The long way home: Catching up to Davon Acklin.

Some of you may recall Davon Acklin, the Arizona state prisoner who let us use him as a poster child when his mom, Julie, was fighting to get him treatment for Hepatitis C. I corresponded with him for a year while he was in Tucson prison, and had the wonderful experience of greeting him with his family as he was freed this spring. Then my own life fell apart and we lost touch.

Today I saw Davon for the first time since the day he headed home. Sadly, it was to visit him at the 4th Avenue Jail. He's facing at least four felony charges, and - needless to say - violated his probation. He's going away for a long time this time; it may be more than ten years before we see him walk free again...except that he was once a free man in prison. I keep telling myself that, hoping that wherever he lands he can find himself again - what's he's been wearing lately are the worst kind of chains, anyway.

I still don't know just what happened over the course of the past five months, and will leave that story for him to tell when he's ready. I can say, though, that when I saw Davon today he was calm, rational, and appropriately remorseful for hurting those who love and believed in him. He reports that he's getting his psych meds, at least; the place is just a miserable place to be, and he's sick as a dog right now. I suspect he's going through withdrawal. He denied being suicidal, expressed appreciation for those who have tried to help him, and apologized "for being such a fuck-up". I tried to reaffirm that some folks still haven't bailed on him, and that his mom isn't about to give up.

Despite his effort to begin to make amends, I don't think Davon has any idea of how badly he really hurt people this time - I'm figuring out just how to tell him, though. The hurting from this binge has only just begun, too. He didn't just break Julie's heart and devastate his sister, he invited violence into his family's home that may not leave with him when he goes. He compromised the fight to overcome all the barriers to getting Hep C treatment for people with psychiatric disorders and addictions by giving the state a reason to say "I told you so." He may lose his own battle to get interferon now. His mother may well have to recover his body from prison, or see him buried there.

Davon is not responsible for having a mental illness, or even for being an addict any more so than if he had diabetes. He is responsible for his recovery, though, and made decisions when he was well that compromised his ability to make good choices in a very short period of time. Whether or not he was competent at the time he committed the crimes he's accused of is for him and the courts to work out - we didn't discuss any of that. Today he seems to be in his right mind, though - and almost relieved at the prospect of going back to prison. I think he copped out on us all early on, frankly, and I'm mad as hell at him. I'm also angry that I wasn't able to be there for him when he came home myself, though. There were a lot of things I had wanted to share with him, and before I knew it he was gone again. I know it's my egocentricity that makes me think I might have changed this outcome had I been more present for him upon his release; I wish I had been, though.

I never really expected a fairy tale ending to Davon's relationship with the criminal justice system. He grew up in it - he even accidentally referred to returning to prison as going "home". There's absolutely no meaningful treatment or rehab in prison for the vast majority of dually-diagnosed young men like Davon - or for the women, for that matter. He had a lot of good community support - the probation department was awesome, I guess - but few new tools for coping with stress and expectations when he got out. That's not to excuse him from what he needs to own here, but that's the way it is for far too many prisoners I see who have cycled through the system more than once, so I think there's more at work than just Davon's pathology here.

This isn't the end of this young man's story or his struggle to keep from succumbing to either despair or Hep C - nor is his life yet over. In recovery from addictive disorders - especially for those with mental illness as well - relapse is common, and is often so much worse than before because one has to be sicker in order to go back into denial. But Davon doesn't necessarily forget what he learned before - he matured once, and can continue in that direction wherever he lands. Even in prison he can be a positive influence in the lives of others, if he's given the right support so he's able to make informed and capable decisions. Psychiatric disability or not - in prison or at home - Davon can still choose what kind of human being to be. Only when he surrenders that will I believe he's really lost his freedom.

Anyway, I'll let you know when he moves, but will otherwise be giving Davon and his family a break from my blogs while they sort things out. If you've been a correspondent of his, I think it would help him to know that even in back prison he's accountable to his fellow beings for his behavior and commitments. You can trust his mom and I to kick his ass over this, so to speak, but feel free to do so as well if you've been hurt, too. Just try to keep a door open for him if you can; he should be safe, but he really doesn't deserve exile. He needs to make amends and reconcile with not only his family but the community that supported him in order to grow and reduce the chances of this happening again.

Summer Solstice 2011
Firehouse Gallery and Cafe'
Phoenix, AZ

AHCCCS Transplants: Dream a little dream for me...

New Coalition Seeks to Restore Arizona Medicaid Funding

98 Arizonans were promised then denied coverage for life saving organ transplants. New Coalition forms to pressure legislature and Governor to restore funding.


FOR IMMEDIATE RELEASE
Jan 13, 2011

For more information contact:
Bob Aronson
904-434-6512
Jacksonville, Florida
bob@baronson.org
http://bobsnewheart.wordpress.com

New Coalition Seeks to Restore Arizona Medicaid Transplant Funding

A powerful new organization has been formed to help restore Medicaid coverage for Arizona organ transplant patients and to prevent similar cuts in other states. The mission of “The Dream of Life Intervention Coalition” (DLIC) is to help patients with life-threatening health conditions get or keep Medicaid and/or Medicare insurance coverage.

The DLIC will emphasize four points in its campaign:

1. Denying Medicaid patients organ transplants is a death sentence. Transplants are their only option for living. (Two have already died in Arizona and 30 more could die this year. Many children will be left with one parent, others could become orphans).

