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)

Arpaio's Deaths in Custody: Stealing gifts from God.

The wrongful death of Deborah Braillard (Braillard v. Maricopa County, et al)is going to a jury trial tomorrow, September 12, 2012 at the Sandra Day O'Connor Federal Courthouse in Phoenix.

Here's what ABC News most recently has had to say:

http://abcnews.go.com/US/video/arizona-womans-jail-death-leads-to-lawsuit-17209730

Here's my original post, with the lead to the article from the Phoenix New Times below.

 4th Avenue Jail, Phoenix

--------from Arizona Prison Watch (December 11, 2010)-----------

Those citizens with their civil rights intact who flocked to Arizona to exploit cheap labor and avoid paying for public schools - not the families who migrated here from our south - are the people who endanger us the most. Increasingly, elections in this state are not exercises in democracy but acts of violence perpetrated on those of us whose voices don't count. If anyone plans to tamper with the constitution next year, it should be only to disenfranchise all the sadistic, delusional voters who support the likes of Joe Arpaio, applauding his stubborn refusal to provide health care to prisoners, his misogynistic policies and underwear, and his abusive staff.

It's sad how many of Arpaio's posse members seem to think of themselves as "Christians", you know - good ones, at that. They must have missed the part in the Bible about how Christ was a prisoner himself (as were Daniel, the Apostle Paul, and my own ancestor, Brigham Young - who would no doubt be treated as a sex offender today - even if never convicted). Would they entrust the care of their prophet, their Savior, or Mother Mary to the Maricopa County Sheriff - or even to the rest of the good Christians who voted for Sheriff Joe?

How about the care of their own mothers?

Investigative journalist Michael Lacey has written a lot of good pieces for the Phoenix New Times - this one should really bring home an award. I'm just giving you the beginning - follow the link for the rest, and take the extra time to view the depositions after you read. One prisoner testifies that she witnessed guards drag a "mentally challenged" women by her ankle, and begins to cry. Another one details the pains that the other criminals went to in order to try to keep Deborah Braillard alive and restore her to health themselves. Sadly, it's so often the case for people who are incarcerated that the most compassion they encounter as they are dying comes from their fellow prisoners. The last video in the series of depositions is this brief clip of Deborah's daughter describing the last days of her mother's life - on a ventilator and chained to a bed....
 

Good job, Sheriff Joe: that's really being "tough on crime." You can't clear your violent crimes so you vilify and brutalize whatever people you can take prisoner.
It's truly disturbing that your officers don't walk out on you en masse.

We have to figure out how to take back the keys to our jails from Arpaio and his crew before they kill some other little girl's mom or grandma, or someone's else's child. This is not an isolated incident - it's evidence of the criminal practices and patterns of the MCSO and Sheriff Joe that both shame and harm us all. We can't afford two more years.

Finally, remember, dear lawmakers and lawmen: when you deprive the people of meaningful mechanisms to participate in our government peacefully - all the while bludgeoning us and our communities with your rights to profit and your penchant for prisons - you not only risk your re-election, you tempt your fates. You Tea Party tyrants are the ones who will spark a real revolution that can't be contained by your lies and legislation, or by your badges and guns.

That's not a threat, by the way - just a warning. It's all I can see coming of your egocentricity, bigotry, self-righteousness, and hate.

 

--------------------from the Phoenix New Times----------------------

What's Mom Worth? When a Woman Became Deathly Ill in Sheriff Joe Arpaio's Jail, Guards and Nurses Ignored Her Agony...

by Michael Lacey

PHX NEW TIMES

December 9, 2010

Deborah Braillard, mother
(1991)

Mom taught me to sew.

And I' m going to teach my own baby, Jennylee. Eventually.

Jennylee is a quick study for a 6-year-old.

She watches as I sew her Minnie Mouse costume. She is double-twice excited, though honestly, I think I like Halloween as much as she does, even if it is a gloomy time of year.

Come, sit here, Pumpkin, and watch now how I pin the paper pattern here on the cloth. You see that, sweetie? You cut this out while I trim the red polka dots for your bow.

Done.

You take a good look at these pieces and try to guess where they'll go. Mommy will be right back.

As mother and daughter work inside their little trailer, outside, slate-stained cumulonimbus clouds menace, gray anvil domes await the strike.

