Wexford slapped for negligence: Silence on Botulism?

I've been hearing nothing but complaints about Wexford since they took over - especially about the delays in getting prescribed medications to people. The biggest snafu next to the Hep C incident seems to be the 4 cases of Botulism at Eyman in August, though, which no one is talking about. Check out the excerpts from the letter below. Three of the botulism cases went undetected for over a week, despite the fact that the first guy who got ill was on life support and the three who ate with him (no, it wasn't hooch - they were cooking food in their cell) were begging for medical care - which they were repeatedly denied - as their symptoms progressed. One guy told the guards it was hooch they got sick from just because that was the only way the guard would take him to medical. I'd think the CDC would have something to say about the prison medical (and security) staff blowing off something this significant...

------From ASPC-Eyman (September 3, 2012)----

 

 

 

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

Arizona fines provider of prison health care
by Craig Harris - Sept. 28, 2012 
The Republic | azcentral.com

The Arizona Department of Corrections has levied a $10,000 fine against Wexford Health Sources Inc., a new private medical-care provider for inmates that is accused of improperly dispensing medicine  and wasting state resources.

The DOC called on Wexford to fix staffing problems, properly distribute and document medication for inmates, show a sense of urgency and communicate better with the state when problems occur.

Wexford was fined over the actions of a nurse who caused a hepatitis C scare in August at the Arizona State Prison Complex-Lewis in Buckeye, and for failing to properly report the problem to authorities.

Corrections Director Charles Ryan in a statement said the state's demands, called a cure notification, give the state and Wexford an opportunity to "improve communications and ensure the health care  needs of the inmates incarcerated by the State of Arizona are being met."

Ryan was not available to answer questions. Bill Lamoreaux, a DOC spokesman, declined to answer specific questions about the matter.

 Wexford was hired after the Republican-controlled Arizona Legislature pushed to privatize inmate health care to save money. The DOC in strongly worded letters to Wexford alleges the company forced the  state to use public employees to fix its deficiencies. The amount of wasted tax dollars was not disclosed. Arizona houses close to 40,000 inmates.

Lamoreaux declined to answer if taxpayers were still saving money with Wexford's services.

The Pittsburgh-based company took over inmate care July 1 after winning a $349 million, three-year contract. The company plans to appeal the fine, according to Wexford spokesman Jason Rose. Wexford, in a letter to Ryan, contends the conditions of health care in the state prison system were poor and problems existed prior to privatization.

The Arizona Republic learned of the punishment after filing a public records request Friday. The state on Sept. 21 sent a seven-page letter to Wexford outlining the company's alleged deficiencies, according to  documents obtained under the Arizona Public Records Law. The state on Friday notified Wexford it had until Oct. 22 to respond to the notice.

In that letter, the DOC says:

A Wexford nurse on Aug. 17, at the Arizona State Prison Complex-Perryville in Goodyear, improperly administered medication to an inmate by having the inmate "lick the powdered medication from her own hand," instead of putting the medication in a small cup of water.

In August, the state learned that "a significant number of inmates may not have been receiving their medications as prescribed due to expired prescription(s) and inappropriate renewals or refills." The state said Wexford showed a "lack of urgency" to correct the problem, and the state had to deploy staff "to identify inmates in need of medication renewals."

An inmate was found hanging from a sheet in his housing unit in Florence on Aug. 23. The state determined that the inmate had not received his psychotropic medication for the entire month of August,  prior to his hanging, and Wexford's failure to deliver the medication was a "significant, non-compliance issue." Records do not indicate if the inmate survived.

On Aug. 27, a nurse hired by Wexford contaminated a vial of insulin, potentially exposing roughly 100 inmates at the state prison in Buckeye to hepatitis C. Another Wexford nurse was aware of the problem
Aug. 27, but she did not file an incident report until Sept. 4, violating policy. The state was forced to deploy additional compliance monitoring staff to correct the problem. It said Wexford failed to follow established nursing protocols, mismanaged documents and engaged in inadequate and inaccurate communication.

At the Goodyear prison, meanwhile, a known case of whooping cough, a reportable infectious disease, went unreported to DOC staff and Wexford's state-level management for 30 days, indicating a "lack of
urgency" and a "lack of awareness of the situation's potential seriousness."