2. If we don’t reverse the Arizona situation it could be seen by other states as permission to do the same thing and these death panels will begin to spread across the nation (If that happens, thousands if not millions could be sentenced to death and despair by budget slashing, heartless politicians. What’s next, banning chemo or radiation therapy for cancer patients? Is that what America is about?)

3. DLIC strongly believes that sending people to their death is no way to solve budget problems (doing so flies in the face of the constitutional guarantee that our government exists to protect its citizens and provide for their general welfare. The constitution does not say that killing citizens is permissible if it will save money.)

4. We do not want to allow these issues to go unaddressed and therefore encourage medical tourism or influence migration to other states or countries that have more accessible health benefits (that would shift the burden to regions that are unprepared to absorb the impact while maintaining the human and moral commitment to be socially responsible for our citizens).

Circumstances

On October 1, 2010 the state of Arizona told 98 of its legal citizens that Medicaid would not cover life saving organ transplants despite having promised them earlier that the procedures would be covered. Since that order, two of the 98 have died and another is said to be selling her belongings in order to move somewhere where Medicaid will cover her liver transplant. Governor Jan Brewer says the cuts were made to help reduce the state’s budget deficit. She remains opposed to restoring the funding.

Last Monday January 10, 2011, leaders of several advocacy groups joined in a conference call with Arizona senate Minority leader David Schapira and State Senator Kyrsten Sinema (D) to discuss the issue. Senator Sinema has introduced a bill she says would provide more than enough money to restore transplant funding and provide millions more to help reduce the state’s budget deficit.

The conference call revolved around ways in which DLIC could assist with the effort to restore funding. While the Governor’s office says the transplants would cost nearly $5 million, Jennifer Carusetta, legislative liaison for Arizona Medicaid, says cutting transplants would only save $800,000 in the current fiscal year, and only $1.4 million for a full year.
Participating in the call was William Remak Chair of the National Association of Hepatitis Task Forces (NAHTF), two time liver transplant recipient and cancer survivor; Julie Acklin, Arizona Director of the NAHTF; Bob Aronson, heart transplant recipient and founder of Save the Arizona 98 and Facebook’s Organ Transplant Initiative; Patricia Lupole, Director of the Hepatitis C Veterans group (thehvcvets.com) and Flor Felix representing her husband and some other Arizona citizens who have been denied Medicaid covered organ transplants. We will soon announce other members.

Senators Schapira and Sinema said that while Democratic support for the bill was strong, some in the Republican majority were willing to review it while others were less enthusiastic. As a result the new group, Dream of Life Intervention Coalition, decided unanimously to embark on a nationwide campaign to bring greater visibility to the Arizona situation and to rally public opinion to put increased pressure on Arizona officials to restore Medicaid covered organ transplant funding. Additionally DLIC will work to help ensure that Medicaid cuts throughout the country at state levels do not result in restricting life saving interventions for people in dire circumstances.

DLIC is working on a more detailed communication plan and will soon provide the public with steps they can take to begin the campaign to stop the dying by restoring funding.

***William (Bill) Remak, BSMT, BSPH, SGNA, AHCJ., has initiated coordinating this collaborative effort in response to the pleas and desperation demonstrated by the families of the chronically ill from the neighboring state of California where he sits on the steering committee of the California Chronic Care Coalition. Bill said.” No state public servant or elected official should sacrifice the lives of their constituents as a means to flex their political party muscle or power by using policy to destroy the fabric of our value as human beings. It defeats the core of our ability to thrive as a nation and can only lead to the devastation of mankind.”

-30-

“Character cannot be developed in ease and quiet. Only through experience of trial and suffering can the soul be strengthened, ambition inspired and success achieved.” -Helen Keller (1880 – 1968)

# # #

Dream of Life Intervention Coalition is an non profit advocacy group that seeks to help patients with life-threatening health conditions get or keep Medicaid and/or Medicare insurance coverage. Our first project is to restore Arizona Medicaid funding for the 98 people who were denied organ transplatns. Bob Aronson is the founder of Save the Arizona 98 www.savethearizona98.com and Facebook's Organ Transplant Initiative.

And the World Changed: Mass Clemency for Christmas.

I'm taking Davon Acklin's family to prison today to see him for Christmas and may not be blogging much until tomorrow. Will thus leave you all with the wise words of another to contemplate and dream on: a marvelous holiday essay for all the prisoners and their loved ones out there, printed last year in the Huffington Post...


Blessings to all. Be safe and well this day.


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



What I Want For Christmas: Mass Clemency

Jacob M. Appel
Bioethicist and medical historian
Posted: December 23, 2009 09:41 PM


The United States Constitution and the laws of most states permit the President and governors to issue pardons and commutations, a prerogative frequently exercised during the winter holiday season. Unfortunately, with a few laudable exceptions, our chief executives have displayed considerable stinginess--and even outright political cowardice--in exercising this remarkable power.


President George W. Bush drew criticism from liberals for only pardoning 189 individuals and commuting 11 prison sentences during his eight years in office, but Bill Clinton cut short a merely marginally better 61 prison terms and pardoned only 396 convicts. Most of those pardoned each year have committed small-stakes crimes in the distant past such as selling bootleg whiskey or passing bad checks. Others, like Dan Rostenkowski and George Steinbrenner, are politically well-connected. It often seems that the principal purpose of these rare reprieves, much like the pardoning of a Thanksgiving Day turkey, is to make the pardoning politicians appear generous and affable to the electorate.


