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Hepatitis C treatment may cost N.J. millions
By Mark Fazlollah and Jennifer Lin
Philadelpha Inquirer, Jan 12 2003
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A prison official said additional funds would be sought. The number of
infected has risen.
Ten weeks after pledging to pay for treating the hepatitis C epidemic in its
prisons, New Jersey has learned how much it may cost: $4.5 million to $8
million this year, by conservative estimates.
The prison medical provider, Correctional Medical Services (CMS) of St.
Louis, projected the cost in recent memos and e-mails, which were obtained by
The Inquirer through the state's Open Public Records Act.
The documents said one-fourth of New Jersey's 26,000 inmates would probably
test positive for hepatitis C if the prison system decided to screen everyone
for the potentially deadly virus.
In July, The Inquirer reported that New Jersey prisons were not treating
inmates with the disease - which can lead to liver failure. CMS also did not
tell hundreds of inmates that they had tested positive for hepatitis C,
including 21 who had been released.
Corrections Commissioner Devon Brown ordered CMS to find the 21, but the firm
could not locate most of them, the documents show. Without knowledge of the
blood-borne disease, the former convicts could unwittingly pass it to others
by sharing needles or even sharing razors or toothbrushes.
On Friday, Brown said he has asked state investigators to join the search.
The hepatitis C epidemic has hit prisons across the country, but only a
handful of states pay for extensive screening and treatment. At the time of
the Inquirer's report, New Jersey was treating only one inmate, although
1,170 already had tested positive for the virus.
The state this year is paying CMS nearly $100 million for prison medical
care. That does not include the cost of hepatitis C treatment, which the
state started covering Nov. 1. On Friday, Brown said it is routine to request
supplemental appropriations for such expenses. There were not plans to cut
other prison programs.
Three inmates now are getting treatment, which costs $10,000 to $15,000 each
for up to 12 months of injections and pills. The medicines clear the disease
in about half of patients. Treating liver failure can cost $50,000 to
$250,000.
Pennsylvania has treated or is preparing to treat more than 1,000 inmates at
a cost of about $6 million. It screens all inmates and views hepatitis as a
public health issue that must be treated before prisoners go home. New Jersey
only screens inmates who ask to be tested.
CMS told the Corrections Department that if just 25 percent of all New Jersey
inmates were tested, it would cost the state $4.5 million a year for
treatment and testing in accordance with Federal Bureau of Prison guidelines,
a standard New Jersey says it will meet. The estimate also assumes that one
in eight inmates who test positive will qualify for treatment under medical
guidelines.
But if 75 percent of the inmates were tested, the annual cost for testing and
treatment would be $8.4 million, a CMS document said. There were no estimates
for how much it would cost if New Jersey tested all its inmates.
In response to Inquirer reporting, Brown made extensive policy changes in
July and vowed to find funding for treatment, despite the state's budget
deficit. He said the articles were "instrumental in saving lives."
Each month since then, more New Jersey inmates have tested positive for the
disease. As of Dec. 4, the new documents show, 1,407 inmates were known to be
infected - a 20 percent increase in five months. Brown said he expects the
numbers to climb as inmates and medical staff learn more about the disease,
and more prisoners ask to be tested.
"Education is occurring at all of our intake sites," Brown said in a
statement. "It is understandable that there would be a rise in the number of
inmates screened for the infection."
Thus far, the prison system appears to have taken only small steps toward
treatment.
Before an inmate can be considered for hepatitis C medicines, a liver biopsy
must be performed to help determine whether he will benefit. As of Dec. 16,
eight inmates had biopsies.
In letters to The Inquirer since July, inmates have complained that CMS
officials have actively discouraged them from having biopsies, warning them
repeatedly that it could kill them.
Daniel Amos, an inmate at Riverfront State Prison in Camden, said that twice
in the fall he was cautioned that a biopsy could be fatal. Amos, one of the
inmates featured in The Inquirer series about New Jersey's failure to treat
inmates, said he insisted that he wanted a biopsy, and the tests went
smoothly.
Nationally, about 1 in 10,000 people given a liver biopsy dies from
complications. Carroll M. Leevy, a liver specialist at Newark's University
Hospital, said his clinic has conducted more than 3,000 biopsies without a
fatality.
Though New Jersey now is under increased pressure to correct failings in
hepatitis C care, many problems persist.
Minutes from a Nov. 25 meeting between CMS and state officials showed that
the prison medical computer system is failing to properly track hepatitis C
because "there are problems with consistency and completeness" in how doctors
report the disease.
Those were the same problems that in the past led to inmates being released
without being told they were infected.
At the same meeting, CMS officials said 40 to 60 new inmates test positive
for hepatitis C each month, but thousands of prisoners, both current and
new, remained untested.
The state also faces legal problems. In the fall, the first suit seeking
class-action status for civil rights violations for failure to provide
medical care was filed by a former inmate. Since then, more than 100 current
and former inmates have sought to join the suit.
Rosemary Pinto, a lawyer with the Voorhees firm suing the state, said she had
received "stacks of letters" from infected inmates asking to sue.
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