"This is more proof that privatization is not saving us money, not providing better services and is not any more efficient," said Caroline Isaacs, program director for the prison watchdog group American Friends Service Committee. "While the state clearly had its problems, just inserting another layer to the bureaucracy is no way to address the problems, and it complicates the matter."

Wexford, in a letter to Ryan, said it believed in being held accountable, but added the DOC "must recognize that the system that was in place less than 90 days ago was extremely weak." Wexford also
said 34 people who were previously in state prison management positions were hired by the state as monitors, and that has created a void in "leadership and institutional knowledge that Wexford Health is
working hard to fill."

Wexford said those monitors are the same people who allowed the system to get to its current state, and they have interfered with Wexford's efforts to provide appropriate health-care services to inmates.

Before the problems in Arizona, Wexford had issues in other states.

Clark County, Wash., declined to renew a contract with Wexford in 2009 at its county jail and juvenile-detention center after complaints that Wexford was not dispensing medications to inmates in a timely fashion.

And New Mexico terminated a statewide contract with Wexford in 2007 after an audit by that state's legislative finance committee found shortages of physicians, dentists and other prison medical staff, and
noted that Wexford had failed to issue timely reports on the deaths of 14 inmates the previous year.

Seawright Prison Justice Project organizing.

www.facebook.com/SeawrightPrisonJusticeProject

I've been pretty swamped with letters from prison lately, and it's pretty much all bad news. Assaults are so prevalent that guys are having to get smashed or stabbed on several different yards before their protective custody applications are finally approved. I'm in a heated battle with the DOC over the violence they allow to be perpetrated against gay prisoners in particular. Mentally Ill prisoners are racking up tickets for refusing to house where they don't feel safe, and being punished with higher classifications that justify placing them in solitary and Supermax.

I know it sounds crazy, but from everything I'm seeing and hearing go on in the prisons right now, Arizona is actually building 500 new Supermax beds to classify the victims of extortion and violence into needing - particularly those who are mentally impaired - when they seek the protection of the state. That's instead of locking up the guys demanding to see their paperwork at every yard and ordering them to be hurt for the pettiest of infractions. Kill or be killed over bullshit, is what it comes down to, and good for all the guys who call it that and walk away knowing they just got a Kill On Sight jacket put on them. They want to go home to their kids someday, and few really want to keep anyone else from getting home to theirs.

I'm also hearing from families of prisoners who have been deteriorating for months waiting for their medication or a specialist consult to be arranged by Wexford. Wexford has a 1-800-we-hate-prisoners "help line" for families to call (okay, it's really 1-855-890-6307 ), but I was told not to waste my time, and instead got the contact info for the DOC's Director of Health Services in case I ran into any problems regarding health care delivery for prisoners. 

That fellow, Richard Pratt, says he passes my concerns on to the appropriate parties, and I guess I have no reason to disbelieve him. The problem may simply be that Wexford just doesn't care what he has to say, either, because we're having a hell of a time getting decent medical care to prisoners at ASPC-Phoenix/ Flamenco, which is the mental health yard. My friend there went for almost a week without any of the cream he needed when his interferon treatment caused him to break out in boils all over his body. He got visibly agitated about the oozing and pain after 5 days, so instead of filling the prescription he needed for relief they placed him on a suicide watch to make him suffer under closer observation. Brilliant, eh?

I already posted on the stuff I've been hearing from Perryville; it's all pretty bad across the state, but the women are especially vulnerable when buried in the misogynistic heart of any police institution, especially Chuck Ryan's prison system.

Anyway, my mailbox is overflowing these days and it may take me longer to get back to folks than it used to, but I want prisoners to keep on writing if they need help or if they have abuses to report for me to follow up on. I can't promise anything, but if there's something I can do to help even one person survive that place, I'll try. I've been organizing with some friends and families of prisoners lately - people are really rolling up their sleeves and giving to the cause, so I'm not so alone in trying to keep on top of my correspondence and expenses anymore. 

