AZ DOC statement re: Corizon's exposure of diabetics to infectious disease

In response to media reports of the infectious disease exposures at Lewis prison, the AZ DOC has released the following statement about Corizon:

Diabetic prisoners at ASPC-Lewis exposed to infectious disease again.

Shame on the Arizona Legislature for diverting our tax dollars to the pockets of profiteers who are making a killing by providing inferior care to those in state custody. Who's going to pay for the medical care as well as the the grave suffering and deaths of Corizon's victims? WE ARE!!! Our legislators need to take the profit factor out of incarceration in this state and start serving the people, not the corporate elite.

If you have a loved one in the AZ DOC who is diabetic, please contact the American Diabetes Association about Corizon's disastrous mismanagement of diabetes in Arizona's prisons and ask them to send the prisoner an advocacy packet and request for assistance forms. The place to write is:

Director, Legal Advocate Program
American Diabetes Association
1701 North Beauregard Street
Alexandria, VA 22311
Tel: (800) 676-4065
         (703) 253-4822

Also have the prisoner write to me (Peggy Plews PO Box 20494 PHX 85036). Before the news about the latest infectious disease exposure, here are a couple other posts about accessing health care in the AZ DOC :

Corizon and the AZ DOC: Prisoners & Families, Know Your Rights.

Tuesday, March 5, 2013

Corizon's deliberate indifference: fighting back.

 Thursday, May 30, 2013

-----------from the AZ Republic-----------

Official: Nurse exposed 24 Buckeye inmates to hepatitis B and C

By Craig Harris The Republic | azcentral.com  

Wed Jan 8, 2014 9:40 PM

 

For the second time in 17 months, inmates at the State Prison Complex-Lewis near Buckeye have been exposed to a life-threatening disease by a private health-care provider.

The latest exposure involved improper procedures by an employee of a contractor that was brought in to replace the previous company after a similar incident.

A nurse working for Corizon Inc., the private health-care provider, improperly injected and exposed inmates to hepatitis B and C, said Clarisse Tsang, the Department of Health Services hepatitis-prevention coordinator. The nurse’s identity was not revealed.

Tsang’s disclosure to The Arizona Republic came after Corizon, which last year was awarded a three-year, $372 million contract to provide state inmate health care, refused to provide details of the incident, which occurred Sunday night.

The company sent out a news release Wednesday, saying approximately 24 inmates were exposed to “blood-borne pathogens” involving improper procedures for injections.

Some of those inmates were housed in close custody, meaning they represent a high risk to the public and staff because they have been sentenced for violent crimes, according to the Department of Corrections. Other prisoners were housed in minimum custody for low-risk inmates.

In a telephone interview Wednesday, Corizon spokeswoman Susan Morgenstern would not say if inmates were exposed to hepatitis or HIV. She also would not say why the company waited three days to notify the public. She said the company should have additional details to release today.

The Department of Corrections, which awarded the contract, also would not provide details about the potential public health risk despite knowing about the problem since Monday.

Doug Nick, a Corrections spokesman, referred questions to Corizon, saying it was the company’s responsibility to alert the public.

“It’s a medical issue,” Nick said. “They are the doctors and nurses.”

Tsang said the inmates were exposed because of an “improper use of an insulin injection from a vial” on a number of inmates.

Tsang said that up to 10 of those inmates had been exposed to hepatitis in August 2012 when a similar problem occurred with a different private health-care provider whose nurse contaminated the prison’s insulin supply.

Laura Oxley, a Department of Health Services spokeswoman, said her agency is perplexed about how the same problem could have occurred again at the same prison to some of the same inmates.

“It didn’t go without notice,” said Oxley, whose agency is investigating the incident.

The inmates could become extremely ill. Symptoms of hepatitis B and C include nausea, fatigue and yellowing of the skin or eyes. Hepatitis also causes liver problems and can be deadly, Tsang said.
Tsang said it could take up to six months to develop symptoms, though some could occur in two to six weeks.

Corizon said company officials on Tuesday met with the 24 inmates who may have been affected to counsel them and offer the “appropriate preventative medications as a precautionary measure.”

The company, in its news release, said it was developing a corrective-action plan.

Caroline Isaacs, an activist and outspoken critic of privatizing prison health care, said she was “sadly not surprised” that inmates again were potentially exposed to hepatitis.

“It’s just yet another piece of evidence that these kinds of problems are inevitable because they are inherent in the way these corporations do business,” said Isaacs, American Friends Service Committee program director. “This will keep happening until the state of Arizona takes responsibility for medical care in its own facilities.”

Isaacs said she was astounded that the Department of Corrections didn’t inform the public about a possible hepatitis outbreak.

“Who is calling the shots?” Isaacs said. “Arizona ultimately is responsible for what this corporation does or does not do.”

Corizon, in its news release, said it notified the Department of Corrections and Health Services about the problem on Monday.

The company, at the bottom of its news release, also included a statement from Corrections Director Charles Ryan that said: “Corizon responded to this incident immediately and has assured the department that it will conduct a full investigation of this matter to ensure any potentially affected inmates are treated.”

The Department of Corrections, which routinely issues news releases on state letterhead, did not independently disclose information about the incident.

In the 2012 incident, a nurse for Wexford Health Sources Inc., the previous health-care provider, spurred a hepatitis C scare by contaminating the prison’s insulin supply. That nurse, Nwadiuto Jane Nwaohia, voluntarily surrendered her nursing license in September.

Last year, Corrections hired Corizon after the state agreed to terminate Wexford’s statewide contract.

That decision came amid accusations that Wexford improperly dispensed medicine to inmates, wasted state resources and didn’t show a sense of urgency after the hepatitis scare.

Wexford has said its contract performance was hindered by state monitors and a lack of cooperation from Corrections.

