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Hepatitis program
for isle inmates
innovative in U.S.

One benefit will be to see
how such a program can be
successfully carried
out in prisons

By Helen Altonn
Star-Bulletin

A Hepatitis C screening and treatment program is being planned for Hawaii inmates that may help prisons across the country.

"We don't know how bad it is (in Hawaii's prisons); we have not tested the population for it," said Wesley Mun, health care administrator in the Public Safety Department.

But according to national estimates, 14 percent to 24 percent of a prison population may be affected by the blood-borne viral disease, he said.

Mun said the department has had many inquiries from inmates about a treatment program.

"We actually had some people starting medical conciliation panel proceedings against us for failure to treat.

"But this is something we've been looking at quite a while," he added, explaining he did research on the virus as a major risk for an incarcerated population before joining the department.

'Not very easy therapy'

Mun enlisted help from St. Francis Medical Center's Liver Center to establish inmate screening and treatment guidelines.

Dr. Naoky Tsai, medical director of the center, and Dr. Robert Jao, assistant medical director, had received letters from inmates inflicted with Hepatitis C. Tsai said he developed the guidelines based on his experience, and he will provide professional advice to the corrections doctors.

"There are no guidelines at other facilities floating around," he said. "It's pretty much a new thing for the state of Hawaii."

Mun said the department is asking the Legislature for $475,000 to start testing and treatment. The program will begin after staff training is completed, and it will be voluntary for inmates, he said.

They must meet certain criteria for testing and treatment -- a combination therapy approved by the Food and Drug Administration called Rebetron.

"As far as we know at this point," Tsai said, "it can help to eradicate the virus infection in about 40 percent of patients treated. In my book, although people may argue with it, it's a cure."

The treatment combines two therapies -- one taken by injection three times a week, and the other by five or six capsules a day.

"This treatment is not very easy therapy," Tsai said, noting many side effects. "They are mostly manageable, but in a prison setting, we don't know."

He said one benefit will be to understand how such a program can be carried out in a prison system without major disruptions. "The data we can generate can help the country as a whole."

Prisoners entitled to care

Treatment may be needed for six months to a year, Tsai said, with the cost for six months of the drug therapy at about $8,000 to $10,000 for each patient.

"The only American entitled by law to medical care is a prisoner," Tsai said, noting that an inmate has the right to request and receive the standard of care for any disease.

Mun said Hepatitis C is "a very, very long disease," taking 24 years before serious symptoms start showing. "One school of thought is, 'Don't treat it. By the time this impacts a prisoner, he may have died from other causes.'"

But, he said, "If standards in the community are to treat Hepatitis C, we should also."

Obligation to public health

"Our biggest fear is releasing Hepatitis C into the community," he said, noting that most inmates eventually leave prison and that "our obligation is to community health."

The Liver Center was established in 1992 when the transplant program started. The unit has three other doctors and a research nurse, Angie Coste. "She is the spirit of the whole project," Tsai said.

The hospital charges the patients, but the unit is run by the University of Hawaii, and the doctors are medical school faculty members, Tsai said.

The center averages 12 to 15 patients a day, and there are nearly 1,500 people treated and followed on a regular basis, he said.

Facts about Hepatitis C: It is a virus causing inflammation of the liver, possibly resulting in liver cell damage, cirrhosis and cancer. The incubation period is two to 25 weeks, with an average of seven to nine weeks. It is spread by contact with infected blood, contaminated IV needles, razors, tattoo or body-piercing tools, and an infected mother to a newborn. It is not easily spread through sex. Some persons may have no symptoms. Others may have mild flulike symptoms, dark urine, light stools, jaundice, fatigue and fever. Unlike the Hepatitis A and B viruses, there is no vaccine for Hepatitis C. People at risk are blood transfusion recipients before 1992, healthcare workers, injection drug users, hemodialysis patients, infants born to an infected mother, and multiple sex partners. Source: Hepatitis Foundation International