Yet with the United States now boasting the highest incarceration rate in the world -- more than 1 in every 100 Americans in currently behind bars -- our nation is long overdue for a mass clemency of non-violent felons and those unlikely to re-offend. Such a collective pardon and commutation would reunite hundreds of thousands of families, save billions of dollars in incarceration costs, and might foster a national spirit of forgiveness and reconciliation.


Few American politicians have dared to issue mass clemencies in the past. Andrew Johnson's grant of amnesty to former Confederate soldiers and Jimmy Carter's pardon of Vietnam-era draft evaders are likely the two largest acts of blanket forgiveness -- and both helped to heal our national wounds after periods of great division. Former New Mexico Governor Toney Anaya and ex-Illinois Governor George Ryan both deserve credit for commuting all of their state's death sentences to life terms. However, our current political leaders -- in both parties -- far more often appear afraid to ask for broad or bold clemencies.


John McCain's drive to secure a pardon for African-American boxer Jack Johnson -- convicted in 1913 of violating the Mann Act for his relationship with a white woman -- embodies this problem. Don't misunderstand me: I am all for pardoning Johnson, and Ethel Rosenberg, and Sacco & Vanzetti, and righting as many of the moral miscarriages of history as possible. However, I would much rather free the thousands of non-violent offenders serving long sentences under the draconian Rockefeller drug laws in New York State. So here's my Christmas wish: Each chief executive should order a special panel to determine, as quickly as possible, which prisoners either have a history of extreme violence or pose a high risk of re-offending. Those meeting neither criteria should be transitioned home as quickly as possible.


The advantage of a mass clemency is that it can be framed in terms of social policy and a spirit of charity, rather than the merits of any specific incident. That is not to say that there are not thousands of individual cases worthy of attention. In Michigan, for example, Shontelle Cavanaugh has now gone nearly five years without a trial for smothering her infant during a psychotic break -- a calamity compounded when the local prosecutor withheld video footage of Cavanaugh at the height of her psychosis. Governor Granholm could order this unfortunate woman's release. And there is the tragic case of Michelle Collette in Massachusetts, whose own trial judge blasted the severity of her seven-year sentence for possession of 14 to 28 grams of illicit oxycodone -- an injustice that could be rectified by Governor Patrick. But by focusing on these individual cases, as compelling and heart-wrenching as they may be, one risks losing sight of the greater cruelty of denying human beings liberty long after they pose any meaningful threat to society.


An individual pardon focuses on the nature of the crime. A mass pardon allows us to transcend questions of right and wrong. Unlike an individual grant of clemency, which often suggests that a miscarriage of justice has occurred, a mass clemency avoids the controversial issue of whether justice has been served and focuses on the question of whether it furthers any ethical purpose to perpetuate the punishment. One could simultaneously pardon Scooter Libby and all of the undocumented immigrants detained on identity-fraud charges while still avoiding the political hot potato of endorsing their specific conduct.


While an individual pardon may appear to be a slight to crime victims, who also merit our recognition and empathy, a collective pardon does not mitigate the respect that we should accord these victims' suffering. Moreover, a one-time mass clemency does not undermine the deterrent effect of stiff criminal penalties, because no potential offender is ever going to break the law in the hope that a second, future mass clemency will free him if he is arrested.


One of the glaring -- yet too often overlooked -- failings of contemporary America is that we have become a nation obsessed with justice and retribution. We claim to be The Land of the Free, yet we have lost sight of what it means to be imprisoned: denied liberty and access to one's family, subjected to isolation and violence and unspeakable boredom. We have come to believe, in the most pernicious way, that people should get what they deserve. What a sea change it might be in our public discourse and our civic life if we focused instead upon mercy and forgiveness. A merciful and forgiving culture might find itself with less anger, less social disruption, and even less crime. If we liberated only half of our prisoners, we could spend the billions of dollars saved educating children, or providing substance-abuse treatment to addicts, or training mental health workers -- breaking the cycle of neglect that sets future prisoners on their initial trajectory toward misconduct.


I am not naive enough to believe that all of our prisoners should be freed. Some individuals are truly unfit for reintegration into society. No reasonable person would argue that Charles Manson or Scott Roeder or admitted Al Qaeda terrorists should be sent home for the holidays. Fortunately, the majority of our more than two million prisoners are not fanatics and sociopaths. Many are good people who have exercised poor judgment. They have the same hopes and dreams as ordinary, free Americans, but they now squander their lives behind bars because our prison-industrial complex has gone haywire. They are, in short, the meek and wretched who the Biblical Jesus -- whether literal or figurative -- would want us to remember in our holiday prayers.