To replace Wexford, the state agreed to a more expensive contract with Corizon of Brentwood, Tenn., to become the health-care provider at all Arizona-run prisons. Corizon, the country’s largest provider of correctional medical care, took over March 4. The three-year deal with Corizon cost taxpayers at least $372million, but Corizon has the option to seek additional funds in the final year. That contract is at least 6percent higher than Wexford's $349 million, three-year deal.

The state hired private health-care providers, claiming it’s less costly to taxpayers.

Reach the reporter at craig.harris @arizonarepublic.com or 602-444-8478.

CURING HCV in prison: The new Community Standard of Care.

"Q: Will we be able to wipe out hepatitis C entirely?

A: In contrast to HIV, we do have the capability of doing that - essentially curing everyone who got infected. While we have made tremendous progress against HIV, we still don't have a cure, we still don't have a vaccine. The situation for HCV is dramatically different. A cure is achievable. Someday soon, the cure using an interferon-free cocktail is going to be routine...."

 ----------

Until now, I thought it was likely that this disease would kill not only my imprisoned friend Davon, sick as a dog on interferon right now, but also my big brother, who hasn't been able to get treatment - both I feared would die very painfully, at an early age. 

This news gives me hope, though. We have the capability to wipe out this disease and cure those who are ill right now - the question remains: do we have the collective will? That much, I still don't know.


Nearly 6,000 AZ state prisoners have tested positive for the Hepatitis C virus, but only a fraction are deemed eligible for a miserable course of interferon treatment because it costs so much and takes such a toll on body and mind. Many drop out from the side effects, having to face debilitating and fatal liver disease instead. Most public health estimates put the jail/prison population at being over 50% HCV+. Imagine how hard it is already to see loved one do time and maybe even make amends for their crimes in prison, and come home only to find that they were sentenced to die from an infectious disease, as well. 

For those who don't care about prisoners, though, think about this: since 95% of then return to the free world eventually, that means there's already an epidemic in communities with high rates of poverty, unemployment, homelessness, felonization, incarceration, uninsured persons, IV drug addiction, HIV/AIDS, and other compromised populations. It also disproportionately affects people of color, the LGBTQ communities, and Baby Boomers. That's a huge public health problem that no one in Arizona likes talking about - why are they so silent now, I wonder? Surely they've heard this by now.

It sounds like it's time for the AZ DOC and Wexford to re-write their Hep C treatment protocols, in any case, in order to assure that the standard of care they provide to prisoners with the virus (HCV) is consistent with the community's new standard. Otherwise, they can both expect to be named in a new class action lawsuit soon, I'm sure. I'd think the public at large could even sue the state for having an infected population unleashed on us - uneducated, untreated, unsupported, uninsured, and unwell.

remembering those we have already lost...

  

we must accelerate the fight for the living.

Fight the spread of HEP C today: 

support PHRO (Phoenix Harm Reduction Organization)

Phoenix Art Museum: Art of Resistance

Prisoners' Justice Day Guerilla Installation

August 10, 2012

--------from the San Francisco Chronicle----------

Hepatitis C fight - 'watershed moment'

Erin Allday / San Francisco Chronicle

Tuesday, September 11, 2012

Earlier this year, an editorial in the New England Journal of Medicine declared that the world was in a "watershed moment" in the history of treatment for hepatitis C, a virus that is believed to infect roughly 180 million people globally. Dr. Warner Greene, director of the Gladstone Institute of Virology and Immunology in San Francisco, agrees wholeheartedly - and believes that with recent advances in treatments and a cure, the world could be on the cusp of nearly wiping out the virus.

Q: What does the hepatitis C virus do to the body?

A: This is an RNA virus that infects hepatocytes, cells in the liver. That's why you ultimately get hepatitis, or inflammation in the liver, and that can progress on to cirrhosis. About 20 percent of people spontaneously clear the hepatitis C virus, and of the rest, about 20 to 25 percent will progress to cirrhosis, and eventually end-stage liver disease. Hepatitis C is the leading reason behind liver transplants in the United States.

Q: For many years, hepatitis C has been treated with interferon. What is interferon?

A: Interferon is a type of protein called cytokine. It normally triggers an antiviral response in the body. It inhibits key steps in the (hepatitis C) virus life cycle that allow it to replicate. But it's doing it at a cost. Cytokine is pretty toxic. It makes patients very sick.

Q: Last year the Food and Drug Administration approved new drugs to treat hepatitis C. How do they work?

A: It's just like with HIV - you're attacking multiple, key proteins needed for the hepatitis C virus lifecycle. Now you have these small molecules that are attacking the virus itself, as opposed to trying to induce an antiviral response, like with interferon.

These drugs are proving to be just dynamite. We're very close to being able to cure everybody of hepatitis C. The natural history of hepatitis C virus infection has been fundamentally changed.

Q: Why has hepatitis C been so hard to treat historically?

A: One thing that limited progress was the lack of an infectious molecular clone to use in the laboratory to test drugs. It was only in the last few years that an infectious molecular clone came out of Japan. Before that, none of them fully replicated (in the lab). When the molecular clones came along progress just took off at light speed.

Then the blueprint for working on HIV became very informative - protease inhibitors, polymerase inhibitors, they were all targeted very quickly, by multiple pharmaceuticals. Many of the pharmaceuticals just moved their HIV discovery teams into HCV. Progress has been made so rapidly here because the trail had been blazed by all of the HIV drugs.

Q: Will we be able to wipe out hepatitis C entirely?

A: In contrast to HIV, we do have the capability of doing that - essentially curing everyone who got infected. While we have made tremendous progress against HIV, we still don't have a cure, we still don't have a vaccine. The situation for HCV is dramatically different. A cure is achievable. Someday soon, the cure using an interferon-free cocktail is going to be routine.

Then it becomes more of an implementation issue - how you distribute these drugs, what you charge for them. There are 180 million people infected worldwide, five to six times the size of the HIV epidemic, and many are living in resource-poor settings. We're going to have to figure out how to deal with the developing world.

