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Hepatitis C treatment may cost N.J. millions
By Mark Fazlollah and Jennifer Lin Philadelpha Inquirer, Jan 12 2003
  A prison official said additional funds would be sought. The number of infected has risen.
Ten weeks after pledging to pay for treating the hepatitis C epidemic in its prisons, New Jersey has learned how much it may cost: $4.5 million to $8 million this year, by conservative estimates.
The prison medical provider, Correctional Medical Services (CMS) of St. Louis, projected the cost in recent memos and e-mails, which were obtained by The Inquirer through the state's Open Public Records Act.
The documents said one-fourth of New Jersey's 26,000 inmates would probably test positive for hepatitis C if the prison system decided to screen everyone for the potentially deadly virus.
In July, The Inquirer reported that New Jersey prisons were not treating inmates with the disease - which can lead to liver failure. CMS also did not tell hundreds of inmates that they had tested positive for hepatitis C, including 21 who had been released.
Corrections Commissioner Devon Brown ordered CMS to find the 21, but the firm could not locate most of them, the documents show. Without knowledge of the blood-borne disease, the former convicts could unwittingly pass it to others by sharing needles or even sharing razors or toothbrushes.
On Friday, Brown said he has asked state investigators to join the search.
The hepatitis C epidemic has hit prisons across the country, but only a handful of states pay for extensive screening and treatment. At the time of the Inquirer's report, New Jersey was treating only one inmate, although 1,170 already had tested positive for the virus.
The state this year is paying CMS nearly $100 million for prison medical care. That does not include the cost of hepatitis C treatment, which the state started covering Nov. 1. On Friday, Brown said it is routine to request supplemental appropriations for such expenses. There were not plans to cut other prison programs.
Three inmates now are getting treatment, which costs $10,000 to $15,000 each for up to 12 months of injections and pills. The medicines clear the disease in about half of patients. Treating liver failure can cost $50,000 to $250,000.
Pennsylvania has treated or is preparing to treat more than 1,000 inmates at a cost of about $6 million. It screens all inmates and views hepatitis as a public health issue that must be treated before prisoners go home. New Jersey only screens inmates who ask to be tested.
CMS told the Corrections Department that if just 25 percent of all New Jersey inmates were tested, it would cost the state $4.5 million a year for treatment and testing in accordance with Federal Bureau of Prison guidelines, a standard New Jersey says it will meet. The estimate also assumes that one in eight inmates who test positive will qualify for treatment under medical guidelines.
But if 75 percent of the inmates were tested, the annual cost for testing and treatment would be $8.4 million, a CMS document said. There were no estimates for how much it would cost if New Jersey tested all its inmates.
In response to Inquirer reporting, Brown made extensive policy changes in July and vowed to find funding for treatment, despite the state's budget deficit. He said the articles were "instrumental in saving lives."
Each month since then, more New Jersey inmates have tested positive for the disease. As of Dec. 4, the new documents show, 1,407 inmates were known to be infected - a 20 percent increase in five months. Brown said he expects the numbers to climb as inmates and medical staff learn more about the disease, and more prisoners ask to be tested.
"Education is occurring at all of our intake sites," Brown said in a statement. "It is understandable that there would be a rise in the number of inmates screened for the infection."
Thus far, the prison system appears to have taken only small steps toward treatment.
Before an inmate can be considered for hepatitis C medicines, a liver biopsy must be performed to help determine whether he will benefit. As of Dec. 16, eight inmates had biopsies.
In letters to The Inquirer since July, inmates have complained that CMS officials have actively discouraged them from having biopsies, warning them repeatedly that it could kill them.
Daniel Amos, an inmate at Riverfront State Prison in Camden, said that twice in the fall he was cautioned that a biopsy could be fatal. Amos, one of the inmates featured in The Inquirer series about New Jersey's failure to treat inmates, said he insisted that he wanted a biopsy, and the tests went smoothly.
Nationally, about 1 in 10,000 people given a liver biopsy dies from complications. Carroll M. Leevy, a liver specialist at Newark's University Hospital, said his clinic has conducted more than 3,000 biopsies without a fatality.
Though New Jersey now is under increased pressure to correct failings in hepatitis C care, many problems persist.
Minutes from a Nov. 25 meeting between CMS and state officials showed that the prison medical computer system is failing to properly track hepatitis C because "there are problems with consistency and completeness" in how doctors report the disease.
Those were the same problems that in the past led to inmates being released without being told they were infected.
At the same meeting, CMS officials said 40 to 60 new inmates test positive for hepatitis C each month, but thousands of prisoners, both current and new, remained untested.
The state also faces legal problems. In the fall, the first suit seeking class-action status for civil rights violations for failure to provide medical care was filed by a former inmate. Since then, more than 100 current and former inmates have sought to join the suit.
Rosemary Pinto, a lawyer with the Voorhees firm suing the state, said she had received "stacks of letters" from infected inmates asking to sue.
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