Will the White House read this column and decide upon a mass clemency? Unlikely. Such a bold step might make President Obama truly worthy of his Nobel Prize, and win him the praise of history, but political leaders of all stripes think in terms of poll numbers. I suspect that a mass clemency could be sold to the American public -- particularly as more and more Americans find their own loved ones imprisoned -- but I understand that to attempt such a courageous step requires a leap of considerable faith. I am more optimistic that, if enough people clamor for a mass clemency, one inspired state governor -- possibly a lame-duck chief executive without a political future -- will consider such a dramatic and compassionate act. If that happens, and the social order does not crumble, other political leaders may have the courage to follow. In the interim, I can only hope that the government lawyers assembling last-minute pardons lists, possibly as I write this, remember that each name they add to their clemency register is another flesh-and-blood human being who will be able to spent the Christmas holiday with his or her family.

from the Syracuse Cultural Workers

Arizona: Mercy, Mercy Me...

Davon's clemency board hearing was yesterday - the decision to turn him down was clearly made before we walked into the room, however. The chair made only passing reference to the thick stack of mail that had arrived in support of Davon's application, and cut me off when I was speaking on his behalf. He made a special point of reading things into the record to justify their determination against him. The county attorney's office can be expected to oppose such applications, but they went out of their way, it seems, to damn him - which was precisely what the board needed and asked for. Not that I'm accusing them of any impropriety - I'm sure they did what they felt was right - just as I'm doing. We just come from different places, and they don't know Davon like I do. As evidenced by their decision yesterday, They don't know him at all.


Pardons in Arizona have nothing to do with mercy or grace, by the way - or even justice for that matter, even when sincere people try to deliver it. Look at what our good governor did to Bill Macumber, the innocent man who has already spent 35 years in prison for murder and may well die there. Convinced beyond any doubt that his conviction was based on perjured testimony and manufactured evidence, the Arizona Board of Executive Clemency unanimously recommended him for a full pardon, which would have gone into effect if Brewer had simply left it alone for 90 days. Instead she quashed it, in the interest of her kind of "justice". Affirming Bill's innocence would have implied his ex-wife's guilt. As she worked for the Maricopa County Sheriff's office at the time she framed him, I suspect Brewer was doing someone with history there a favor. But what do I know?



Sadly, despite his story saturating the media across the country before November 2, the voters in Arizona elected that woman anyway.



As for Davon: the outcome of his hearing was no surprise, really - probably least of all to him - but it was still a disappointment; his little sister left the room abruptly in tears. We did, however, raise awareness about the prosecution of the seriously, mentally ill for their symptoms rather than their criminality, and built a network for prisoners with Hep C and their families. We also entered our objections to the prison industrial complex into the public record (that was the part I think they didn't want to hear). One of our legislators even turned out to corroborate Davon's mom's assertion that Arizona's prisoners aren't getting the medical care they need in there - and that came from a self-described "conservative Republican". I suspect he will pay a price for having done that, which is why I won't name him here. I doubt he would endorse my own take on the system, but he's still one of the few politicians I've ever met with real integrity. I can't think of a single Democrat in this state who would put themselves on the line like that for a convicted violent, crazed felon seeking mercy - much less another Republican.



I'm convinced that clemency boards exist largely to reinforce the illusion that the system we have of doling out punishment in our country is a "just" one that serves the best interests of society at large. By allowing room for pardons and commutations, we suggest that the legal system we live under, as a rule, delivers justice to criminals and victims alike, and that any abuse of power or injustice perpetrated by the state in the process is an exception that needs to be dealt with on a case-by-case basis. If that was the reality, however, our prisons would not be packed almost exclusively with the poor - most of whom have the least ability to do great harm. In a truly just and morally evolved society it is the money-lenders, warmongers and rogue sheriffs of this land who would be doing time for exploitation, mass murder, and kidnapping - not making the rules the rest of us have to live by. They certainly wouldn't be retiring with honors and drawing down our collective dime.



But ours is neither a just nor a moral society - it isn't even a democracy. It is a capitalist republic in which the wealth and power of the few still depends on their ability to co-opt, terrorize, and restrain the many. We literally replaced our plantations with prisons when overt slavery went out of style. America's governments exploit and injure far more innocent and vulnerable people than all our lone criminals combined do. We've even made the perpetuation of victimization and crime an attractive, acceptable industry from which savvy investors can profit.



Thanks, everyone, for all your support through this. Stay with us, please - this fight is much bigger than one young man, and has only just begun. Keep an eye on what's happening with Davon for awhile longer - he went further out on a limb in the interest of prisoner rights and health care than any of the rest of us had to - and risks paying a much higher price now than the one extracted from him at sentencing. We'll see if he's allowed to keep his good time - and make it successfully through the 4 years of probation he has yet to serve -in light of his and his mother's public defiance. I guess we'll also see if the Arizona State Legislature shows any mercy for the honesty and courage of one of their own.

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)

Dear Director Ryan: Writing to Goliath.

The following is an excerpt from an email I sent to Director Charles Ryan at the Arizona Department of Corrections this weekend. I offered to meet him in his office to discuss a few things, so don't expect me to post a written response from him - they aren't often forthcoming, as emails have their way of making it to court.

My side was a long letter, though - this part of which was a complaint about the phone call I witnessed Friday between Julie and Ryan's people. I still can't figure out how to get the video of that call posted and distributed, but will leave those links here once I do. That recording is as real as it gets, and everyone who's advocated on Davon's behalf needs to see it. Keep acting up out there.

