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Pennsylvania’s Barbaric Protocol for Non-Treatment of Prisoners with Hep-C

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One of the most astonishing things to come out of a three-day hearing in federal court in Scranton, where noted prisoner-for-life Mumia Abu-Jamal was last month seeking an injunction to force the Pennsylvania Department of Corrections to provide him with medication to treat his raging Hepatitis-C infection was the discovery that the state has been withholding that life-saving treatment not just from him but from almost all of the 6-7000 inmates in state prisons who have active Hep-C cases, and that the state’s doing this not just for medical reasons, but as punishment for prisoners found guilty of “misconduct” or suffering from any “addiction.”

Word of this medieval and sadistic approach to medical care for prisoners in a state that as a colony and later as a young state in the new nation of the United States of America had pioneered humane punishment came late in the hearing when the attorney for the DOC, Laura Neal, admitted that she had at her desk in the courtroom a copy of a “protocol” for treatment of Hep-C.

At first, Neal was not even going to admit that there was such a protocol. In fact, under cross-examination by Abu-Jamal’s attorneys, a DOC witness testified that the state had until 22 months earlier been at least offering some infected inmates treatment with the then best medical option — interferon — but that even this had been halted because of medical studies concluding that it wasn’t very effective and that the side-effects could be worse than the cure.

This was, it turned out, only half the story, though. The actual national medical guidelines in question had said to stop using interferon all right, but the other part of those new guidelines said the reason for dropping interferon treatments was precisely because by 2013 there were several new medications available that have few side effects and that offer cure rates for Hep-C as high as 95% of those treated.

The Pennsylvania DOC, however, simply stopped treating prisoners at all, and didn’t offer the new medicines.

Once she had conceded that she had in her possession a new November 2015 DOC protocol for treating Hep-C, Atty. Neal told Federal District Judge Robert Mariani she didn’t want to have it placed into evidence, except if it were sealed from public view. She said she was only planning to use it in questioning the state’s expert witness, and didn’t intend it to be entered into evidence in the case.

Pressed further about her reason for wanting to keep the protocol secret, Neal admitted she didn’t want it “getting into the hands” of a legal team that has filed a class-action suit in western Pennsylvania seeking to compel the DOC to provide the new medication to all infected prisoners in its facilities, where, as in the US prison system nationwide, there now is a raging Hep-C epidemic.

The judge was not sympathetic to this argument and ordered her to provide the protocol to the court, unsealed.
A copy was obtained by ThisCantBeHappening! courtesy of Bret Grote, legal director of the Abolitionist Law Center and one of Abu-Jamal’s attorneys in this case.

The document is stunning in its callousness and sadistic punitiveness, which belies any notion that the state’s prison system has anything to do with redemption or “correction.” It is in fact, positively medieval in its heartless language and punitive philosophy.

Under the protocol, as I wrote earlier [1], a prisoner with Hep-C is considered ineligible for treatment with anti-Hepatitis drugs unless found to have advanced cirrhosis of the liver. Cirrhosis, a deadly and irreversible scarring and functional destruction of the liver, is a sign of advanced Hepatitis infection, not an early sign of the disease. Nonetheless, once found to have a sufficiently serious case of cirrhosis, the ailing prisoner must still cross a second medical hurdle in order to obtain treatment: He or she must undergo an endoscopy of the esophagus, where doctors must find present a condition called esophageal varices.

The Mayo Clinic defines esophageal varices as:

…abnormal, enlarged veins in the lower part of the esophagus — the tube that connects the throat and stomach. Esophageal varices occur most often in people with serious liver diseases. Esophageal varices develop when normal blood flow to the liver is obstructed by scar tissue in the liver or a clot. Seeking a way around the blockages, blood flows into smaller blood vessels that are not designed to carry large volumes of blood. The vessels may leak blood or even rupture, causing life-threatening bleeding.

In other words, a person doesn’t even have a shot at getting the new medicine that cures the Hep-C infection unless he or she is near death from cirrhosis and at risk of any moment suffering deadly internal bleeding.

But then, if varices are found in the esophagus, there’s yet one more thing in the way. A “death panel” of DOC executives and top medical personnel from the for-profit contracting firm that provides what passes for medical care at the DOC next looks into the case to see whether the inmate in question has any record of “misconduct” involving obtaining a tattool, whether the person may have shown evidence over the prior 12 months of any “addiction” problem, or whether the person has a history of failing to follow medical procedures.

Now remember, most of the prisoners crowding Pennsylvania’s prisons are not hardened killers. They are, for the most part, just folks who have committed felonies of one kind or another, many of which are relatively minor, may have been non-violent in nature, like fraud, check kiting, drunk driving, or maybe burglary, and who are serving sentences of five years or less, yet here the DOC is effectively sentencing them to death from complications of untreated Hep-C. And it’s handing down this capital sentence not even for any serious reason — simply for someone having taking the health risk of getting tattooed, or having an addiction problem.

Gov. Tom Wolf, to his credit, has put a moratorium on executions in Pennsylvania, and yet here he is allowing the state’s prison system, in effect, to condemn to death inmates who have active Hepatitis-C cases by denying them available medicines that could cure their disease — a disease which they may well have actually contracted while in prison.

There is only one word for what is happening here: barbaric.

Dave Lindorff is a founding member of ThisCantBeHappening!, an online newspaper collective, and is a contributor to Hopeless: Barack Obama and the Politics of Illusion (AK Press).

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