Sunday, Nov. 28, 1999
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Inmate with hepatitis denied new treatment
State says man is getting care that he needs
By MARK SCHAVER, The Courier-Journal
Michael Paulley has hepatitis C, a viral disease that his doctor says is ravaging his liver.
But officials at the Luther Luckett Correctional Complex in La Grange, where Paulley is serving a 25-year sentence for rape and burglary, refuse to let him get the free medical treatment recommended by his physician, Dr. Bennet Cecil.
"I think there's a very good chance he'll die in the next five years," said Cecil, who works at the Veterans Affairs Medical Center in Louisville.
Paulley's disease is common in prisons. Studies suggest as many as 40 percent of inmates are infected with hepatitis C.
Paulley's case is putting the state Department of Corrections -- which insists it is giving him the medical care he needs -- at the center of a nationwide problem: How do officials care for thousands of inmates with an illness that has no certain cure?
A hearing is scheduled Wednesday in U.S. District Court in Louisville on a lawsuit that Paulley filed to force the state to give him the treatment he wants.
"There's a tendency to say they're just prisoners and they're just getting what they deserve," said Alan Rubin, one of Paulley's attorneys. "But I don't think prisoners deserve to be denied medical care."
Vicki VonBokern, a medical reimbursement analyst for the Corrections Department, said the drugs Cecil recommends to treat hepatitis C could do Paulley more harm than good.
Other doctors who have examined Paulley recommend against using the drugs, she said, because they can have severe side effects and could cause more harm than hepatitis C itself.
"We feel we do have a legal, moral, and ethical obligation to maintain an inmate's health," VonBokern said.
Fourteen years of Paulley's life have been spent in prison. His most recent sentence began in 1993, when he received five years for third-degree rape, third-degree sodomy and third-degree sexual abuse for having sex with the 15-year-old daughter of a friend. His probation was revoked and he was ordered to serve out a 20-year sentence for previous convictions for burglary and being a persistent felon.
He learned he had hepatitis C in the early 1990s, and was just being tested when he was arrested again in 1992, he said.
An estimated 3.9 million people in the United States have hepatitis C. People can live for decades with the disease and never show symptoms, which include jaundice, fatigue, abdominal pain, loss of appetite, nausea and vomiting. It is fatal in only about 5 percent of cases, but is one of the leading causes of liver disease, according to the federal Centers for Disease Control and Prevention in Atlanta.
The virus is spread through blood-to-blood contact, and most new cases are the result of people sharing needles through drug use. It can also be spread through sex or blood transfusions.
Paulley has cirrhosis of the liver, which Cecil said could have been caused by hepatitis C.
CECIL, who is medical director for a private practice that treats hepatitis patients, says Paulley has a 50-50 chance of living until 2004, when he will be eligible for parole. Cecil wants to treat Paulley with two drugs, interferon and ribavirin. At $18,000 a year, the newly developed drug regimen is expensive. But because Paulley is a veteran, his veteran's benefits would pay for his treatment at no cost to the prison.
He just needs the prison to take him to the veterans' medical center in Louisville, 25 miles from the prison. The Corrections Department has refused to do that.
Paulley and Cecil said they have a letter from Dr. E. Thompson O'Neal, the department's former medical director, saying it won't let Paulley go to the center because it would be unfair to other prisoners who can't pay for the treatment.
A copy of the letter provided by Cecil shows that O'Neal wrote that "the state of Kentucky must be prepared to take on the financial burden of such a program since a significant number of inmates are involved." The letter also said that the department was looking for a way to be fair to all inmates and "focus our limited resources on those most likely to benefit from treatment."
O'Neal, who has moved to Israel, couldn't be reached for comment.
VonBokern said the cost is "a side issue" and not the reason the prison won't allow Paulley to receive the treatment. She said the department has developed criteria for treating hepatitis C patients. She said Paulley doesn't qualify for interferon and ribavirin, and neither do other inmates who have requested it.
Cecil strongly disagrees and said the side effects of the drugs are less threatening to Paulley than the hepatitis C itself.
KENTUCKY SPENDS less than most states on medical care for inmates.
A report released in August by the federal Bureau of Justice Statistics found Kentucky spent $1,318 a year per inmate for medical care, which was ninth lowest among the 46 states and the District of Columbia in the study. The report used 1996 figures.
VonBokern said Kentucky, which has its own doctors and also uses private doctors, spends less because it is one of the few states to use a managed-care system. She said that allows the state to negotiate for lower prices. "It's not that we're providing less care," she said.
Prisons have a higher percentage of drug abusers than the population at large and so have a higher percentage of people with hepatitis C.
The Corrections Department doesn't know how many of Kentucky's 15,000 inmates have hepatitis C because they are not routinely tested for it, VonBokern said. Studies of inmates in other states found that between 30 percent and 40 percent had it.
Paulley, who is from Louisville, said in a telephone interview from prison that he has never abused drugs and thinks he may have contracted hepatitis C when he was in the Army stationed in South Korea in the early 1970s.
PRISON OFFICIALS are struggling with the issue of hepatitis C, just as they did with treating HIV-positive inmates at the beginning of the AIDS epidemic, said Carol Czirr, a department spokeswoman.
It's one of the biggest issues facing prisons across the United States, said John May, a regional director for Prison Health Services in Indianapolis, a company that provides medical care for prisons.
The treatment Paulley wants is effective for suppressing the hepatitis C virus in only about 40 percent of those who receive it, May said. And even then, no one knows whether the virus will return once treatment ends.
Treating all inmates would cost many times current prison budgets for inmate medical care, he said.
More promising treatments are also on the horizon, May said.
Some prisons have decided that since hepatitis C can persist for decades, and most who have it will die of something unrelated to hepatitis C, corrections officials can wait while they decide what to do, he said.
Like Kentucky, prisons elsewhere are developing ways to screen who is eligible for treatment, May said. This includes eliminating those whose prison stay will be short or whose history of drug or alcohol abuse makes them poor candidates for the drugs now in use.
The issue is so difficult that the National Commission on Correctional Health Care, a coalition of health groups that sets standards to improve health care in prisons, took three years to develop a policy on treating hepatitis C, commission President Edward Harrison said. It issued its statement just this month.
The statement says prisons should give "standard therapy to appropriate patients."
It doesn't define standard therapy. Harrison said the commission recommends only that prison doctors use "the best resources available to make the appropriate medical decisions."
The statement doesn't say every prisoner should get treatment. For example, it says that the benefits of prolonging life through treatment "may only be realized decades after. . . . Inmates should have a remaining life expectancy of one or two decades" to qualify for treatment.
Cecil said he could not get Gov. Paul Patton to pardon Paulley so he could get the care he recommended, and he condemns a system he says won't do more.
Paulley said the only treatment he receives now is pills for his pain and other symptoms.
"Just because a man has made a shambles of his life out there," he said, "doesn't mean he should come in here and die."