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Dr. Bruce Luxon, a liver specialist and associate professor at the St. Louis University School of Medicine, explains that the liver is the organ that makes most of the chemicals that allow blood to clot. "So if your liver is not working, your blood doesn't clot as well and your platelets -- a blood element -- are often low, so you're more at risk to have significant bleeding. If you've ever taken care of somebody that bleeds a lot because they have cirrhosis," Luxon adds, "it is a very scary thing."
Luxon, who says hepatitis C is known as "the silent epidemic," believes the best way to combat the spread of the disease is to root it out. "What we recommend is not to test on symptoms but to test on risk factors," he says. "So if you walked into my clinic and said, 'I have injected drugs,' or, 'I had a transfusion before 1991,' those things would cause me to test you." Luxon says that a decade or so ago, only about 5 percent of people with the virus could be cured; the figure is now up to 50 or 60 percent -- when the disease is detected before a person becomes cirrhotic. "It is a rough course of treatment with the interferons, which are shots and pills that people take for six months to a year," Luxon adds.
In January of this year, the CDC noted that screening inmates and, where possible, treating them with antiviral therapies such as interferon drugs helps to halt chronic liver disease and slows transmission.
"Each inmate with risk factors for hepatitis C is evaluated by a trained healthcare provider and offered appropriate diagnostic testing," responds CMS spokesman Ken Fields. "If the tests indicate chronic infection with hepatitis C, the patient receives an evaluation and treatment in a chronic-care clinic for liver disease."
But the August 2003 issue of Harper's contained a story about CMS that featured an internal memo from Dr. Gary Campbell circulated in February 1999: "Unless I have given you specific approval to do Hep C testing, do not do so unless the patient has obvious moderate to severe liver disease or has exposure as described by the exposure policy of the DOC. Remember, all Hep C testing has to be approved by me," the memo reads.
Fields calls the statement attributed to Campbell a "partial quote" that was "taken completely out of context" by the magazine. He declined, however, to furnish a copy of the memo in its entirety.
And the MDOC's understanding of CMS's current protocol at Vandalia would seem to give credence to the gist of what Campbell wrote back in 1999. "I don't think they specifically test for hepatitis C," says Kniest. "My understanding is that hepatitis C is an ailment that can lie dormant in an individual for many years. And if it is not an active case of hepatitis C, there really isn't any treatment to follow anyway. If someone starts suffering symptoms, then the medical staff make a decision as to what kind of treatment regimen we will follow for this individual."
Citing confidentiality regulations, CMS declines to discuss Lavenia Populus' death. Corrections spokesman Tim Kniest confirms that Populus died of cirrhosis of the liver. After investigating Troupe's allegations, the MDOC concluded they were unfounded. "There was no finding that that had occurred," says Kniest.
Owing to term limits, Troupe's 24-year career as a legislator ended in 2002.
Meanwhile this past March, Crystal Smith, who was serving a five-year sentence for drug possession, was found unresponsive in her cell at Vandalia. Kniest says an autopsy revealed the 46-year-old inmate died from cardiomyopathy, or heart disease.
On July 2 Vandalia inmate Al'Deana Simmons, who was serving a four-year sentence for forgery, died of an aneurysm at age 33. Her ex-husband, Jeff Simmons, says a Vandalia prison official called his home. "They told me that she was in the infirmary and that she ate breakfast and they went back and checked on her twenty minutes later and she was dead and they thought she might have choked on food," Simmons recounts. "Actually, she was in isolation and died of a brain aneurysm."
Al'Deana Simmons called her mother the day before she died. "She told me she was at the infirmary and she couldn't see and there was something wrong with her head -- it was sizzling," Virginia Terry recalls. "And she said the doctor saw her for ten minutes and said there wasn't nothing wrong with her." Before being incarcerated her daughter had been treated for bipolar disorder with medication that doctors said she'd have to wean herself from, Terry says, but Simmons wrote from prison saying she'd been switched to another medication. Terry also says she has met with the federal investigators in St. Louis who had questions about Simmons' death.
The day after Al'Deana Simmons died, a CMS nurse at Vandalia mistakenly administered the antidepressant Sinequan to about fifteen inmates who previously had been receiving Prozac. Thirteen of the inmates had to be sent to the hospital. "Two were kept overnight for further observation," says the MDOC's Tim Kniest. "Basically what happened was that when they took their medication, their blood pressure dropped significantly." Both women returned to Vandalia the next day, Kniest says. "None of the inmates suffered any long-term ailment because of that."