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

"...By the way, your doctor was really cruel and condescending to Julie Acklin and owes her an apology - at the minimum - as far as I'm concerned. If you all taped that conversation from your end, you'd better play it back. I hope you weren't there condoning his behavior. I also hope you know more about Hep C in prisons than he does - and more about your high profile prisoners, too. He didn't even know if the patient he swore was in no mortal danger had been tested yet for HIV - yet he seemed to think that Davon hadn't asked for an HIV test, either (which was by way of justifying why he wouldn 't have had an HIV test. He knows that kid wouldn't have known to ask before all this.).

That's inexcusable. Furthermore, it's a standard Hep C practice guideline, even in prison, for the physician to automatically test for other forms of hepatitis and HIV whenever a lab comes back HCV+. He should have had some certainty that Davon had been tested if he knew his patient was so healthy that he wouldn't even evaluate him further at this time.

He's full of it. This guy is either strategically trying stall and ridicule Julie, or he really hasn't been keeping up with his profession, so you might want to check him out again. Even I know more about current treatment recommendations than he does. And medical ethics, apparently.

My report of how that conversation went will be in my blogs, whether or not we plan to meet this week - there's no damage control to be done to head off that one. It exemplifies the stone wall your administrators maintain when you're really into denying a problem that everyone else out here can already see - like security in the private prisons...we've been screaming about a lot of this stuff for awhile. Funny how it's ending up an election issue. It still looks a lot like you're waiting Marcia out - as if you're hoping we collapse from the heat or fatigue and shut up already. I guess your doctors are pretty much the same...

...Regarding Davon - whether it takes five months or 15 years to kill that kid, I'll figure out how to prove that he could have become virus-free and avoided such a fate if he'd been treated according to current community standards now, before his liver functioning deteriorates any further. You could be responsible for helping spread Hep C through the community, with the shoddy care he's received.

The one good thing the doctor had to say today is that it may still be early enough in the progression of the disease that there's still hope if he gets prompt treatment - even though he refused to admit that's what he was really saying. That part - the hope - I celebrated tonight. But it is good news that Davon isn't in imminent danger of dying only if that is true, and your physician didn't exhibit a lot of knowledge about either Davon or Hep C..."

Mother and Goliath: The AZ Department of Corrections.

Julie had a phone appointment with Davon's prison doctor Friday; it's just taken me awhile to figure out the software to save and upload it for you. This is unedited, so be prepared for Julie to really articulate herself on the whole thing after she hangs up. We can use legal assistance on this if any help is out there, but I'm afraid it won't come in time to get Davon treatment now. Therefore, we still need everyone's help putting pressure on the Governor and the ADC.

I think Julie did a pretty good job dealing with these guys, frankly. And Davon's doctor has some studying up to do. He isn't current on his practices, and doesn't seem to know anything about Davon except a few notes he jotted down to justify refusing him treatment for Hep C. How can he swear that Davon isn't in any kind of imminent medical danger when he doesn't even know if he was ever tested for HIV? (He was, by the way, and needs to be tested again. The original test was negative, though. We knew that already, ourselves...)

Making sure Davon was tested for HIV and other forms of hepatitis (which they, on their own initiative, vaccinated him against) was one of the first things Julie did when she began to learn about this disease. That's a standard protocol in the community these days, so the doctor's ignorance about whether it was even done is both an indicator that he hasn't read the chart very well, and a sign that it isn't standard practice for the prison to do that with everyone who tests HCV +.

In any case, his word about how well Davon is doing can't be trusted. Otherwise, we would have both been celebrating the news from this call, not swearing at the end. Every test that might substantiate his health status is being delayed until October because "it isn't indicated" right now (by the tests that were done nine months ago). Despite their lack of current, critical information, the "Hepatitis C Committee" reviewed Davon's case last week and also decided that "treatment isn't indicated". Based on whose account of his medical condition, I wondered? This condescending osteopath's who doesn't even know his patients? This man tried to justify the possibility that Davon may not have been tested for HIV by stating that he wouldn't have been tested if he didn't ask.


Should he really have to? He's disabled by virtue of his mental illness, and beaten down by the discouragement of trying to get help and being ignored. His mom has to fight him to get him to put in a health request - he doesn't expect them to do anything for him. They don't.

What is the ADC exposing the public health sector to, by botching Hep C and HIV treatment in prison this? They're following guidelines that were developed a decade ago - the research out now totally contradicts half of what these guys try to convince Julie of. And it's very clear that Davon's best chances of ever ridding himself of this virus is before further organ damage occurs, not afterwards, as the ADC stipulates.


The reason that October is the magic month to do further labs on Davon, by the way, may have to do with the ADC's budget cycle. It really means that nothing will be done until November, when they have new money again. They've probably spent their medical budget for the year on 911 calls to prisons where they don't really have 24-hour clinical staff on site, as they suggest that they do.


Note that what the doctor is telling Julie, by the way, is not only that Davon won't be getting any treatment right now for his Hep C, but that he won't be recommended for medical release to the AZ Board of Executive Clemency, either.

That makes your appeals to them all the more important. Take the time to write a letter. Insist that these young guys with a shot at responding to treatment get to choose whether or not to go through it. Assert that this community's standards of care are outdated, as are the ADC's. Remind them that prisoner health is public health, and that withholding treatment for infectious diseases running rampant through the prisons puts us all at risk. Please remember, as always, to cc both the Governor and Julie (julie.acklin@yahoo.com) on that, too.