Hepatitis C drugs offer hope for cure

Erin Allday / San Francisco Chronicle

Updated 4:09 p.m., Wednesday, September 12, 2012

Scientific breakthroughs, one piled on top of another at breakneck speed over the past few years, have put medical researchers on the cusp of curing almost everyone who suffers from hepatitis C, if not wiping out the disease entirely.With 180 million people in the world thought to be infected with the virus - 12,000 of them in San Francisco alone - that's potentially a huge public health coup, doctors and scientists say.

In a little more than a decade, a virus that was once almost untreatable could be made nearly extinct.
"It is just a remarkable moment in the history of hepatitis C," said Dr. Warner Greene, director of the virology and immunology division at the Gladstone Institute in San Francisco. "I think hepatitis C and its sequela - liver cancer, cirrhosis, liver transplants - can largely be gone in the future. We just won't have to worry about it."

In the past year, new treatments have come out that already have doubled the number of people who can be cured of hepatitis C. Now the race is on among drug developers to market the first medical cocktails that would cure almost everyone on the planet, and do it safer and faster than the best treatments currently available.

New treatments - both those already available and those expected to be approved in the next five or so years - were a large part of the reason the U.S. Centers for Disease Control and Prevention recommended this summer that all Baby Boomers get screened for hepatitis C.

That generation is thought to have the largest number of undiagnosed cases of the disease, with so many of them potentially exposed to the virus in the wild, drug-friendly hippie years of the '60s and '70s. Until recently it wasn't practical to screen millions of people for possible cases of hepatitis C because few good treatments were available.

Hepatitis C's spread

Hepatitis C is a virus transmitted through the blood, similar to HIV. It's often spread through shared needles used by intravenous drug abusers. Decades ago, and even still in some developing parts of the world, people were exposed to hepatitis C through unsterilized equipment used for tattoos or surgical procedures. Also, the U.S. blood supply wasn't screened for hepatitis C until the early 1990s, so people sometimes became infected from a blood transfusion or organ transplant.

In roughly 20 percent of hepatitis C cases, the body's immune system fights off the virus without any medical intervention and probably without the individual ever being aware of having it. The remaining cases develop into chronic hepatitis C.

In some of those cases, the virus may lie dormant for decades, or even a lifetime, but in about 1 in 5 chronic cases, the virus will attack the liver, scarring it and causing cirrhosis, and potentially leading to liver cancer and liver failure. The infection causes about 10,000 deaths a year in the United States, and it's the leading reason for liver transplants. Hepatitis C is especially prevalent in people who also have HIV infections; in fact, HIV-positive patients are more likely to die of hepatitis-caused liver disease than of AIDS or HIV.

Antiviral drugs

It's only in the past seven years or so that doctors and scientists discovered the first antiviral drugs that can stop the virus, giving the body's natural immune system a chance to fight it off. The cure rate with those drugs is 75 to 80 percent, but they require that patients also take interferon, a toxic medication that can cause disabling side effects for a year.

In the next five years, researchers expect to develop even more potent antiviral medications - drugs that will cure more than 90 percent of patients, and do it in half the time and without the interferon.

"There's no question that with these new treatments, cure is going to be the rule and not the exception," said Dr. Brad Hare, medical director of the HIV/AIDS ward at San Francisco General Hospital, who studies HIV and hepatitis C co-infections. "It's more important than ever to identify people with hepatitis C, because we have something even better to offer them."

That said, Hare added, it's unlikely that the virus will ever be eradicated. There will always remain a pocket of people who don't respond to drug therapy or aren't able to take it for some reason. Those who have been cured can be reinfected.

And getting new medications to the tens of millions of people affected by hepatitis C won't be easy, especially because the drugs will almost definitely be expensive.

Strains on the system

Just screening the millions of Baby Boomers in the United States, and getting those who test positive for hepatitis C into treatment, could be an overwhelming strain on the health care system, public health experts say. Drugs in development could ease some of that burden if they're easier to take and more effective than the current treatments.

Hepatitis C was discovered in the late 1980s, although scientists had known for years that a virus existed that was causing inflammation in the liver and that wasn't the hepatitis A or B viruses.

The U.S. Food and Drug Administration approved the first treatment for hepatitis C - the chemotherapy drug interferon - in 1991, and added a second drug, ribavirin, in 1998. Those two medications were considered a breakthrough therapy for a virus that had previously been untreatable, but the treatment itself was rough and not all that effective.

The ribavirin comes in pill form, but the interferon has to be given intravenously three times a week for 48 weeks. Both drugs, especially the interferon, often come with awful side effects - major depression and, sometimes, suicidal thoughts, plus fatigue, nausea and flu-like symptoms.

And the worst of it is that the treatments lead to a cure only roughly half the time - less than half for patients with the most common strain of hepatitis C.

"A lot of us didn't have bad symptoms before we went on treatment," said Daniel Berrner, a San Francisco resident who was diagnosed with both HIV and hepatitis C in 2005, and underwent successful treatment for the latter in 2009. "People maybe feel some fatigue, but that's it. So to convince them to feel awful for a year when they're not feeling that bad to begin with is a really hard thing to do."

Because treatment was, for many people, tougher to endure than the virus itself, many doctors over the years have "triaged" patients by performing liver biopsies or blood tests to determine if hepatitis C was causing severe enough damage to treat even at the risk of failure. If patients weren't experiencing acute symptoms and their livers seemed relatively healthy, they'd often postpone treatment.

More seek treatment

Whether to get treatment for hepatitis C is still a personal decision and best made after a thoughtful conversation with a primary care doctor or a liver expert, doctors said. But increasingly patients are being encouraged to get treatment, even if their infection isn't particularly virulent.

"I still try to triage based on the risk of end-stage liver disease. But now more patients are willing to be treated," said Dr. Natalie Bzowej, a liver disease specialist at California Pacific Medical Center.