Deborah ducks, briefly, into the tiny, plywood-framed bathroom for a little pick-me-up. When she emerges, the sweetness of this moment with Jennylee does not escape her notice.

But lightning in the darkness overcomes it.

Deborah shivers in spite of herself.

Hey there, Pumpkin, here's the last part.

I'll just straight-stitch the seams, roll the fabric to make a hem, and secure the bow with a whip-stitch.

Let me iron up the white apron and spray it with starch to give it a little oomph.

You look perfect.

Wait! Wait! . . . Here, a little mascara, we'll make a black dot for your nose and whiskers. Hold still now, a little lipstick.

Okay, let's walk over to the community center.

Grandma will meet us there.

Jennylee, if you aren't the best mouse ever . . .

Jennylee Braillard, daughter
(2010 interviews)

"Just about my first memory of my mom was the Minnie Mouse costume she made me at Gold Bar, which is where you can hook up your trailer just outside Monroe, Washington.

"I won first place that Halloween. My prize was a six-pack of root beer."

As Jennylee speaks, her own infant daughter, Kaylynn, coos and looks around, a bow tied to her little, full-moon head.

"My mom was always happy. She was nurturing, caring. She was my mom."

Her mother's ashes sit in a container in Jennylee's home in west Phoenix. The dust is such a small amount inside a little vessel; you'd hardly believe that someone's remains could amount to so little.

It is a fact that Deborah Braillard did not always make good choices.

She died an agonizing death in a diabetic coma that would wring the life out of her over three weeks that seemed without end.

The bigger truth is that she was hurried on her way.

Deborah Braillard's passing is never far from Jennylee's thoughts; after all, she watched the worst of it.

"I was terrified to open the plastic bag with her ashes. I put mom in a big jewelry box. I think about taking her back to Gold Bar. That's where my grandmother and great grandmother are buried. It's been in the family forever. There are nature trails there . . .

"But I worry if something happens to my uncle who lives there [what would happen to Mom]."

Consider: In May 2010, researchers at the University of Wisconsin find that, in stressful situations, cortisol levels in girls soar. But for many of the young women, simply hearing their mother's voice is enough to wash away the anxiety, replacing the stress hormone with feelings of love.

Men have no such relief.

What happens between a mother and daughter comes from God.

Tamela Harper, inmate

(2007 deposition)


Tamela Harper is detained in Sheriff Joe Arpaio's jail when they put Deborah Braillard into her cell in January 2005.

"She was unconscious [on the evening of the 2nd]. She wasn't hardly there. She walked back to her bunk, and that was the last time I saw that lady walking. People were helping her. She was throwing up constantly.

[Next day] that's when she started moaning and groaning and throwing up. She was basically unconscious at the time. She couldn't speak. She couldn't eat. The officers kept saying she was kicking heroin.

"She defecated on herself several times. There was no help for her. We kept telling the officers, you need to help her."

Brenda Tomanini, inmate

(2007 deposition)


Deborah Braillard threw up on other inmates, from her bunk to theirs. No guards, no nurses. The inmates, and Deborah, were alone on the 3rd.

On the morning of the 4th, medical asked to have Braillard brought into the clinic. But trusties could not wake the unconscious Deborah. She was left vegetating.

"I couldn't get Ms. Braillard up. Couldn't do it. She wouldn't respond to me at all. I could tell that she was breathing, but I couldn't get a response out of her.

"It just freaked me out because I don't think in my experience . . . I don't think she had been on drugs."

But the guards in the jail say different.

"Don't worry about Deborah Braillard. She's getting what she deserves. She's coming off drugs," is how Tomiani remembers it.

The inmates understand the drill, says Tomanini.

Tomanini described a retarded inmate brutalized for her sass.

"It broke my heart. I had to put my head under my blankets, and I cried. It broke my heart to see something like that."

Tomanini's experience with the medical clinic underscores the sense of neglect.

"I got sick and I was running a fever, and I had put a tank order in — that's what they call it for medical. And two months went along, and I didn't get any better. I was waiting for medical to call me . . . You had to fight to get medical attention.

Consider: It was standard procedure to collapse on the floor in order to get medical attention. Otherwise you might well be ignored by an overwhelmed medical clinic. Inmates report that guards would actually instruct them to drop, to collapse. Only then would a call — man down! — go out to the nurses.

Deborah Braillard, mother


Do I think? I think not.

I am aware.