(The video is too long to actually post here, so I'm giving you the Youtube links...no, still too long. I'll keep working on this...).

The Free Man in Prison: Visiting Davon Acklin.

Wanted to let folks know that I was finally allowed to see Davon at ASPC-Tucson this weekend, and we had a really nice visit. Considering my recent protests and letters, I was kind of surprised that they didn't greet me with all sorts of bomb- and drug-sniffing dogs, hostile guards, petty rules, and unpleasantness falling just short of a strip search to get in. The whole affair was pretty low-key, though: the men and women in brown were civil - even friendly - as they checked me in and told me to keep my feet on the ground (they were killing me and I kept stretching them out on the bench).

Davon looked gaunt and pale, but his smile was warm, his hugs were strong, and our conversation flowed as if we had been friends for years. He's mature, insightful, bright, and kind. I correspond with a lot of prisoners, some of whom have committed pretty heinous crimes, but many of whom are either innocent or have been abusively sentenced. Davon is one of the few who takes responsibility for the decisions and conduct which led to his arrest and ultimate incarceration, even though his prosecution was inappropriate and the sentence was excessive - in my book, anyway.

Rather than ruminating on how unfair life has been to him, Davon's spent a lot of time learning what he can from being where he's at, and thinking about what things he needs to do differently once he's free again. It's not just that he wants to avoid returning to prison - he spoke both humbly and eloquently of his remorse for what he's put his family through, for stealing from others who worked hard to acquire their possessions, for letting addiction run his life and wreak havoc in the lives of others. We talked about our respective sources of spiritual strength and understanding, and struggles managing our moods and minds. I was AA-raised and he was prison-raised, but somehow we both ended up with similar conceptions about our responsibilities to our families, our communities, and ourselves.

Davon isn't in a 12-step program, nor is he enrolled in any kind of formal treatment in prison. But he's spent a bit of time studying religion, reflecting on his own values, exploring the world through the Discovery Channel, and growing despite his confinement. He is as engaged in the process of recovery as I was at his age, going to meetings every day and celebrating sobriety anniversaries (my 3 and 6-month ones over and over again the first few years) only he may well be more mature than I was at the time. His wisdom has come at greater price than most have to pay, though - and he'll likely be paying for it for awhile.


Davon worries more about his mom and little sister (whom he adores) than he does about his health. He wasn't nonchalant about it - he really hasn't been feeling well and as much as he wants a job to occupy his time and pick up a few more bucks a week (which is all it amounts to, literally), he admits he doesn't have the energy to be a predictable employee right now. The day we visited he said he was having a good day - that was evident by the life in his eyes and all the cupcakes he consumed. But once you get a job there, if you fail to show up for it you start accumulating tickets - there doesn't seem to be any real accommodation for someone who is struggling with fatigue, weight loss, and other symptoms like he is.

It was clear from our conversation that Davon's been studying up on Hep C and taking responsibility for not exposing others to his virus. A few months ago I sent him a calendar for prisoners about Hep C, which he read through and has been using. He talked about the different recommendations they made for preventing transmission in prison - like not sharing tattoo equipment, razors, or other items that could have blood on them. He observed that they were good recommendations for preventing HIV infection, too, so he's trying to protect both himself and others from further harm.

It was also clear to me that he doesn't have his hopes up about a pardon - I'm not sure he's convinced he "deserves" one. Davon sees men suffering around him every day who have heavier burdens that he thinks he does, and less help to carry them. He takes responsibility for his crimes and has accepted his sentence; he's not expecting to get out until his scheduled release date, though he appreciates everything that Julie and others are doing to try to spring him. He does hope to be better educated about his medical status, to get a full workup, and to have some kind of choice about treatment to rid his body of this virus - he realizes that the sooner that happens, the better his chances are of successfully recovering. He doesn't like being sickly and wasting away, and he's concerned about the implications of the labs that have come back thus far, as is Julie. He doesn't want to be an infectious threat to the health of others, nor does he want to die at an early age of liver or kidney failure. He wants to work in construction with his step dad and have a family someday; he wants to have a life after prison, and put what he's learned into better use for others than he has thus far. That doesn't seem to be too much for a young man to yearn for.

Davon is still good-natured about being a poster boy for Hep C in prison - he figures that with all the work his mom has done to get him decent health care, at least his misfortune can help educate and serve others. He seems to have the respect of his peers, and has managed to avoid being sucked into the gang scene. He stands on his own two feet, but I can tell there are plenty of fellows there watching his back, too. According to him, that's as much due to the help his mom has given the other guys and their families as it is to his own reputation and character. He chuckles knowing that he's probably experienced some retaliation by guards as a result of Julie's activism as well, but sees a certain amount of that as unavoidable.

Not that he's happy about that, but he seems to think that it's still better to be mistreated because of something good he or a loved one does than to be ignored for being indifferent to injustice or suffering. He's not stupid and running to everyone's rescue, but his value system tells him that doing nothing when something is clearly called for can be worse than getting in trouble for doing the wrong thing. That's the kind of person he is.