Bzowej helped lead national research into one of the first antiviral treatments that targeted hepatitis C, a protease inhibitor called telaprevir made by Vertex Pharmaceuticals, which was approved by the FDA in June 2011. A similar drug, boceprevir from Merck, also won FDA approval last year.

Remarkable success

In clinical trials, about 80 percent of patients with the most common strain of hepatitis C who took one of those drugs, plus the usual interferon and ribavirin combination, were cured. That was a remarkable improvement over the previous 40 to 50 percent cure rate.

Also encouraging: Most of the patients who were cured were able to stop taking the medications after just 24 weeks, cutting the treatment time in half.

The reason for the difference is that the new drugs single out the hepatitis C virus specifically, whereas the interferon and the ribavirin essentially just give a boost to the body's natural immune system. For many people, the immune system is not strong or fast enough on its own to fight off the virus.

Protease inhibitors are best known as a class of drugs used to treat HIV infection. They work by attacking specific enzymes, or proteases, in a virus that are a key part of the replication process. By inhibiting those enzymes, the virus is unable to reproduce and eventually dies off.

Now, scientists are looking for the next line of drugs to attack other points of the hepatitis life cycle. The pharmaceutical industry is racing toward clinical trials - companies battling to be the first to get new drugs, especially those that would make interferon obsolete, to the market.

Multidrug attack

Doctors and scientists alike expect the first of the new wave of drugs to be available in four or five years. Part of the reason not everyone can be cured of hepatitis C is that, like many viruses, it mutates so quickly and becomes immune to drugs. So ideally, doctors will have at their disposal several drugs - maybe dozens - that will attack the virus on several fronts at once.

If those drugs are strong and fast enough, they could cure patients without the need for interferon. Protease inhibitors and other antiviral drugs aren't without side effects, but the symptoms are much less severe than those from interferon, and the newest classes of drugs may work in as little as 12 weeks, or about half the time it takes telaprevir, the protease inhibitor, to do the job.

"I feel like we are glimpsing the beginning of the end for hepatitis C," said Dr. Cami Graham, vice president of global medical affairs at Vertex. "We really are beginning to see what that path to eradication is going to look like."

Long incubation period

Both drug developers and doctors alike said they are advising patients not to raise their hopes too high. Almost all of the clinical trials are in their earliest stages, and for the Baby Boomers especially, patients with decades-old infections may not have even a few years to wait for new treatments.

"What we have now is better than anything we've had in a long time," said Dr. Joanna Ready, chief of gastroenterology at Kaiser Santa Clara. "What will be even better is interferon-free therapies, and the early studies have been very, very, very promising. But the disease has such a long incubation period and damages the liver over decades, so we really need to be following people over time.
Still, Ready said, she's hopeful.

"If we don't wipe out hepatitis C entirely, we can probably make it go away like polio, where you haven't gotten rid of it but you've really beaten it down," she said. "The science behind these treatments is improving every day. And the more we know, the better we are at treating it."

Erin Allday is a San Francisco Chronicle staff writer. E-mail: eallday@sfchronicle.com 

---------------------

FIGHT THE SPREAD OF HEP C TODAY. 

 Phoenix Harm Reduction Organization (PHRO)

UPDATE: ASPC-Lewis Hep C exposure incident.

excellent report by Craig Harris at the AZ Republic is at the bottom.

 --------------------

Bury Hep C, Not People.... 

Wexford Health Sources, Phoenix (JULY 2012)

Wexford connection for prisoner health information:

toll free 1-855-890-6307, or email your request to azcorrections@wexfordhealth.com. 

This media release comes to us this afternoon from Wendy Halloran at KPNX Channel 12 News. They will be covering the story tonight at 5pm and 6pm. Wendy was recently nominated for an Emmy for her investigation of the highly preventable suicide of Tony Lester.

Hep C is already a leading killer in our state prisons. Nearly 6,000 prisoners are already diagnosed with it, and another 20-30% of the prison population likely have it but don't know it yet...

From: LAMOREAUX, BILL [mailto:BLAMOREA@azcorrections.gov]
Sent: Tuesday, September 04, 2012 11:35 AM
To: Halloran, Wendy
Subject: RE: MEDIA REQUEST FROM WENDY HALLORAN AT 12 NEWS

Ms. Halloran:

On August 27, 2012, a potential exposure event occurred at the Arizona State Prison Complex – Lewis while administering medication. A vial of medication, which may have been compromised with a previously used syringe, was subsequently used to treat additional inmates.

Review of this event determined the potential exposure to Hepatitis C and involved up to 105 inmates. As a result, these inmates were notified and are currently being screened for infectious diseases as per protocol in such an exposure event. An independent laboratory, under contract with Wexford, will provide continued medical monitoring and testing of these potentially exposed inmates over the next several months. All patients will be informed of the results of the testing.

The medical protocols related to this potential exposure have been reviewed to ensure that subsequent events do not occur. The initial event remains under review by Wexford Health, the contracted provider responsible for inmate health care.

The nurse who violated the basic infection control protocols is an employee of a staffing agency under contract with Wexford Health. Wexford has banned the nurse from working under any of its contracts and has also requested that the individual be referred to the State Board of Nursing for investigation.

Regards,

Bill

---------from the AZ Republic------------

Prison nurse tied to hepatitis C exposure

by Craig Harris - Sept. 4, 2012 11:12 PM
The Republic | azcentral.com

A nurse for the new medical provider for Arizona prisons may have exposed 103 inmates at the Buckeye state prison to hepatitis C by contaminating the prison's insulin supply, and state and local health officials were not alerted for more than a week.

Officials with the state and Maricopa County health departments, who confirmed to The Arizona Republic on Tuesday that they had not been informed by Wexford Health Sources Inc. of the problem, said they will launch investigations into the incident.

Official notification of the Aug. 27 error only came late Tuesday afternoon, hours after an inmate's family member had told 12 News of the potential health risk.

State rules require health-care providers and correctional facilities to notify health departments within five business days of a hepatitis C diagnosis, treatment or detection.