I am aware of the I-will-nots:

I will not see my granddaughter, Kaylynn, walk. I will not give her my finger to steady her early toddles. I will not go down a slide with her. I will not put a Band-Aid on her owie.

I will not get a chance to be a better grandmother than I was a mom. Ever.

Consider: Deputies find methamphetamine in Braillard's purse about midnight on January 1, 2005. She is with a small group of users whose car breaks down in a parking lot on the west side when officers happen upon them.

She is admitted into the jail about 2 a.m. on January 2. Though the entire prison is videotaped around the clock, the sheriff is unable to produce any film of Deborah's early custody.

Historically, when inmates are killed or injured, Sheriff Arpaio loses evidence and incriminating video surveillance or produces video so degraded it is unwatchable.

Almost a full day after her initial booking, Braillard is transferred from the intake jail downtown to the all-female Estrella jail in west Phoenix. For the next 60 hours, guards at Estrella assume, mistakenly, that her wretched condition is the result of her kicking drugs.

This lethal mistake is aided and abetted by a poultice of organizational neglect combined with personal insensitivity that overwhelms thin outbreaks of humanity...

(Go to the source to read the rest... then PLEASE contact the Maricopa County Attorney's Office and tell them you want these people criminally prosecuted to the fullest extent every time they neglect or abuse a prisoner. Only then will some of this stop.)

Parsons v Ryan: Suicide Prevention Day, 2012, AZ DOC.

My young friend Davon Acklin is finally on interferon treatment at ASPC-Phoenix, which has been pretty rough on him. He's been covered with painful lesions for a week and can't get the medicated cream he needs to treat them. They did put him on a suicide watch when we complained about his lack of cream, however. We fear that's a pretext to justify terminating him from the HCV treatment program this week. 

Davon's adamant that he never said anything suggesting he was suicidal - nor did I. We're trying to get him off the watch now. Suicide watch in AZ state prisons makes people more likely to kill themselves, anyway, not less. Get it right, people.

Please think good things for Davon and his family; we are still at war with the DOC over his care.

remembering Susan Lopez, Geshell Fernandez, and all the other victims of suicide 

at the AZ Department of Corrections. 

The prison suicide rate has doubled under the Brewer administration, 

and is twice as high as the national average for state prisoners.

This is the state of suicide prevention in Arizona's Department of Corrections, under Director Charles Ryan. I hope the DOC responds to this critique with a detailed description of what else they're doing to reduce the rate of despair and violence that's driving Arizona prisoners to kill themselves at twice the rate than the national average for state prisoners. I want to know what the training consists of. So do the families who have already suffered a death in custody - as well as the loved ones of those mentally ill prisoners fighting to be safe and well in custody now. How have the conditions described below changed since Parsons v Ryan was filed?

If you have a loved one in prison with a serious mental illness whose safety or sanity you fear deeply for, please feel free to contact me. I'm just an artist and activist - I'm not a lawyer or professional anything, but I can refer you to resources in your community, and connect you with other families who share your struggle. 

Have your loved ones write me as well. 

Arizona Prison Watch  /  PO Box 20494  / PHOENIX, AZ 85036

thank you again to all the attorneys working on this case...but most of all, to the prisoner-litigants who had the courage to put their names and faces to the abuses and neglect going on behind bars in this state...

Peggy Plews 

480-580-6807

arizonaprisonwatch@gmail.com

Parsons V Ryan (p. 47)

2. Defendants Deprive Suicidal and Self-Harming Prisoners of Basic Mental Health Care

82. Defendants have a policy and practice of housing prisoners with serious mental health needs in unsafe conditions that heighten their risk of suicide. In FY 2011, there were 13 suicides in ADC prisons, out of a population that averaged 34,000 during that time. That is a rate of 38 suicides per 100,000 prisoners per year, more than double the national average suicide rate in state prisons of 16.67 per 100,000. Three prisoners committed suicide in one week in late January 2012, including a 19-year-old woman.