Speaking of organizing: The Seawright Prison Justice Project is hosting meetings at my place every Sunday this fall - contact me for the address and to confirm time (arizonaprisonwatch@gmail.com). Generally speaking, families come by in the mornings (10-noon) to do case management and advocacy type stuff, while the anarchists tend to come out at night (6pm). Go like the page if you want to join us, and keep posted.

Scottsdale PD and the Wrongful death of John Loxas.

  RIP John Loxas.

-----------from the American Civil Liberties Union-----

Relatives of Man Killed While Holding His Infant Grandson File Wrongful Death Lawsuit Against the City of Scottsdale

September 24, 2012

FOR IMMEDIATE RELEASE
CONTACT: (212) 549-2666; media@aclu.org

PHOENIX -   The family members of John Loxas, Jr., who was killed instantly after being shot in the forehead while holding his infant grandson, today filed a wrongful death lawsuit against the City of Scottsdale and the Scottsdale Police Department. The 50-year-old Scottsdale man was shot in February by Officer James Peters without warning and despite having no weapon and posing no threat.

The lawsuit was filed on behalf of Loxas' daughter, Alexandria Loxas, and his father John Loxas, Sr. They are being represented by attorneys with the Chicago-based law firm of Loevy & Loevy and the American Civil Liberties Union of Arizona. The plaintiffs seek an unspecified amount of damages.
"My father was my best friend," said Alexandria Loxas, 23, whose son, Neo, now 14 months old, fell to the ground after her father was shot. "I felt safe knowing I had him in our lives because he was always there to protect us, and now he's gone forever."

In addition to listing Officer Peters as a defendant, the lawsuit also names Scottsdale Police Chief Alan Rodbell, arguing he failed to implement adequate policies to hold the City of Scottsdale and abusive officers accountable.   Officer Peters was involved in an unprecedented seven shootings over the past ten years - six of them fatal. A Scottsdale Police Department official acknowledged that Peters' history of shooting civilians was "an anomaly in our department, and in most departments." Peters also had a long history of excessive use of force against civilians, including dozens of incidents involving Tasers; he was the subject of four separate citizen complaints in the three months leading up to the fatal shooting of Loxas.

"There may well be no other police officer in the country who has been involved in more fatal shooting incidents over this time period," said attorney John Loevy of Loevy & Lovey. "Our lawsuit alleges that the Department had no business trusting him with a gun after he had killed so many other Scottsdale residents."

The incident that led to Loxas' death occurred shortly after 6 p.m. on February 14th, when police officers showed up at his house after he got into a dispute with his neighbors who called police.  Several Scottsdale police officers arrived at the house and confronted Loxas while he was standing in the doorway of his home. He was unarmed and holding his grandson in his arms. Without any warning, Officer Peters shot Loxas in the forehead with a scope-equipped rifle, killing him instantly. None of the other officers at the scene fired a weapon.

There is no indication that since starting as Police Chief in 2003, Defendant Rodbell has ever determined that a   shooting by a Scottsdale officer that resulted in death was improper or outside of police department policy.  The complaint outlines the inadequacies in the city's internal review process for officer-involved fatal shootings, including the failure to obtain testimony from civilian witnesses and the reliance on the involved officers' self-serving version of events.

For example, on November 7, 2008, two SWAT team officers shot David Hulstedt in the back, leaving him paralyzed from the waist down.  Despite the fact that Hulstedt - like Loxas - was unarmed and holding a child in his arms, Rodbell found the shooting justified and "within policy."  A federal court judge later concluded that "no reasonable officer could have believed that shooting David without warning, while he calmly walked back toward his house with the young child over his head, was a proper means of protecting [the child's] safety."

"What we have here is the total absence of meaningful review by the Scottsdale Department and City of Scottsdale even for deadly shootings done without warning and involving unarmed civilians," said ACLU of Arizona Legal Director Daniel Pochoda. "The clear message to Scottsdale officers, including Peters, has been: there will be no consequences, no loss of gun privileges, no matter how questionable or illegal the nature of the shooting."

In addition to Loevy and Pochoda, the plaintiffs also are being represented by Elizabeth Mazur and Elizabeth Wang of Loevy and Loevy, and Kelly J. Flood and James Duff Lyall of the ACLU of Arizona.
Click here to read the complaint that was filed today.