Wexford said it suspended the nurse on Aug. 27, immediately after learning the person "had violated basic infection-control protocols while administering medication that day."

"In talking with the Department of Health Services, they believe it should have been reported first to the county," Corrections Director Charles Ryan said late Tuesday. "That is a question we will have of Wexford -- as to the lack of notification or an explanation as to why that did not occur.

"The department has concerns about this issue, and we will be having further discussions with Wexford in terms of this requirement and some other issues as well."

Ryan said the incident occurred when a diabetic inmate who also has hepatitis C was administered a routine dose of insulin by the nurse on Aug. 27. The needle used on that inmate was inserted into another vial to draw more insulin for the same inmate.

Ryan said the contaminated needle was inserted into a vial which was then put back among other vials in the prison's medication refrigerator. It got mixed up with other vials used throughout that day to administer insulin injections to more than 100 other diabetic inmates. Later that day, Ryan said, officials realized that the vial that potentially had been tainted with hepatitis C may have been used to dose other inmates.

At that point, the nurse in question was suspended and prison officials sought to determine how many inmates may have been exposed.

All the vials of medicine were destroyed after the discovery.

Wexford spokesman Larry Pike on Tuesday minimized the potential exposure of other inmates. He said that the company acted "expeditiously" to identify those who were potentially affected and that the company believes the potential for their exposure was small.

Though corrections officials and Wexford declined to name the nurse, the Arizona State Board of Nursing identified her as Nwadiuto Jane Nwaohia. She has been under state investigation since June 2012 for unsafe practice or substandard care, but the board would not provide additional information on the nature of the previous problem.

Corrections officials first acknowledged the matter Tuesday morning after 12 News asked about the incident at the Arizona State Prison Complex-Lewis, which houses 5,382 inmates in minimum- to maximum-security facilities.

Hepatitis C is the leading cause of liver transplants and causes liver cancer. Seventy-five to 85 percent of people with hepatitis C develop a chronic infection, according to the U.S. Centers for Disease Control and Prevention.

Shoana Anderson, head of the state Office of Infectious Disease Services, said one of the biggest dangers for those infected with hepatitis C is "it sits in the liver quietly, and 20 years later, a person can develop severe liver disease."

Anderson and Jeanene Fowler, a spokeswoman for the Maricopa County Department of Public Health, said Wexford should have notified them of the issue.

"It's extremely disturbing that something like this could happen. It calls for a thorough investigation to determine all of the surrounding causes of the mistake or the negligence," said Don Specter of the Prison Law Office, a prison watchdog group based in Berkeley, Calif.

Ken Kopczynski, executive director of the Private Corrections Working Group in Tallahassee, Fla., called the incident "scary" and said it shows a lack of oversight by corrections officials.

"This is a problem with privatization," Kopczynski said. "They are just accepting who Wexford will hire."

Wexford, which has previously lost contracts for poor service in other jurisdictions, this spring won a $349 million, three-year contract to provide health care for Arizona inmates. The company began providing services for nearly 40,000 Arizona inmates on July 1.

In a written statement, the Pittsburgh-based company said it suspended the nurse immediately upon learning she "may have compromised a vial of medication by placing it in contact with a previously used syringe."

Wexford, in its statement, said a local staffing agency assigned the nurse to the prison complex. The company said that at no time was the same syringe and needle used on more than one patient and that no staff members were exposed.

Wexford said it reported the nurse to the state nursing board for investigation, but that did not occur until late Tuesday afternoon, after the news had been reported. The company also banned the nurse from working under any of its contracts in the future. Wexford provides health-care services nationwide to roughly 124,000 inmates and other residents at more than 100 institutions.

The state said inmates exposed were notified and are being screened for infectious diseases. An independent laboratory under contract with Wexford will provide continuing medical monitoring and testing of the potentially exposed inmates over the next several months, the state said. All patients will be informed of their results, though Ryan noted that some inmates may previously have been exposed to hepatitis C.

Before the problem at the Buckeye prison, Wexford had issues in other states. Clark County, Wash., declined to renew a contract with Wexford in 2009 at its county jail and juvenile-detention center after complaints that Wexford was not dispensing medications to inmates in a timely fashion.

Action Plan to Prevent, Care and Treat Viral Hepatitis. Live Webcast

Webcast from The National Press Club

http://www.visualwebcaster.com/hepatitisplan

First Amendment Lounge, 13th Floor
529 14th St, NW

Washington, DC 20045

Thursday, May 12
1:00pm - 2:00pm

Created by: Hepatitis C - Caring Ambassadors Program

It is our pleasure to invite you to join HHS Assistant Secretary for Health Dr. Howard Koh and other HHS officials on Thursday, May 12, 2011 as they announce the new

Action Plan to Prevent, Care and Treat Viral Hepatitis.

Though hepatitis is a leading cause of death in the U.S., many people who have it don’t know they are infected, so they are at greater risk for severe – or even fatal – complications of the disease, and at greater risk of unwittingly spreading the virus to others.

The U.S. Department of Health and Human Services is committed to ensuring that new cases of viral hepatitis are prevented and that persons who are already infected are tested, informed about their infection, and provided with counseling, care, and treatment. Comprehensive and sustained efforts are necessary to effectively eliminate this epidemic. Please join HHS officials and community representatives as they discuss the actions necessary to achieve this goal.

Howard K. Koh, M.D., M.P.H., HHS Assistant Secretary for Health

Kevin Fenton, M.D., Ph.D., FFPH, Director, National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention, Centers for Disease Control and Prevention

Jim Macrae, M.A., M.P.P., Associate Administrator for Primary Health Care, Health Resources and Services Administration

Michael Ninburg, Community Perspective

Su Wang, M.D., Provider Perspective

WHEN:
Thursday, May 12, 2011
1:00 – 2:00 p.m. ET

WHERE:
The National Press Club
First Amendment Lounge, 13th Floor
529 14th St, NW
Washington, DC 20045


To attend the event in person, please RSVP to rsvp@team-psa.com by 5:00 p.m. Monday, May 9, 2011.