83. One factor responsible for such a high suicide rate is Defendants’ policy and practice of maintaining suicide watch facilities that offer no meaningful treatment. Usually the only people who interact with prisoners on suicide watch are correctional officers who check on them periodically, medication assistants who dispense pills, or psychology assistants who talk to them through the front of their cell. Plaintiff Swartz did not receive psychotherapy for more than two months in the summer of 2011 while on suicide watch at the Lewis facility. After he swallowed glass and was taken to an outside hospital, the hospital psychiatrist recommended that he be taken to an inpatient mental health unit. These units are in the Phoenix complex. Instead, Mr. Swartz remained at Lewis where he continued to harm himself. He finally was moved to the Phoenix inpatient unit almost three months after the hospital psychiatrist had made that recommendation, but after a short period of time he was again returned to Lewis. Plaintiff Thomas did not see a psychiatrist for 11 months despite being placed on suicide watch multiple times.

84. Defendants also have a policy and practice of holding suicidal and mentally ill prisoners in conditions that violate all notions of minimally adequate mental health care and basic human dignity, and are not compatible with civilized standards of humanity and decency. Suicide watch cells are often filthy, with walls and food slots smeared with other prisoners’ blood and feces, reeking of human waste. Mental health staff show a lackof professionalism and little compassion for prisoners enduring these conditions: for example, prisoners in suicide cells are taunted for being in “the feces cells.” When Plaintiff Swartz complained to a LPN about the unhygienic conditions of the suicide cell at Lewis, the LPN described him in the mental health notes from the encounter as “bitching about cleanliness – germs and disease.”

85. Defendants have a policy and practice of keeping suicide watch cells at very cold temperatures. Prisoners are stripped of all clothing and given only a stiff suicide smock and a thin blanket, making the extreme cold even harder to tolerate. Plaintiffs Rodriguez and Verduzco report that the suicide smock used in Perryville barely comes to the top of female prisoners’ thighs, so both their legs and arms are exposed to cold air. Many prisoners are also deprived of mattresses and as a result must sleep on bare steel bed frames, or on the floor made filthy with the bodily fluids of prior inhabitants. Plaintiff Brislan spent several weeks in a frigid suicide cell with no mattress.

86. Defendants have a policy and practice of exposing prisoners on suicide watch to gratuitously harsh, degrading, and damaging conditions of confinement. Prisoners are given only two cold meals a day, and are denied the opportunity to go outside, brush their teeth, or take showers. The only monitoring prisoners receive in suicide watch is when correctional officers force them awake every ten to 30 minutes, around the clock, ostensibly to check on their safety. In some suicide cells, bright lights are left on 24 hours a day. The resulting inability to sleep aggravates the prisoners’ psychological distress.

87. Mentally ill prisoners on suicide watch complain of correctional staff behavior that interferes with any therapeutic effect of being on suicide watch, including harassment, insults and taunts, and the excessive and practically sporting use of pepper spray. Prisoners at the Perryville suicide watch units, including Plaintiff Verduzco, have jerked awake when awoken by staff on the “safety checks,” and are pepper sprayed for allegedly attempting to assault the officers. Guards in the Perryville suicide watch units also frequently pepper spray female prisoners in their eyes and throats when they are delusional or hallucinating. Plaintiffs Rodriguez and Verduzco have asthma and rely upon inhalers, and they have had asthma attacks from the regular use of pepper spray in the women’s suicide watch unit. On multiple occasions after she was pepper sprayed in the eyes, nose, and mouth, Ms. Verduzco was dragged to a shower, stripped naked, and sprayed with extremely cold water to rinse away the pepper spray; she was then left naked to wait for a new vest and blanket. A prisoner in the Florence prison’s suicide watch unit reports that while there he was handed razor blades to swallow by other prisoners, and told “just die right away.” He started to swallow the blades, and security staff pepper sprayed him while he coughed up blood, and did not provide other emergency response.

88. Defendants’ policy and practice of holding suicidal prisoners in excessively harsh conditions does not prevent but rather promotes self-injurious behavior. Plaintiff Brislan has cut himself numerous times with razors and pieces of metal while on suicide watch at multiple prisons, including Tucson, Lewis, and Eyman’s SMU 1 and Browning units. At the Tucson prison, staff put him on suicide watch in a cell with broken glass on the floor which he used to cut himself. During another stay in suicide watch, Mr. Brislan was given a razor blade that he used to deeply lacerate both of his thighs. While on suicide watch in the Lewis prison during the summer of 2011, Plaintiff Swartz, on separate occasions, swallowed multiple foreign objects, including two large staples, plastic wrap, a piece of glass, a lead-head concrete nail, a spork, two pens, sharpened paper clips, a metal spring, a steel bolt, and two copper wires. As with Plaintiff Brislan, Mr. Swartz’s repeated suicidal gestures and ability to access dangerous objects while on suicide watch confirms that he was not being properly monitored and that any mental health treatment he might have been receiving was inadequate.