 

police brutality protest in Old Town Scottsdale

February 25, 2012

 

SOS: ASPC-Perryville Conditions of Confinement.

September 20, 2012 
PERRYVILLE UPDATE: 

My friend Christy, a prisoner out at Perryville / Santa Cruz, dropped me a letter late last week that just came in yesterday. It was dated 9/14/12. Here's the update:

"I was called up to the Deputy Warden's office to talk about my kites. Here is what has been done:

Water was turned down (hot water off)
Coolers were purchased but they ran out of money to install them so that is still a problem
I was given tape to tape my vent for roaches
the exterminator is supposed to come out & spray inside and out
the back window is still broken does not close (we have a bag with tape covering it)
they power-washed the showers 
we still only have 2 showers working - the lady who was fixing them was out here on 9/11...
the doors are still having to be keyed for a total of 48 rooms - that is a fire hazard!"

All that happened in response to earlier complaints filed by her and a few of the other women prisoners, and while I brought some things to the  DOC's attention a couple of weeks ago, this happened before I made the following post which had new information, so I can't really claim the credit for getting them to clean things up there. Christy and these women who protested their conditions of confinement have my respect for their courage and persistence.

I plan to organize a prison watching group for Perryville, soon, so stay tuned.


Peggy Plews

----------Original post (9/16/12)----------

I received this anonymous letter this past week from ASPC-Perryville/Santa Cruz yard, and have since challenged Richard Pratt, the Director of Health Services for the AZ DOC, to take the lead in cleaning up the place since so many chronically and critically ill women are trying to survive more than just their sentences under these conditions. I also asked him to set me up with a tour - suggesting we go together unannounced, if things are really as hunky dory at Perryville as they want me to believe. We'll see what he says once he gets a chance to respond. I'm probably now considered an external Security Threat Group leader, so my chances of getting in - sans the orange jumpsuit and chains the DOC would no doubt like to see me in - may not be too good.

In addition to the letter below from Santa Cruz last week, I received another one the week before from the same yard stating that there's a huge roach infestation problem that wasn't mentioned below, as creatures can easily enter through the cracks in the walls and window sills. 

Furthermore, I've been told by several sources that many women haven't been getting their medications for most of the time that Wexford has been in charge of medical services - that's been since the beginning of July. Hopefully, Wexford's brilliant administrators have finally figured out how to get their drugs to Arizona from Pennsylvania (or Columbia, or China, or wherever they're really importing their prescriptions from).

Also not articulated in the letter below is my concern about the high rate of suicide and deaths from sheer neglect at ASPC-Perryville. Most of those have occurred on Lumley yard, though, not Santa Cruz. Lumley is the maximum security yard where female prisoners who are seriously mentally ill, defiant, assaultive, or on death row are typically held in isolation cells. The ACLU's lawsuit Parsons v Ryan enumerates many of the additional concerns I have about the conditions of confinement and medical/mental health care for the women across the prison complex. Lumley is where Marcia Powell was killed by the desert sun after being left in an outdoor cage for four hours - theoretically while on a suicide watch.

I'm planning to set up a "Perryville Prison Watch 101" meeting this fall for community members who are interested in bettering the chances these women have of surviving prison and coming out able to lead lives as "responsible citizens" again; we aren't going to change any of this without help from more of the ordinary People out here who believe this kind of abuse and neglect - in our names, with our money - is unacceptable. And for Women's History Month in March 2013 we'll be celebrating the history of women's resistance in prison. Stay tuned for more on all that.

Remembering some of the women who have died out at Perryville, the following photos were taken from a mural laid out by community members in front of the Phoenix Art Museum for Prisoners' Justice Day in August of this year. Some things at Perryville can be fixed with caulk and elbow grease that the women would put into it themselves, given the right resources, but the culture of contempt for prisoners that fosters this kind of neglect is going to take a lot more to change.
 

Brenda Todd, 44. 
Victim of institutional indifference.
(January 21, 2011)

 

 Susan Lopez, 35. 

Victim of suicide and psychiatric neglect.