The event will also be webcast live at: http://www.visualwebcaster.com/hepatitisplan

Have a Heart 4 AHCCCS Transplant Patients

FRANCISCO FELIX: Father of 4 beautiful girls.
Hepatitis C AHCCCS Patient on Liver Transplant Waiting List.
Needs $500,000.
Car Wash today and Tomorrow.

--------------------

My friend Julie Acklin and I spent a few hours today with the friends and family of Francisco Felix, a Hepatitis C patient in need of a liver transplant. He actually had a match donated to him by a family friend who passed away in November, but he couldn't afford the $200,000 tab - and the state refused to step up to pay it.

Francisco is one of 98 patients in our state (now 97, I believe, with Mark Price's death) who lost funding this fall for their desperately needed organ and tissue transplants through the Arizona Health Care Cost Containment System (AHCCCS - Arizona's name for Medicaid, which is less and less accessible under our compassionate conservatives). Several of the links I've embedded in this post will help you find out who voted for and against the cuts, but I can tell you it was pretty much a party-line thing. A week or so ago I protested at the Capitol and blogged on this issue, too (see "Bury My Heart in An AHCCCS Patient").

13-year old Carlos Olivas, Jr. (above, with Jessica Felix) also hit the Capitol to protest and has been everywhere fund-raising recently. I met him at the car wash today, and he's an amazing kid. Read the CNBC story about him if you need some inspiration to stop talking and take action for these folks. He's pretty humble about it, but as I understand it, he's single-handedly raised nearly $2,000 for the cause so far. Really, all those kids out there today were heroes; just a few (including Francisco's daughters) are pictured here.

The AZ Senate Democrats have filed a bill to restore the transplant funding, but they aren't the ones in control of the state legislature - the Republicans are, so lobby the Governor and your lawmaker for it hard, reminding them that it's our money they're depriving Arizona's families of, not theirs.

Anyway, the occasion today was a yard sale and car wash being held to raise money for Francisco, who will now need about $500,000 for his transplant and related expenses. A lot of people turned out, but I don't think we raised enough. In fact, I'm sure we didn't.


There will be another fundraiser for him tomorrow as well, so please bring your dirty cars, a little cash, and some rich friends or Republican legislators to support the cause.

It's being held from 7am-3pm at the entrance to Acclaim Charter School at 7624 W. Indian School Rd., on the West side of Phoenix between 76th and 77th Ave.

The easiest way I found to get there from my place on Central and Roosevelt was to hop on the I-10 going West, take the 75th Ave exit North, and head up to Indian School Road, where you'll make a left, going West again. About 1/4 mile down the road you'll see a ton of eager children on your right (probably waving hot pink signs) imploring you to wash your car. Turn in it even if it's already clean.


While you're waiting for your vehicle shop at NAPA Auto Parts (the guy there threw his support behind this whole thing), hit the yard sale for things you might (or might not) need, buy a Francisco Felix t-shirt, or mosey on to the back of the lot to pick up a couple of tacos. If you're really brave, turn your clean car over to me and the kids to have your back window painted. The photos throughout this post should give you an idea of what I mean.




If you can't make it tomorrow, don 't worry - you can still give to Francisco's fund. In fact, that's all I really want for Christmas, so if you really love me, go to the NTAF and donate today.

Thank you in advance for your support.


Feliz Navidad, mis amigos y amigas.



(hope I got that right... Love to all.)

Justicia Ahora: Resist State Violence this Friday.

Ricardo Levins Morales

National Day of Action Against Police Brutality

Friday, October 22, 2010 11am- 1pm

MEDICAL NEGLECT
IS VIOLENCE:

STOP KILLING THE PRISONERS!!!

Arizona Department of Corrections
1601 W. Jefferson St. (at 16th Ave)
Phoenix, AZ 85007
(park in the SE lot at Wes Bolin off Jefferson - the ADC is across the street.)


17 suicides/15mos
5 homicides/9 months
6,000 HCV+ prisoners and counting…

HARD TIME HEP C ALLIANCE - AZ
http://hardtimehepc.blogspot.com

For more information, contact:
Peggy at 480-580-6807 or
prisonabolitionist@gmail.com

ALL FAMILIES WELCOME:
CHALK, BUBBLES,
and GREAT PEOPLE WILL BE THERE.

PLEASE WEAR BLACK.
BYOB. A sack lunch would be smart, too.

Youth on Fire: Heroin and Hep C everywhere.

I read this last night and wept. This thing is going after our kids with a vengeance. It's already bigger than AIDS. What's it going to take for us to step up the to fight with everything we've got? How will kids get help while they still have hope if they're too afraid of arrest?

We can't just keep throwing addicts into prison and leaving them to die there, but in America, chains and cages for our people seem to be all we're willing to invest our resources in. How is that either good public health policy or justice?

---------------------------

Hepatitis C Spikes Among Young Heroin Users

By Martha Bebinger

WBUR

Sep. 9, 2010, 6:27 AM

BOSTON — Heroin, a drug that claims nearly two lives in Massachusetts every day, killed a young woman in Cambridge late last month. She had just turned 18 when she overdosed alone in a bathroom.

“It was a real tragedy, it always is,” says Michael May, the outreach coordinator at Youth on Fire, a teen drop-in center in Cambridge. “She was really young, had been using for a long time and was a pretty key fixture in the community around here.”

May worked with the girl he can’t name and worries that the epidemic he fights every day is gaining steam.
“This summer has been very intense for heroin use in this area,” May says. “And we’ve been getting a lot of kids who, rather than a slow progression into injection drug use, have kind of jumped right into it.”

Needle Use On The Rise

This signals trouble for diseases transmitted through needles, which are also on the rise. The Department of Public Health says infection rates for Hepatitis C in 15- to 25-year-olds have almost doubled since 2002. But there’s no money in this year’s budget for Hep C prevention or to treat new patients.