89. Defendants also have a policy and practice of improperly using the suicide watch cells to punish prisoners for alleged disciplinary infractions. An Eyman prisoner who went on a hunger strike to protest prison policies, but did not display signs of mental illness or distress, was put in a suicide watch cell for several weeks and was told by a mental health provider, “If you weren’t on this hunger strike, you wouldn’t have to live in the feces cell.”

AZ Republic: Ignore the prisons at our own peril...

Phoenix, AZ 2010

Excellent editorial below from the folks at the AZ Republic. They've been doing a great job covering the prisons this past year - which takes a lot of courage for mainstream media to do in this town.

This exposure incident is potentially devastating for those men affected - up to 20% will likely die from liver cancer or cirrhosis as a result, if they don't get successfully treated. Hep C is epidemic in our state prisons already, though -that incident was a drop in the bucket compared to the 12,000 already infected (almost 6,000 confirmed cases alone, compared to less than 200 with HIV/AIDS...it's pretty bad).

As long as they aren't treating addictions inside or doing an aggressive harm reduction campaign, though, the disease will continue to be spread by needles among IV users and tattoo recipients - 95% of whom ultimately return to the community, becoming a serious public health concern. One of the things that could do most to reduce the incidence and impact of Hep C in the community is to provide adequate substance abuse treatment and Hep C education, screening and treatment in prison, but neither is really happening.

According to the DOC 75% of prisoners are coming in with serious substance abuse issues, yet they aren't providing substance abuse treatment for more than 4% of the total prison population in a year - not even for all those guys being sent off to DUI prison, where everyone thinks we pay for a special treatment setting so they don't relapse and kill someone on the road next time. Coming into the mess we already have in the DOC medical system, I don't see how Wexford is going to do any better by prisoners - especially those with Hep C - AND turn a profit.

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Out of sight, out of mind

Sept. 8, 2012 01:26 PM
The Republic | azcentral.com

On Aug. 27, a nurse working for a company called Wexford Health Sources Inc. administered a dose of insulin to a diabetic patient who has hepatitis C, a deadly and extremely infectious liver disease.

The nurse then inserted the needle into another vial of insulin to draw still more of the drug for the patient.

She put that second vial, and the remainder of its contents, onto a shelf with other vials of insulin.

You can well imagine where this health-horror story is going: More than 100 other diabetes patients who later were given insulin treatments may have been infected with hepatitis C.

Mistakes happen. Including potentially tragic ones like this. But there is a bit more to this story.

Wexford is a private company that just this spring won a $349 million, three-year contract to provide health services to Arizona's nearly 40,000 prison inmates. The nurse, who already was under investigation for providing slipshod care, worked for Wexford at the Arizona state prison at Buckeye.

State rules require health-care providers, including those working out of prisons, to alert county and state health authorities about a potential outbreak of an infectious disease within five business days.

Wexford alerted public health officials of the incident on Sept. 4, more than a week afterward -- and only after Wendy Halloran of 12 News learned what happened from an inmate's family and The Republic's Craig Harris broke the story online.

In Arizona's seemingly inexorable march toward privatizing ever more of its prison system, this incident is but one more red flag about the pitfalls of that policy.

Sure, it was an accident. Accidents happen. But are more such accidents occurring at prisons whose profit motives tempt supervisors to cut corners?

Corner-cutting appears to have been a factor in the escape of three prisoners on July 30, 2010, from a Kingman prison operated by Management & Training Corp. A faulty alarm system appears to have contributed to the incident, during which the escapees murdered a New Mexico couple.

Another private contractor hired by Arizona, GEO Group Inc., has lost at least 27 of its prisoners around the country since 2004, including one from a facility in Florence, albeit from mostly low-security facilities.

The Wexford incident, however, raises a still more unsettling concern: Are there more accidents and incidents than we know about? Is Wexford's slow-mo reaction to following established protocol evidence of other incidents being swept under the rug?

The state Legislature's most ardent Republican critic of private prisons, Mesa Rep. Cecil Ash, argues that private prisons "are the wrong business model" for exactly that reason: "They are out of sight, out of mind."

If private-prison operations were cheaper to operate, that might mitigate the more minor operational concerns. But they are nearly 10 percent more expensive to operate. Lawmakers like them because of the up-front cost savings on construction, which the private firms often bear.