I have no idea how long we ended up visiting Sunday, and there's a whole bunch of stuff we talked about that I can't even begin to get into, but that pretty much sums up the heart of it all. Davon apologized for not writing back to everyone who's written to him - those letters really do mean a lot, and he loves the pictures he gets of other places in the world. Postage is hard to negotiate sometimes - especially for letters overseas. And he just doesn't have as much energy or focus as he used to - even I don't get as much mail from him now. He asked me to extend his appreciation, though, to everyone who's written to him, signed his mom's petitions, joined his cause, and pulled for him in one way or another. He's especially relieved to know that Julie isn't in this alone, for her sake. He loves her and worries about her a lot. He doesn't want her to worry so much about him. Because of that, I suspect that he's feeling worse than he lets on most days.

Davon's rap sheet would tell you that he's an out of control drug-addicted, mentally ill violent criminal - a repeat offender, even - who some would say shouldn't ever see the light of day. But a closer look at him reveals a compassionate, responsible, maturing young man who has become a better human being despite, not because of, the dehumanization of life in an Arizona state prison. Perhaps his good character shouldn't have any bearing on whether or not he gets medical treatment for his Hep C infection, but we all know that value judgments figure into equations like that anyway. Why else would the state eliminate AHCCCS funding only for those liver transplants needed by people with Hep C, if it wasn't because the population is made up largely of those who have been criminalized for their addictions? It's the same reason we took so long to do anything meaningful about treating AIDS: the twisted logic goes that these are society's undesirables, anyway, who did it to themselves, and therefore deserve what they get. Some sick pups would even call such a fate divine justice. They've clearly never lost anyone they love before.

Davon is a more free man in prison in many ways than a lot of us - he chooses who to be and how to conduct himself without making excuses like so many do. He deserves better than what he's getting now, I can assure you, whatever standard you measure that by. They all deserve better, but he's the one in my sights right now.

As for Divinity's role in this young man's future - God is Love, as I understand it, and works miracles through the actions of ordinary people. Davon seems to be doing his part. So, please join the cause, visit the new page Julie's friend set up for her urging that he gets treatment now, and sign the petition to the Clemency Board if you haven't already - then spread the links to your friends. If you've done all that and want to take it a step further, write Governor Brewer a personal letter urging better treatment for all those with Hep C, and send a copy to Julie, the AZ Department of Corrections and your local paper. Remind them that prisoner health is public health, too. We need to be educating everyone else about this, before it's too late.

Called to Care: Hospice of the Valley.

Hey all,

Called to Care is one of the main ministries addressing the needs of people with disabilities that has been supporting the efforts of the Hard Time Alliance, which is organizing Arizona's Hepatitis C + prisoners/ex-prisoners and their families. They had us give a little presentation at their coordinating meeting a month ago (where they had an awesome main speaker), and were on hand for the Candlelight Vigil last month at the ADC. Robert's also been a real support to my friend and comrade, Julie, who's trying to get either treatment for her son in prison or a pardon / compassionate release so he can get care in the community before the disease progresses further.

Anyway, I don't think these folks would mind if a few of us crashed this meeting in order to address concerns about the terminally ill in prison: is there even hospice space available to release dying prisoners to? Do hospice workers go into Arizona's prisons or jails? Does Hospice of the Valley deal at all with the prisons (like training other prisoners to be end-of-life caregivers, for example)? Are they a resource for the families of elderly and terminally ill prisoners?

I'm sure the rest of you can think of more questions to ask. Do just that - ask questions that concern these issues - wherever you go. In fact, if you can, make a point of going to things like this specifically to engage the rest of the community in a relationship with people dying behind bars: we have to do something about the hang-up on compassionate release (word is, there have been none/few signed by the governor since the Baseline Killer - that means Janet let a lot of sick people die in there who the ADC found eligible and the Arizona Board of Executive Clemency recommended for release).

So, if you have a chance to talk with someone from the American Cancer Society or other patient education/support/advocacy groups, please speak to the issues of compassionate release and hospice care for dying prisoners. If they hear it from several sources, maybe they'll jump in and help.

Thanks again, Robert, for your kindness and solidarity.

------------------from Called to Care---------------------

Dear Friends:

This is a reminder for the Called to Care Coordinating Council meeting, Sunday, June 27, 2010, 12 noon, Anthony Lounge, First Congregational United Church of Christ,1407 N. 2nd Street, Phoenix, potluck, carry-in meal. All are welcome. Sue Bartz, First Church member and Hospice of the valley Patient Insurance Department Coordinator, organized this speaker meeting. She invited Heather Chapple, Community Liaison, Hospice of the Valley, to speak on "The Hospice of the Valley's Senior Placement Service" that helps families find appropriate care for their loved ones at no cost to the family. Check attachment for details. For more information, contact Robert Koth by telephone at: 602-284-4159 or by email at: RobertKoth1@cox.net.

Our speaker, Heather Chapple, is a long-time Valley resident, moving to Arizona from Colorado in 1988, Heather served in the U.S. Navy for four years as an executive assistant at a submarine base in San Diego. She joined Hospice of the Valley in July 2009. She works as a community liaison, giving educational presentations about end-of-life care. Heather graduated from the University of Phoenix in 2008 with a bachelor's degree in education. I hope that you can join us to hear this exceptional speaker.

