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Prisons:3 8/23/07 8:54 AM Page 14 Both Pat and Nikki described repeatedly watching inmates following a course of predictable decline due to illness and disease, easily recognized by inmates but apparently mysterious to prison staff. "You hated to see someone get sick," Pat said, "because you knew what would happen." Among the untreated and undiagnosed illnesses epidemic in California prisons is Hepatitis C. A 1994 study shows that as many as 40 percent of prisoners in California had Hepatitis C that year. Hepatitis C is a blood-borne infection that is potentially life threatening. Treatments for Hepatitis C, like Interferon, are both costly and risky for older patients who are less able to tolerate the treatment's side effects. Transmission most often occurs through infected needles but can also occur in prison through use of unsterilized tattoo needles. Some prison medical personnel recognize that the best opportunity to prevent a Hepatitis C epidemic from reaching the outside world is by managing it within prison walls. So far the court-appointed receiver of the California prison system has not defined a specific plan for treating and managing Hepatitis C in prison, addressing it as it does all other chronic diseases. According to California Prison Focus (CPF), an organization whose mission is to end human rights abuses and medical neglect in California, many prisoners are screened for Hepatitis C when they enter prison but are never treated, incorrectly treated, or treated too late. CPF cites cases and provides first-hand reports of prisoners cross-infected with HIV and Hepatitis C showing significant signs of liver degeneration, including severe jaundice and bleeding from the nose and mouth, while prison administration and care providers continue to give liver-damaging HIV medications without reassessing inmates' needs. Recent national news reports indicate that other prisoners aren't treated until their liver has reached a near-terminal stage of deterioration and chances of improvement are small. Others have never been told about the disease until symptoms from nosebleeds to chronic pain have developed. Both Pat and Nikki have direct experience with Hepatitis C and have witnessed conditions for Hepatitis C patients within prison walls. The last time Pat saw her friend Karen, who had Hepatitis C, was on a prison yard. "She said that when she asked how long she had, the doctor shouted at her that she could die any time," Pat said. Her friend was unable to hold anything in her hand and she was shaking. "She didn't have a life sentence and she only had 15 days before she was supposed to go home. She died in the hospital just before she would have been released." Pat's friend was not diagnosed until late in her illness, a common problem in California prisons. In 1998 Nikki, herself concerned about the mounting risk of Hepatitis C infection in the prison, received a blood test and requested her own prison medical records. She discovered that a blood panel taken from her in 1976 showed evidence of Hepatitis A, B, and C—but she was never informed of the results. After learning of her condition, Nikki wanted to be treated, but medical personnel refused, saying she was too old to endure the drugs' side effects. She had to file an appeal and a year passed before she finally won the right to take drugs to fight her hepatitis. Besides the Hepatitis C, Nikki has her own medical horror story to tell. In 2000, on a visit off prison grounds to a local medical clinic, Nikki, chained at the wrist and ankles, tripped and fell forward with 14 REGISTERED NURSE her wrists bound. "The wrist chains were forced up into my breasts," Nikki said. Nikki had breast implants, and she knew immediately that they had ruptured. She felt the cool silicone gel filling her chest cavity as the guards tried to get her to stand. She repeatedly told them that she could not. The guards continued to try to make her stand. Nikki believes that the only reason she got immediate attention was because a nurse from a nearby hospital saw her fall. The nurse grabbed a gurney and made the officers take Nikki inside. The ER doctors confirmed that her implants were ruptured. Nikki wrote an appeal to have the ruptured implants removed, her chest cavity flushed out, and new ones replanted. "What happened to me amounted to an instant double mastectomy," said Nikki. It was a situation that emotionally devastated her. She fought with the California Department of Corrections and Rehabilitation (CDCR) for a year as they continued to blame her for the fall, claiming she had "veered from the path," despite previously-documented falls by inmates because of the design of the shackles. (Nikki's appeal was eventually partially granted in recognition of problems with the design of the shackles. For several months, Nikki said she was placed in safer shackles. Later, the shackles that contributed to her fall were used on Nikki again. Despite her objections, the more dangerous shackles were still in use at the time Nikki and Pat left prison). Nikki's request for help with the silicone was denied by the corrections department. Her only recourse was to file a lawsuit, or be left without breasts, the silicone still inside her. Eventually, the doctors at Riverside Community Medical Center, where the fall had happened, advocated for Nikki and agreed to perform the surgery to replace the implants and flush the silicone out of Nikki's chest cavity. By the time the surgery took place, the silicone had been in Nikki's chest for a year. For Pat and Nikki, it is a triumph that they got out alive. "Lifers thought that if they fought the system, they would never get out," said Pat. "I didn't want to go out in a pine box or a wheelchair. I wanted to walk out." Both Pat and Nikki served their fellow inmates like sisters while in prison. They helped newcomers learn different trades, and Pat helped sick prisoners file their cases with attorneys. Nikki worked W W W. C A L N U R S E S . O R G J U LY | A U G U S T 2 0 0 7