Legislators need to take this Wexford incident for what it is: stark evidence that transparency is a serious issue with private prisons.

Prisons are out of sight, out of mind, at our peril.

Disabled in Prison: Daniel's journey.

Some folks think that criminals who are abused - or even murdered - in prison probably got what they had coming - as if some kind of Divine Justice is meted out when the "worst of the worst" brutalizes each other where our laws otherwise prohibit it. Most of the folks I see being victimized in prison, though, aren't the kind of criminals we all love to hate. The ones being victimized so often are vulnerable to exploitation, violence, neglect and abuse due to a serious mental illness, closed head injury, or developmental disability - not because their crime was so heinous that the other prisoners felt compelled to punish them, too. The Divine hand I put my faith in would intervene to stop the neglect of and violence against these prisoners - not silently condone it. That is the hand that causes me to write this post today. I hope that same hand compels others to respond.

Cognitive impairments, disabilities affecting communication, and laws designed to prevent prisoners from filing "frivolous" lawsuits against their keepers - like the Clinton-era Prison Litigation Reform Act (PLRA) - make it extremely difficult for some individuals to assert their rights behind bars. I received the following letter from one such prisoner nearly two years ago, when I didn't really know what I was doing, and I wasn't much help to him. It was somewhat outdated then, and getting updates from Daniel has been hard, I presume because he depends on the kindness of others to help him write. The last letter I sent him was July 23; I haven't heard back yet. As I understand it, though, not much has changed for him.

According to his record, on November 2, 2001, Daniel killed three people. I don't know how; I always presumed it was in the accident in which he was so badly injured himself, since the convictions were for manslaughter. That's a lot of devastation to cause in one fell swoop...and to live with, for both the survivors and the one who destroyed those lives.

Daniel was sentenced to three consecutive ten year terms in state prison for his crimes. He has lost his freedom, been exiled from society, and grown estranged from his family as a consequence of his actions. Short of death, incarceration and lifetime felonization are the most severe penalties we can hand out to people; incarceration is in itself a special kind of torture. Prisoners of war and kidnap victims are treated for PTSD even if they were well cared for by their captors, because simply being involuntarily seized and imprisoned causes terror and trauma. We don't need to add individualized torment and humiliation on top of what we have already decided to dish out to those we have imprisoned. That is cruel and unusual, and barred by the US Constitution for a reason. It's not just becuase of what it does to them when prisoners are neglected or abused- it's because of what it does to us, too. Our own humanity is diminished in the process of doing so to another.

When I received Daniel's letter I spent my energy trying to get help from the organizations that I thought were supposed to intervene in cases like his, to no avail. What I learned in my quest was that the DOJ answers almost every SOS from prisons with a form letter denying any intent to investigate, and the resources of the American Civil Liberties Union are quite limited. The Arizona Center for Disability Law - which is the only Protection and Advocacy agency in the state for people with  disabilities refused at the time to serve disabled individuals in custody, simply because they were in prison. As far as I know, except for lending technical assistance and the weight of their P&A authority to the  Parsons v Ryan litigation, they still don't serve disabled prisoners. I called a few attorneys at the time but found no takers; Daniel, of course, can't afford to retain one, so they'd need to be willing to take his case on pro bono.

The ACLU-AZ and ACDL now have their hands full in with Parsons v Ryan, the class action suit they're pursuing against the AZ Department of Corrections for substandard health care. Hopefully that will ultimately help prisoners like Daniel. But any settlement or judgement that comes out of it - if there is one - will be years down the road - he's suffering now, and the degree to which he can regain any functioning through physical therapy declines with time. 

The matter of accommodating people with disabilities for moral and legal reasons aside, someday this man will be free again, and totally dependent on public benefits if we can't help him engage in rehabilitative activity and learn to compensate for his disabilities soon. Daniel was 19 when this tragedy happened that landed him in prison; he will only be 47 when he is released, according to his earliest supervised release date. He can still be productive and contribute to his community once free - unless we leave him to waste away in prison as he has been, growing more dependent and more bitter with the passing of the years.

