HEPATITUS C has surpassed AIDS as the next stealth epidemic. And no demographic has been hit harder by HCV than California prisoners, who have a previously unimaginable infection rate of 40 percent. A disease of slow progression, 85 percent of inmates are projected to develop chronic HCV over a period of 10 to 40 years. These conditions are fueling a health crisis of monumental proportions because correctional health-care administrators are unable to provide even basic medical treatment, falling well below the bare-minimum constitutional requisites.

One of the inmates the California Department of Corrections and Rehabilitation is failing to treat is Larry Gilmore, originally from San Jose and now serving a life sentence for armed robbery at the California Correctional Center in Susanville. Gilmore contracted Hepatitis C many years ago. Since being diagnosed with this fatal ailment, Gilmore has no choice but to stave off the inevitable through diet and exercise.

"Right now I am being refused treatment," says Gilmore. "It is the CDCR's policy not to treat a patient until his liver has sustained considerable damage from the virus. Instead of early treatment, when a patient is healthy and able to tolerate the Interferon and Ribaviron, they insist on waiting until the liver is malfunctioning."

Due to his age and the fact that his viral load counts are within an acceptable range, Gilmore is barred from treatment under prison guidelines. Hepatitis C protocols implemented by the CDCR in 2005 automatically exclude anyone over 60 from receiving the combination drug therapy that begins at $10,000 a year. Gilmore believes prison officials implemented these exclusions as a short-sighted cost-cutting measure—without considering the consequences.

"I believe that a person should be treated upon request. We are not talking about heroic measures here," he says. "We are talking about an easily available drug treatment therapy."

According to San Francisco District Court Judge Thelton Henderson, Hepatitis C is concentrated in a system responsible for roughly 60 preventable deaths a year. In the landmark 1995 case Madrid v. Gomez, Henderson found that the inadequacies of the prison health-care system violated the Eighth Amendment rights of inmates. After officials in charge of the CDCR failed to enact a myriad of medical reforms, the judge found that "incompetence and indifference" were so "deeply entrenched" he appointed a correctional medical receiver answerable only to him. Together they will try and bring the CDCR out of the penological Dark Ages.

Grim Reality

When Steve Silvera from Vallejo came to the California Correctional Center with a five-year sentence for drug possession in late 2003, he knew little about Hepatitis C. Silvera, 41, couldn't believe that literally every other inmate has the virus.

"I had no idea so many had it [HCV]. I thought it was a rare occurrence," said Silvera, who has lived in the Bay Area since the early '90s. "Plus, on the streets, I never knew anyone to have it."

Silvera's epiphany didn't have anything to do with a hepatitis awareness campaign; instead, the death of Robert "Freddy" Hagenson brought it to his attention. Hagenson had chronic HCV that led to his death in December at age 54, when his liver failed due to advanced cirrhosis. Many at the California Correctional Center witnessed Hagenson's excruciating demise.

"It scares me that this disease can destroy a human being like it did Freddy," says Silvera. "But by the same token, preventative measures can be taken. One foolish decision in prison, like injecting drugs or a dirty tattoo needle, can end up a death sentence. Luckily, I've done neither."

Hepatitis C is a blood-borne pathogen and can spread quickly in a community of intravenous drug users. High-risk behavior like tattooing and unprotected sex can lead to transmission. But the fact that 80 percent of prisoners have histories of substance abuse—and continue to share tainted needles while incarcerated—explains why HCV is transmitted so efficiently in correctional facilities. By concentrating so many drug addicts together without substance abuse management or education about the dangers of contagious diseases, the death of inmates like Hagenson will grow in frequency as the natural progression of the liver disorder takes its toll on the afflicted.

"It was a shock to see him [Hagenson] deteriorate that fast. That was the first time I ever seen someone die in prison and I didn't like it," Silvera said. "I feel like I am serving two sentences: one the judge gave me, and the death sentence the CDCR might or might not have given me by surrounding me with so many with the disease."

Silvera, whose drug of choice was methamphetamines, is dismayed by the casual attitude toward the affliction even though nearly "everyone here has it [HCV]." With a June release date, and plans to go back to work with the roofers' union, Silvera is just trying to make it through some very deadly territory.

"Three months to the finish line, but it only takes one microscopic virus to beat me there; it's like I'm running for my life. Freddy's death made me feel like I'm walking through a mine field, and I only have three months to make it to the other side safely," said Silvera.

Legal Challenge

Hepatitis C is considered an incurable disease. However, if the combination of Interferon and Ribaviron is administered before severe cirrhosis develops and damages the liver beyond repair, 50 percent to 60 percent respond favorably and clear the virus. Yet, since the CDCR's medical is plagued by "incompetence and indifference," negligence is automatically suspected by Gilmore in the death of Hagenson.

"It really shook me up because Freddy had been pressing medical for treatment for a year or more before he died. Freddy told me that all he got was the run-around; lost blood tests, months and months of ... first they treat him and then they wouldn't. While all this was going on his liver worsened to the point of total failure. I can't help but wonder if I will meet the same end in here," says Gilmore.

With no other recourse, Gilmore is challenging his exclusion from combination therapy by filing an administrative appeal, a likely precursor to a lawsuit. Gilmore hopes to force the CDCR to abandon their protocols that deny him treatment based solely on age. In the statistical likelihood his condition develops into chronic HCV, he would be denied treatment under the new protocols and allowed to die.

Henderson recently appointed Robert Sillen as the court's receiver. For inmates like Gilmore, Sillen's success is a matter of life and death. The judge gave the receiver, a respected health-care manager, six months to implement life-saving measures. Already considered a national disgrace, the resignation of the Corrections Secretary Rod Hickman in March has sent the beleaguered agency into an unprecedented downward spiral. Some CDCR critics suggest that the governor should appoint an outsider with the political clout and wherewithal to transcend decades of bureaucratic ineptitude. Others want Henderson to place the entire agency under federal control. Gilmore just wants the CDCR to abandon its current protocols and provide treatment for those afflicted with this deadly disease.

"If the politicians and voters think it is such a great idea to build this huge, overbloated prison system—and pass out life sentences like candy—then they should be willing to pay the price of decent health care," added Gilmore. "[The] HCV care is an example of short-term thinking. There will come a day when there will be an aging prison population, half of which will be HCV infected. Treatment now will be far cheaper than down the road, when thousands will require more expensive measures in the end stages of liver disease."

Serving a life sentence for a nonviolent drug conviction under the three strikes law, writer Eugene Dey is an inmate at the California Correctional Center in Susanville.

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