DISEASE RAGES BEHIND BARS

SALEM - On Dec. 1, 1998, health officials at the Oregon State Penitentiary
learned that inmate Rodger Anstett had elevated liver enzymes, an
indication that he might be infected with hepatitis C, according to a
lawsuit against the Department of Corrections.

It took two more years until prison doctors ordered a blood test that
confirmed Anstett had the viral disease. To date, Anstett has received no
treatment for the disease, and his health is failing.

"They won't treat the hepatitis C. They're dragging their feet," said
Anstett, who is serving a 20-year sentence for multiple counts of arson and
attempted murder out of Washington County. "The problem in prisons is, they
really want to look the other way. They have an intentional policy to
misdiagnose consistently until you leave."

Or die.

That's the central allegation in the $17.5 million lawsuit, filed last fall
by Portland lawyer Michelle Burrows on behalf of 10 inmates, including
Anstett, and one former inmate.

"The state of Oregon, through the DOC, has a de facto policy of not
treating hepatitis C," Burrows said. "I've had four inmate clients die from
hepatitis C-related issues."

Anstett is one of three plaintiffs whose disease has reached an advanced
stage and could die at any time, Burrows said.

Burrows is trying to get the suit, filed last fall, certified as a class
action complaint. Attorneys for the state are preparing to fight the class
action request.

Although state lawyers won't discuss the merits of the case, the
Corrections Department's top medical official contends that most people who
get the disease suffer few serious health problems and that it's
appropriate for the department to take a cautious approach to treatment.

But the sheer numbers of prisoners with the disease shows that the state
has a growing, costly health problem on its hands.

An estimated one in three Oregon prisoners is infected with hepatitis C, a
chronic, potentially deadly disease that's costly to treat. Although the
numbers are startling, they're similar to numbers found in prisons across
the country, said Phyllis Beck, director of the Eugene-based National
Hepatitis C Prison Coalition.

"In essence, our state prisons have become a state-sponsored incubator for
HCV, by default," Beck told Hepatitis magazine.

Prison officials said about 30 percent of the nearly 11,000 inmates in the
14 Oregon prisons, work camps and release centers - 3,300 prisoners - have
hepatitis C. Burrows believes that the number could be closer to 40 percent.

Hepatitis C is the fourth-leading cause of death in Oregon prisons, after
heart disease, cancer and suicide, Burrows said, citing Corrections
Department death reports.

About 4 million Americans are infected with the hepatitis C virus, many of
whom don't know they have the disease. Hepatitis C is spread through
blood-to-blood contact, often through injection drug use and from needles
used to inscribe tattoos. Some people got the disease through blood
transfusions or organ transplant before 1992 when better testing of the
blood supply became available.

The virus can lurk in a body for years without detection, slowly wrecking
the liver. Federal health officials report that 10,000 people die each year
from hepatitis C, a number expected to triple by 2010.

The Department of Corrections won't say how many inmates are being treated
for hepatitis C. Burrows said she's aware of eight inmates who are
receiving treatment.

Burrows alleges that treatment decisions are being made for financial, not
medical reasons. The disease is expensive to treat, with a single course of
the recommended combination therapy, interferon and ribavirin, costing
$17,000 to $20,000, she said. One course of treatment can take 25 to 45
weeks. The expense doesn't include liver biopsies, which are required to
assess the amount of liver damage and cost several thousand dollars.

Measure 11, which mandated tough sentences for violent offenders, has
exacerbated the problem, Burrows said.

"We put people in prison for a very long time, and we expect that to be the
end of it," she said. "We don't want to deal with it. ... The unfortunate
thing is, you have to take care of them. These are captive, vulnerable people."

However, Corrections Department medical director Dr. Steve Shelton said the
state adequately cares for inmates who have hepatitis C, most of whom
probably won't experience serious health problems.

"Over 80 percent of the people with hepatitis C will not show evidence of
health problems during the course of their full lifetime," he said.

Knowledge about hepatitis C has evolved rapidly in recent years and doctors
have not settled on a single standard of evaluation and treatment, Shelton
said.

"It is reasonable to take a very careful, reasonable medical evaluation,
though some people want it to move faster," he said.

Treatment decisions are based on medical evaluations that seek to identify
patients for whom it appears to be a progressive disease, he said.

"For those people for whom it is not a progressive disease, is it a
problem? I think you'd probably have to say it is not a problem for those
people," he said. "Everyone who has chest pain doesn't get taken to open
heart surgery."

Hepatitis C attacks different bodies in different ways, depending on the
strain of the virus and the strength of the person's immune system,
according to the National Institutes of Health.

According to the federal Centers for Disease Control and Infection, 70
percent of hepatitis C patients suffer chronic liver disease and 15 percent
may develop cirrhosis of the liver over a period of 20 to 30 years. The
risk is greater for people who have abused alcohol.

Dr. Hugo Rosen is a liver specialist at the Veterans Affairs Medical Center
and Oregon Health & Science University in Portland. He said for the "vast
majority of patients," hepatitis C is a progressive disease, albeit one
that progresses slowly.

"If you follow patients, many will develop progressive liver disease," he
said. "The ultimate progression is a point where they die or need a
transplant."

He favors treatment in most cases, though not for patients with psychiatric
problems because the combination therapy can cause side effects, including
depression, anxiety and flulike symptoms.

In some cases, the combination therapy can cause the virus to go into
remission.

"If you treat someone with less degree of injury you may prevent them from
developing cirrhosis," he said.

For Anstett, it may be too late to treat his disease. If he has cirrhosis,
as Burrows suspects, drug therapy may do more harm than good.

Anstett said he's never injected drugs and believes that he contracted the
virus while serving in Vietnam.

He said the disease has given him a skin rash that feels "like acid coming
up from under my skin," leaves him constantly achy and fatigued, and fogs
his brain so it's hard to think clearly or carry on coherent conversations.

"I do not consider any of the treatment I have received to be responsible
or responsive," he wrote in an affidavit prepared for the lawsuit. "I
believe the various delays and denials are simply calculated to see whether
I die or am released first."