I believe the conditions of confinement that Daniel has endured, as well as the neglect of his requests for reasonable accommodations, are an egregious violation of the Americans' with Disabilities Act, and he has suffered both physical and psychological harm that was not intended by his sentencing judge as a result. If there are any attorneys or disability rights advocates reading this now who think they may be in  a position to help this man, please contact me, Peggy Plews, at 480-580-6807 or arizonaprisonwatch@gmail.com.

Daniel's Journey

ASPC-Tucson

January 2010

I was shot in the back twice with a 357 magnum.  I lost 1 kidney, 3 feet of intestine, piercing my liver and stomach as well.  I went out the back window of a vehicle at over 90 mph, split my head open & was in a coma for over 6 weeks.  I suffered severe brain & nerve trauma, as well as collapsed a lung, needed a trayek, stomach tube to be fed, tore every ligament in left leg, shattered my right femor, which was replaced.  Destroyed 2 bones in left arm, got replaced, destroyed all 3 major nerves & all tendons in left arm as well.  I also had a catheter, which was never supposed to be taken out because of the severe brain damage I acquired, & I urinated on myself for well over 9 months, at least 100 times a day, & frequently still do.  Never was I supposed to walk either.  So, in 2002 I came to prison, 1 year after my accident.  I fell on my face 100 times a day, crippled people fall much harder than normal people with balance, all the while urinating on myself, only able to take a shower every other day. 

I never got info, help or therapy for any of my disabilities.  I loved my family very much, needing to hear from them, so I began my sessions of pure painful frustration to regain my writing ability.  I would have to write twice a day everyday, painfully, bloody blisters is what I created just to keep the ability I acquired, which was garbage.  And, to create the garbage, I would have to press down really hard to stop my hand from shaking, creating a wound, that had to be broke open that night or I would lose the garbage ability I created.  I even developed a way of stopping the blisters from being created.  I had to buy constant bandaids, which we could only buy 1 pack of 10 a week, so I had to get other people to buy every week as well, so I didn’t lose the garbage ability I acquired, what was at least readable if you focused & were able to see thru the blood.  I was unable to tie my shoes, so that made a lot of things more difficult.  Was unable to brush teeth or any other things that needed two hands or required fine motor skills, which I just found out was one of my major disabilities, 7 years being in prison.  I was unable to communicate with my family, friends or loved ones.  I missed all of my daughter’s baby years growing up regardless, but not even being able to hear about them because I couldn’t write & correspond was torture!

Any little cold or medical problem I was automatically denied treatment for because of not even being able to fill out an HNR.  In ’03, I started to acquire small cuts on my fingers and mouth that would not heal & were very painful.  I couldn’t imagine what they were from until I just presumed they were from not drinking enough water & only having 1 kidney.  So I got someone to fill out an HNR & made it to the doctor, who confirmed my theory.  So, I drank more water, but the cuts kept appearing, so I drank more water & the cuts on my fingers & mouth kept showing up becoming more & more painful.   

So, once again I begged to have an HNR filled out the doctor said I wasn’t drinking enough water.  So, I could never get this simple, yet very painful problem taken care of.  And, I was drinking several gallons of water a day & was just dealing with crazy pain from such a simple problem.  All the while continually falling on my face pissing on myself that much more, smelling up the runs until I made it to a 4 yard.  Then it was just my cell stinking, getting my cellie made at me!  Getting in numerous fights physically with my cellies, as well non-stop arguments, being physically & verbally abused.   

That is about the time I started to see the dentist on my several years of not being able to brush my teeth properly.  My many years of painful cavities & the painful fillings they created, numerous fillings and root canals.  Now, Dec 31^st ’09, I got two painful cuts on my lip that will not heal, still I’m getting these cuts on my lips from brain trauma!  Starting in ’03 D.O.C. began to start their continual denial of treatment & cause suffering & pain from not listening to me when I said I cannot have my finger nails clipped like a normal person & they’d bleed if they were.  So, every month the nurses would clip my nails & make them bleed, despite my attempts to get them filed.  That happened until the supervisor nurse Nash at Rincon unit in ’07 paid attention to the nurses constantly making me bleed & my yelps from the pain every month, sometimes it needed to be done twice a month & she got myself the info I needed to fill out to get a pumice stone.  So, I ended up only having to have the intentional pain of having my fingers clipped by D.O.C. FOR ABOUT 4 YEARS.   