Blessings,

Robert Koth

HEP C: Pray For the Dead, and Fight like Hell for the Living.

http://hardtimehepc.blogspot.com

Thanks to Mother Jones and AIDS activists for the inspiration, and thank you to those of you who joined or supported the walkers at the Liver Life Walk, Saturday. The T-shirts and banner invited a number of opportunities to raise awareness about Hepatitis C in jail and prison, and it was good to meet so many other people interested in working towards some common objectives. We also made a huge birthday card for Davon (March 23, 2010). Once I get my 35mm film from the day developed and on a disc, we’ll have the photos and thoughts on the walk up for you.

The new blog is up, now: hit it at http://hardtimehepc.blogspot.com. Let us know how it works for you, if you have other resource ideas for us to link to or upload, or if you’d like to help organize and keep posts current. I'll be anchoring it for awhile as Julie learns the mechanics, so shoot me an email if you have thoughts on content, links, layout, tone, etc. (prisonabolitionist@gmail.com). If you need to connect about family organizing stuff, start with Julie. You can track her down fastest at Julie.acklin@yahoo.com .

The audience here is mainly us: friends and families of prisoners, ex-prisoners, anarchist and Unitarian sympathizers, and hopefully the folks inside as well, since some articles would be good to put together and mail out as a newsletter for those who aren't on-line. We expect the State to be listening in from time to time as well, and will probably automatically shoot them our posts to keep them informed. ADC employees on the line or in health services who share our concerns and have information to offer, we will respect your anonymity. We’re much more about finding out who’s going to take responsibility for helping us through this with as many survivors as possible, than we are about ferreting out who’s to blame for where we’re at to begin with.

Really, I’ve done some research and we’re in about the same place most of the states and the Feds are - only we’re lifting the veil of silence that fell over this epidemic soon after it was announced, a decade ago. They must have realized how much it would cost to treat all those infected, and decided to just watch it, for the most part, until the more important socioeconomic classes were affected. Criminals and their families – and their communities (mostly of color) – are intended to be exploited; that’s why the 13^th Amendment was written as it is. It’s interesting that they designated the “duly convicted”, not the “guilty,” as slaves of the state.

Anyway, as for the HARD TIME blog, the authors and editors are us, too. We're developing some basic guidelines for guest blogs/submissions so we can maintain a constructive dialogue, but anyone interested in posting (beyond a comment after someone else's) should contact myself or Julie (hardtimehepc@gmail.com) with their interest and the email address they want to use to log on. We still have to decide editorial responsibility, etc. once we have a more developed collective of family/prisoner activists. Since this is the time frame when we work that stuff out - dividing responsibility and power, basically - it would be a good time to get involved.

The Liver Life walk was an amazing experience, by the way, and brought home to me again the importance of what we’re doing. I’ve lost several family members to liver cancer or disease, and am hoping not to lose my big brother that way; his Hep C has already been wreaking havoc on his liver, and he’s not eligible for treatment. He’s nearly 50 now, though, and at least he’s a free man. Not many people can say that, even in their 70’s with no criminal record. I think my brother could honestly say he’s a free man if he was in prison – on a good day, anyway. God knows he’s transcended hell enough time himself – he might as well have been getting shuffled through USP-Lewisburg and beat up each time, as they appear to be fond of doing there…

I’ll be calling on folks for help with that place soon. It’s the federal pen in PA that Leonard Peltier and my buddy Byron Chubbuck are at right now, among others. I have documentation of more than one person’s abuse at the hands of guards, now, which is on its way to the PA ACLU and the DOJ. If any of those prisoners out there are further abused or retaliated against, I want their families to notify us and the DOJ and the PA ACLU immediately. I’m asking directly for a CRIPA investigation of the place, not just blogging it (though I know they read that post). After mailing our letter to the DOJ, we (Arizona Prison Watch) will make sure it gets posted in as many places as possible to increase the intensity of the spotlight on both the BOP and the DOJ.

It should be a far more serious offense for an officer of the law to do violence to an institutionalized person – a captive who is completely at the mercy of them and their institution – than for a prisoner to defend himself against a rogue guard (or six of them with tasers). We expect more of people in uniform than that. The officers in question in each of the abuse cases (I’m sure Warden Bledsoe already knows who they are) should be removed from positions in which they can harm prisoners pending the outcomes of multiple investigations – internal and external alike.

More on the Liver Life Walk once I recover. Thank you to the American Liver Foundation for all the good work you do, and the lives you help save. Please, folks, if you even just drop them $10 with a note to “support Hep C treatment for prisoners,” it would be awesome. There were even some folks from the GLBTQ activist community in drag, there. The Liver Foundation was accommodating of everyone who cared about their constituents. I think this means they consider prisoners with Hep C to be “theirs”, too. That’s actually more than I might have expected, after the way I’ve seen the “duly convicted” treated in recent months – particularly Jamie Scott.

I don’t know what’s up with the Mississippi Kidney Foundation. It would help if a wealthy Mississippi citizen contacted them to let them know you think prisoners have the right to life, too. We throw a lot of victims in with a handful of hungry predators when we fill our jails and prisons with the desperately poor or addicted. In America, the innocent can’t be protected if we don’t assure that the “duly convicted” still retain the access to reasonably speedy remedies for their conviction or sentence. It’s an emergency when people are held against their will in hostile and dangerous environments – vulnerable to fire, disease, medical neglect, sexual abuse, and assault. Remember the Scott Sisters and Courtney: they could be anyone’s kids out there…