Hepatitis C is passed through blood in needles, on cotton and on other equipment drug users share. It is 10 times more infectious through a needle stick than HIV. If untreated, Hep C inflames, scars and can ruin your liver.

Dan Church, an epidemiologist at the Department of Public Health, says a spike in Hep C among young heroin users is an urgent matter.

“It’s very alarming to see these numbers of cases with a disease that we really have not seen in this age group for quite some time.” So I think it’s very important that we start thinking about how we can prevent Hepatitis C and provide them education so they will not continue to transmit this disease unknowingly to other people,” Church says.

That is happening. Heroin users and counselors say Hep C is everywhere.

“Once I found out about Hep C, it was just like, yeah, everyone has Hep C,” says Gabe, a 23-year-old who fears arrest if he gives his last name. He started shooting heroin nine years ago but says he only uses occasionally these days.

Gabe does not have Hep C. He tries to keep a few clean needles on him as he moves between Boston and his other home base, Chicago, hopping freight trains, but it doesn’t always work out.

“I’ve definitely gone back and grabbed my old needles off the ground; I don’t know if someone used them, or somebody else’s got dropped there,” Gabe says.

“I generally kept them hidden in one spot but sometimes, you know…”

In Cambridge, and in the the state’s three other needle exchange programs, counselors work Hep C into their prevention talks even though state funding was eliminated this year. May, from Youth on Fire, has a list of precautions he urges users to take. But he knows they may not stick to them in the heat of the moment.

“If somebody’s in a hurry, if they’re sick, it’s just now, now, now,” May says, “and then after they get well is when the rational thinking comes back into play.”

What’s also scary, May says, is that many users aren’t too worried about Hep C.

Johnny, a 24-year-old who also won’t give his last name because he worries about being apprehended by police, sleeps in the woods and hangs out at “Youth on Fire” during the day. He has Hep C.

“It just makes you tired, that’s it. I mean, people can live with it for the rest of their lives right and not die,” he says.

Johnny may be able to manage Hep C with a good diet, rest and no drugs or alcohol. But even if he gets worse, he says he won’t seek treatment because “I heard it makes people really sick and it can kill you.”

Treating Hep C

Hepatitis C is difficult to treat. The drugs won’t kill but they can make patients feel like they have the flu on and off for six months to a year and are only effective in 30 to 40 percent of cases. But on the medical side, things may be looking up.

“We’re really on the dawn of a new era of treatment for Hep C,” says John Ward, director of the division of viral hepatitis at the Centers for Disease Control. “The drugs we have now aren’t specific for the virus.”
Ward says new drugs that are specific to Hep C could be on the market next year.

“When those [new drugs] come on, it will probably double the likelihood of being cleared of this virus and having to go through about half the weeks of treatment,” Ward says.

Ward is understandably excited about better treatment options. In addition to the new wave of young people infected with Hep C, one in 30 Baby Boomers have it, according to the CDC. They could have been infected through a blood transfusion if it occurred before 1992 or in a non-licensed tattoo parlor, but the main way people get Hep C is through intravenous drug use. Cynthia Jorgesen, who runs education and training programs at the CDC, says many people don’t want to recall a past that might have included Hep C.

“Because of that association with negative connotations,” she says, “a lot of people don’t assume they’re at risk because they’re not ‘one of those people.’ ”

Baby Boomers And Hep C

Sixty-five to 75 percent of Baby Boomers who have Hep C don’t know it. Ward says that’s because “they call Hep C the silent epidemic. You can live for decades and don’t know you are infected. The liver doesn’t complain much until it is very, very ill. So you don’t get sick often until it’s too late to help the liver.”

The CDC says death rates are expected to triple in the next 10 to 20 years if the Boomers don’t find out they have Hep C before they get seriously ill.

Most health insurance plans cover a Hep C screening if there’s reason to think you need one. The Department of Public Health is hoping word about Hep C will spread faster than the virus until there’s money again for prevention and new treatment.

From Conspire to Perryville, with love.

I did a few actions earlier in the evening, chalking up the sidewalks outside of the Goddard Brewer debate, bringing my signs by the Capitol and ADC for some postcard photos, and stopping by Conspire to get some friends to help me show some solidarity with the women at Perryville / Santa Cruz who are on lock-down and have been resisting the conditions there...




Note that this cop doesn't hassle me -
he just looks curious. (Central)

(First St./KAET)

I knew the ADC central Office would want to show the women their support, so I included them in my evening shoot. The light was awesome.












While I was there, I also pulled my Hep C
sign out - looks pretty sharp, eh?
Great postcard that'll make.

Didn't want to leave the Governor's office out, either.

And finally, the women of Conspire,
in solidarity with our sisters in Perryville Prison.
Resist!

Dear Director Ryan: Community standards for treating Hep C.

More unanswered correspondence with Director Ryan about Hep C. For all I know he's just sending me to his Spam Box now. The only way I can be relatively sure he sees this is by posting it or hand-delivering it - and I don't want them to trespass me down there if I show up too much.

Besides, this has useful info for everyone. Check out the links to the professional standards. Keep in mind when they were written, too.

