials had not
provided treatment, saying it was unlikely to be effective.

The case of Edward McKenna, 55, a New York prisoner dying of the
infection, shows the charged debate surrounding hepatitis C. Mr.
McKenna, an inmate at the Woodbourne Correctional Facility in
Woodbourne, N.Y., is suing the state, accusing prison doctors of denying
him treatment that could save his life.

"In a roundabout way, they're telling me I'm going to die and that's the
way it is," said Mr. McKenna, who expects to live only two more years at
best. "They won't treat me."

In 1990, Mr. McKenna shot his younger brother during a backyard argument
in Bay Ridge, Brooklyn. The murder, which he called an accident, led to
a prison sentence of 10 to 20 years.

In July 1999, Mr. McKenna was diagnosed with hepatitis C, something he
believes he contracted while injecting drugs when he was an Army private
stationed in Thailand in the early 1960's.

Mr. McKenna said he asked for treatment in September 1999, but a prison
doctor told him he was not eligible because he had an appearance coming
up before the Parole Board within a year. New York, like other states,
follows guidelines from the National Institutes of Health that say only
people who will be available for a full year of intensive care should be
treated. Otherwise, the treatment is ineffective.

But when Mr. McKenna appeared before the Parole Board a year later, he,
like 80 percent of violent offenders in the state, was denied parole and
given two more years in prison.

Jack Beck, a lawyer for the Legal Aid Society who is advising Mr.
McKenna, said that prison doctors used Parole Board appearances as a
pretext for denying them the costly treatment. In a medical document
provided by prison officials, a doctor wrote that Mr. McKenna did not
qualify for treatment because his earliest anticipated release date was
his Parole Board appearance.

But Mr. Beck said the expiration of an inmate's sentence should be used
when deciding on treatment because the chances of a violent offender
being paroled were slim.

"It's definitely a rationing protocol," he said, referring to New York's
rules for deciding whom to treat. "It's very expensive and they clearly
don't want to treat people."

Dr. Lester N. Wright, chief medical officer for the New York Department
of Correctional Services, said the state's procedures met national
standards, and that prison doctors did not use inmates' Parole Board
appearances to deny treatment. "I usually look at the conditional
release date," he said, referring to the expiration of a prisoner's
sentence. "We don't know what the Parole Board will do."

Prison officials produced a document on Thursday from Mr. McKenna's
medical record that quoted him as telling a doctor he did not want
treatment for hepatitis C. Mr. McKenna, they added, also had to be
counseled to take medication for severe emphysema, and was a poor
candidate for hepatitis C treatment.

Mr. McKenna denied both claims and cited 10 documents in his medical
record that he said supported his version of events. When asked to
provide copies of the documents on Friday, prison officials said they
did not have enough time to locate them.

Mr. McKenna's infection has progressed to full-blown liver disease. Most
doctors agree that once the disease reaches that level there is no point
in treating it. Mr. McKenna says he is willing to try anything at this
point. He has lost 50 pounds.

"As long as I'm breathing, there is always hope," he said.

The men and woman guarding Mr. McKenna also fear the infection.
Officials with the state's correction officers' union say that a
half-dozen officers have recently reported being infected by prisoners.
They say officers may not make their infections public for fear of being
stigmatized by co-workers.

Prison officials say only one guard has reported being infected, and
there was no evidence that an inmate was the cause.

Glenn S. Goord, New York's commissioner of correctional services, said
the state was addressing the problem aggressively, as it has with other
medical problems. "We're committed to providing the best constitutional
and community standards as we can," he said, referring to treatment.
"The governor has asked me to do whatever is appropriate to protect my
inmates and my staff."

Doctors say that having so many people infected with the virus
incarcerated creates an opportunity for education. Before returning to
the community, inmates must learn how not to infect others.

But the debate over the costly new treatments continues. New national
treatment guidelines are due out this fall.

Dr. Anne S. De Groot, a Connecticut prison doctor and editor of a
newsletter on infectious disease in prisons, said prisoners with
identical illnesses were being treated differently in different states.
"If you're in Pennsylvania you will get treated, but if you're
incarcerated in other states in the Northeast you will not," she said.
"It's ridiculous we don't have a standardized approach."

"STATUS REPORT: Hepatitis C in Prisons"

Thousands of inmates have hepatitis C, but states are taken widely
different approaches to the problem.

California
TOTAL INMATES: 161,00
ESTIMATED NUMBER INFECTED: 53,000
NUMBER CURRENTLY TREATED: 500+

Texas
TOTAL INMATES: 157,00
ESTIMATED NUMBER INFECTED: 44,000
NUMBER CURRENTLY TREATED: 102

New York
TOTAL INMATES: 69,000
ESTIMATED NUMBER INFECTED: 9,700
NUMBER CURRENTLY TREATED: 95

Pennsylvania
TOTAL INMATES: 36,500
ESTIMATED NUMBER INFECTED: 6,200
NUMBER CURRENTLY TREATED: 417

Arizona
TOTAL INMATES: 27,000
ESTIMATED NUMBER INFECTED: 6,000
NUMBER CURRENTLY TREATED: 6

New Jersey
TOTAL INMATES: 27,000
ESTIMATED NUMBER INFECTED: Unknown
NUMBER CURRENTLY TREATED: 0

Maryland
TOTAL INMATES: 26,000
ESTIMATED NUMBER INFECTED: Unknown
NUMBER CURRENTLY TREATED: 0

Connecticut
TOTAL INMATES: 17,500
ESTIMATED NUMBER INFECTED: 2,600
NUMBER CURRENTLY TREATED: 6

Kentucky~
TOTAL INMATES: 15,500
ESTIMATED NUMBER INFECTED: 635
NUMBER CURRENTLY TREATED: 7

Rhode Island*
TOTAL INMATES: 3,300
ESTIMATED NUMBER INFECTED: 825
NUMBER CURRENTLY TREATED: 40

*Includes jail population and pretrial detainees.

+Estimate

~Known cases

(Statistics From: State corrections departments)