Now, it’s ‘09& I’ve been trying to get an arm brace since ’07 to stop the constant atrophy from turning my left arm into a ball.  And, it’s now Dec 31^st ’09 & my arm is curling up in a ball, killing me.  I’ve been approved from the doctor that works for D.O.C. to have a cell mate assistant since ’06 & numerous deputy wardens have refused their own physician’s prescriptions & the o DW now Jacobs.  I’ve talked to her several times & she says, “it will be taken care of when she finds the time, there’s other more important things.” & that’s why I have to go without communication with my family, friends & loved ones during the holidays, brushing my teeth, functioning without having to beg to have my shoes tied, being able to turn in HNR’s or any inmate letters.

It’s 1/1/10, & still no brace for my arm.  I can literally feel it curling as I’m writing these words.  In ’03 I started to have a severe pain in my right testicle, so I begged to have a C.O. fill out an HNR, being in SMU, I made it to the doctor who said it was just a hydrocele & I wasn’t going to die.  The next couple years it grew larger & larger, giving more & more pain, as well making it that much more difficult to rehabilitate by myself with no therapy until finally it didn’t just beat me up both physically & mentally, but making every single other thing harder to function, but broke me down physically & I collapsed in ’06.  

The nurses came took my vitals, put me on a lay in over the weekend & seen the doctor Monday, who said I’d live.  In ’08 on a Friday my testicle was the size of a baseball & forced me to the ground again & I was taken to medical again, told I was going to live, given a lay in until I see the doctor on Monday.  Sunday came around & it forced me to the ground again with unbearable pain.  I went to the hospital in an ambulance this time, where the doctor told me I definitely needed surgery, but he couldn’t perform if I was going to live unless D.O.C. approved it.  I was taken back to prison & after was told my surgery was approved.  I was told by the surgeon that there was a large percentage of the hydrocele returning after surgery if I continued my rehabilitation with no therapy.  So, with the mental stress from having a baseball for a testicle for 6 long years & the constant physical pain & from it making everything so hard to work on rehabilitation myself on my own I was manipulated by D.O.C’s negligence into having one of my testicles removed!  

 In ’09 I was told by Ms. Mongia, a 504 representative that works for D.O.C. that I was supposed to be provided physical therapy for my arm, as well for my other physical therapy needed, my writing, brushing my teeth, feeding myself, walking, running, as well for occupational therapy.  So, I turned in a HNR asking for, which was returned with the response this is not an ADA yard, where I wouldn’t get no therapy, occupational nor physical, as well would be denied my physical access & movement, which is mandatory I’ve learned for people with severe brain & nerve trauma like I possess.  Which was like when I was placed in SMU & Central unit with no movement & I kept losing my movement abilities over & over, which were beyond impossible to establish, especially without therapy, instruction or even a direction or just an opinion.

1/7/10

I received a First Level Appeal Response to answer my inmate First Level Appeal that I wrote on Oct. 21 ’09, today 1/7/09.  Stating, that it’s been noted that I’ve received treatment over the last year to accommodate my disabilities, which included the issuing of knee sleeves, an arm brace, and recent steps to replace an arm brace due to irreparable damage.  Also stating, I’ve been evaluated and diagnosed for a sore right shoulder incurred as an injury after my participation in repetitive pull-ups.  I’ve requested adjustments on my arm brace since ’07 & got documentation of continual pleas since 5/12/09, several, and have all just sent me around in circles.  I’ve gone to the HUB several times since ’07 being fitted for a new arm brace & continually apologized to by different medical personnel employed by D.O.C. for D.O.C. not sticking with a company, not allowing them to do their job by letting them come to work to do their job & still haven’t received a brace.   

The knee sleeves I was issued by my request, supposing that they would probably help me not get arthritis if my knees are constantly popping.  My arm brace finally was taken & I was seen for replacement in Nov., I still haven’t received a replacement, all the while, like it has been for the past 7 years, except in ’06 when I got an arm brace, my arm is literally killing me from pain & curling up in a ball.  I haven’t received any kind of physical or occupational therapy, which I was made aware I qualified for because of my impairments & to request for by a Ms. Mungia, a 504 personnel employed by D.O.C. in June of ’09.  I requested & my response was this is not an A.D.A. yard.  The injury in my shoulder I got was from pull ups, which were done to somehow stretch the tendons, self sufficiency therapy, since no therapy was being provided, as well a step approved by the supervisor nurse Larry, who stated my arm would be so much more crippled from all the atrophy & having no brace, no therapy if I wasn’t doing them.