-----------------------------

Arizona Prison Watch	Fri, Aug 20, 2010 at 10:15 AM
To: cryan kklausner
For all my criticism of them (which still stands), at least the CDC has easily-accessible information on the basics. Robertson stopped evaluating the extent of Davon's liver disease - and possible co-morbid conditions - when he should have kept going. He still needs the genotyping done to make sure he doesn't have more than one strain of HCV, and to determine the likelihood that he'll even respond to treatment. And in light of the increased risk for disorders like diabetes (and his weight loss and fatigue), his glucose should be monitored more regularly to determine what his ranges are. Davon should also be treated like a human being, not a veterinary specimen - no one seems to really be trying to educate him on his medical condition or lab results, or even ask him about his fatigue, weight loss, headaches, etc. despite hearing concerns from Julie multiple times a week. ------------------------------- CDC HCV FAQs: Testing and Diagnosis Who should be tested for HCV infection? HCV testing is recommended for anyone at increased risk for HCV infection, including: Persons who have ever injected illegal drugs, including those who injected only once many years ago Recipients of clotting factor concentrates made before 1987 Recipients of blood transfusions or solid organ transplants before July 1992 Patients who have ever received long-term hemodialysis treatment Persons with known exposures to HCV, such as healthcare workers after needlesticks involving HCV-positive blood recipients of blood or organs from a donor who later tested HCV-positive All persons with HIV infection Patients with signs or symptoms of liver disease (e.g., abnormal liver enzyme tests) Children born to HCV-positive mothers (to avoid detecting maternal antibody, these children should not be tested before age 18 months) What blood tests are used to detect HCV infection? Several blood tests are performed to test for HCV infection, including: Screening tests for antibody to HCV (anti-HCV) enzyme immunoassay (EIA) enhanced chemiluminescence immunoassay (CIA) Recombinant immunoblot assay (RIBA) Qualitative tests to detect presence or absence of virus (HCV RNA polymerase chain reaction [PCR]) Quantitative tests to detect amount (titer) of virus (HCV RNA PCR) How do I interpret the different tests for HCV infection? A table on the interpretation of HCV test results is available at http://www.cdc.gov/hepatitis/HCV/PDFs/hcv_graph.pdf [PDF - 1 page]. Is an algorithm for HCV diagnosis available? A flow chart on HCV infection testing for diagnosis is available at http://www.cdc.gov/hepatitis/HCV/PDFs/hcv_flow.pdf [PDF - 1 page]. What is the next step after a confirmed positive anti-HCV test? The level of ALT (alanine aminotransferase, a liver enzyme) in the blood should be measured. An elevated ALT indicates inflammation of the liver. The patient should be checked further for chronic liver disease and possible treatment. The evaluation should be performed by a healthcare professional familiar with chronic Hepatitis C. Can a patient have a normal liver enzyme (e.g., ALT) level and still have chronic Hepatitis C? Yes. It is common for patients with chronic Hepatitis C to have liver enzyme levels that go up and down, with periodic returns to normal or near normal levels. Liver enzyme levels can remain normal for over a year despite chronic liver disease. Management and Treatment What should be done for a patient with confirmed HCV infection? HCV-positive persons should be evaluated (by referral or consultation, if appropriate) for presence of chronic liver disease, including assessment of liver function tests, evaluation for severity of liver disease and possible treatment, and determination of the need for Hepatitis A and Hepatitis B vaccination. When might a specialist be consulted in the management of HCV-infected persons? Any physician who manages a person with Hepatitis C should be knowledgeable and current on all aspects of the care of a person with Hepatitis C; this can include some internal medicine and family practice physicians as well as specialists such as infectious disease physicians, gastroenterologists, or hepatologists. What is the treatment for chronic Hepatitis C? Combination therapy with pegylated interferon and ribavirin is the treatment of choice, resulting in sustained virologic response (defined as undetectable HCV RNA in the patient's blood 24 weeks after the end of treatment) rates of 40%–80% (up to 50% for patients infected with genotype 1, the most common genotype found in the United States, and up to 80% for patients infected with genotypes 2 or 3). Combination therapy using interferon and ribavirin is FDA-approved for use in children ages 3–17 years. Treatment success rates are now being improved with the addition of polymerase and protease inhibitors to standard pegylated interferon/ribavirin combination therapy. How many different genotypes of HCV exist? At least six distinct HCV genotypes (genotypes 1–6) and more than 50 subtypes have been identified. Genotype 1 is the most common HCV genotype in the United States. Is it necessary to do viral genotyping when managing a person with chronic Hepatitis C? Yes. Because there are at least six known genotypes and more than 50 subtypes of HCV, genotype information is helpful in defining the epidemiology of Hepatitis C and in making recommendations regarding treatment. Knowing the genotype can help predict the likelihood of treatment response and, in many cases, determine the duration of treatment. Patients with genotypes 2 and 3 are almost three times more likely than patients with genotype 1 to respond to therapy with alpha interferon or the combination of alpha interferon and ribavirin When using combination therapy, the recommended duration of treatment depends on the genotype. For patients with genotypes 2 and 3, a 24-week course of combination treatment is adequate, whereas for patients with genotype 1, a 48-week course is recommended. Once the genotype is identified, it need not be tested again; genotypes do not change during the course of infection. Can superinfection with more than one genotype of HCV occur? Superinfection is possible if risk behaviors (e.g., injection drug use) for HCV infection continue, but it is believed to be very uncommon. Does chronic Hepatitis C affect only the liver? A small percentage of persons with chronic HCV infection develop medical conditions due to Hepatitis C that are not limited to the liver. These conditions are thought to be attributable to the body's immune response to HCV infection. Such conditions can include Diabetes mellitus, which occurs three times more frequently in HCV-infected persons Glomerulonephritis, a type of kidney disease caused by inflammation of the kidney Essential mixed cryoglobulinemia, a condition involving the presence of abnormal proteins in the blood Porphyria cutanea tarda, an abnormality in heme production that causes skin fragility and blistering Non-Hodgkins lymphoma, which might occur somewhat more frequently in HCV-infected persons Where can I find more information about management and treatment of patients with chronic Hepatitis C? The American Association for the Study of Liver Diseases: AASLD Practice Guideline: Diagnosis, Management, and Treatment of Hepatitis C . The National Institute of Diabetes and Digestive and Kidney Diseases: Chronic Hepatitis C Current Disease Management. -- Arizona Prison Watch http://arizonaprisonwatch.blogspot.com A community resource for monitoring, navigating, surviving, and dismantling the prison industrial complex in Arizona. “The degree of civilization in a society can be judged by entering its prisons.” - Fyodor Dostoyevsky (1821-1881)