(March 25, 2011)

Marcia Powell, 48

Victim of a 10-minute suicide watch, bad policy, 

unconstitutional practices, and cruel and abusive guards.

(May 19, 2009)

-----------------received 9/13/2012--------------

"In the winter months, the heat is turned on by date rather than temperature. The heat runs full blast and the rooms get to be unbearably hot. The officers do not have the authority to turn the heat off, even if it is an unseasonably warm day. On a "warm" winter day, the room temperatures can reach the 90+ degree mark. The window cranks in most of the rooms are broken and do not open so there is no way to get any relief. This is absolutely cruel and unusual punishment.

In the summer months, the evaporative coolers or air conditioners are turned on by date rather than temperature. Some rooms have coolers, others have AC. In the early spring, the rooms are very cold. In the heat of the summer, when the humidity rises, the coolers do not work well. Once again the temperatures inside the rooms can reach the 90+ degree mark, with no way to get any relief. When the AC works, the rooms that have it are comfortable in the summer. The challenge is that they are often broken. As of this writing, the temperature outside is 113. The AC In my room and the 7 other attached rooms is not functioning at all. It has been out of service for the past 2 weeks. Unfortunately, or fortunately, I do not perspire very much. Extreme heat causes my muscles to cramp. I get very light headed and dizzy and ultimately vomit. I do not know if there is a medication of any kind of solution since I cannot seem to get to medical. Often we live in exceedingly hot, or exceedingly cold rooms with windows that do not open. Just another example of cruel and unusual punishment.

The Arizona sun can be punishing,. especially for those of us that have little or no tolerance for heat exposure. Lines for medical appointments, property pick up, state issue, and the store are often long. In the medical waiting area, shade and water are provided. Not much can be done to reduce the heat since the waiting area is outside. The wait can be several hours. The lines for property, state issue, and store are not in shaded areas. The wait is usually a couple of hours at best.

The mattresses in most of the cells are worn out. They are leaking black material of some kind. The coverings are cracked. The mattresses are thin and do not provide any kind of support or much protection from the metal bunks.

Many of the cells have cracks in the walls that leak rain water. In my cell, water seeps in only one corner so I am lucky that mine is not one of those that floods. However, in that corner mold is growing. In one of the rooms next to a shower, the mold is so bad that it is growing down the outside walls as well as the inside.

The showers leak gallons of water daily. Some of them have been leaking for years. The erosion of both the concrete and the metal support beams is clearly visible. I am not a building inspector, but I can clearly see that the iron railings and support beams are rusted clear through.

Hot water for showers is not always available. Sometimes we have no hot water for days at a time. When this happens, there is no hot water for washing the trays or kitchen utensils either. This has been an on-going challenge since I have been here (1997). Budgets were not restricted for the majority of those years so I find it difficult to understand the situation. The trays, sporks, and cups in the kitchen are frequently dirty. Dirt is actually embedded in the trays and sporks where the plastic coating has been worn away.

On 16 yard, dinner "sacks" are passed out at 5pm Monday-Friday. Breakfast starts being served at 8 or 8:30 on Saturday mornings. 15+ hours between meals. ON weekends, we are provided with breakfast and hot dinner, just two meals. The ladies from 14 yard walk to our kitchen and eat breakfast around 7am. The kitchen on 14 yard has been closed and the building has been condemned. At 5pm the ladies from 14 yard come to our kitchen once again for dinner. Our yard has dinner after all of them have left the yard. That is usually around 6:30 or so. For those that do not have money to purchase food from the store, it is a very long time between breakfast and dinner.

Adequate clothing is no longer provided. I waited over 6 months to have 2 pairs of panties that were lost in the laundry replaced. per policy, we are allowed to exchange clothing or linens once every 90 days. The challenge is that most of the time, state issue does not have the size or the items that are needed. On this unit we have been out of medium panties, small pants and medium t-shirts for months. When I tried to exchange clothing I was told sizes 3x were the only one available. I weigh 120 pounds! Incoming inmates are not provided with the policy-stated issue.

Each inmate is provided with 1 roll of toilet paper for the week and 12 sanitary napkins for the month. Further discussion of this is probably unnecessary."

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 

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