Tainted drug test kept inmate off transplant list
The day after the war began in Iraq, a more personal battle ended.
March 23, 2003, Jeffrey Muller died. He fought hepatitis C for years on two fronts -- one medical, the other legal. As a Michigan prison inmate, the Grand Rapids man filed a lawsuit, insisting the state, through its for-profit health-care provider, treat his illness and allow him to be placed on a waiting list for a liver transplant.
He won the lawsuit but lost his life.
But his persistence helped bring to light what many regard as an unchecked epidemic of hepatitis C, a sometimes fatal liver disease, among Michigan prison inmates. The Department of Corrections and Correctional Medical Services, the company hired to care for the state's more than 50,000 inmates, are not doing enough to treat the disease and stem its spread, prisoner rights advocates charge.
"The same thing that happened to him (Muller) is happening to hundreds of prisoners," said Penny Ryder, head of the Criminal Justice Program for the American Friends Service Committee.
The files in her Ann Arbor office are filled with letters from inmates saying they are not being treated for their hepatitis C.
By some estimates, as many as 40 percent of inmates in America's prisons have hepatitis C, well above the 2 percent infection rate for the general population. Dr. George Pramstaller, chief medical officer for the Michigan Department of Corrections, once estimated 30 to 35 percent of the state's prisoners, about 15,000 inmates, had hepatitis C.
But state corrections officials insist the rate is much lower. Two years ago, the department tested 650 incoming inmates and found 13.8 percent had hepatitis C.
"I wish it was that low," said David Santacroce, a University of Michigan law professor, whose students have filed lawsuits for prisoners, including Muller. "I suspect it's not. I've never heard a reason why Michigan would be that much lower than other states."
High costs of disease
The testing program failed to account for the older inmates, who contracted hepatitis C before it was identified in the late 1980s, he said. The testing also did not include those prisoners who contracted the liver disease after coming into prison.
Two years ago, Gov. Jennifer Granholm requested $5.9 million to test inmates for hepatitis C, but the Legislature cut it to $1.15 million. Last year, the Legislature eliminated all funding for hepatitis C testing and treatment.
As a result, the state is not meeting the U.S. Centers for Disease Control's guidelines on hepatitis C testing, a corrections official admitted in a memo to legislators last April.
"The Department is not aggressively testing as recommended by the CDC and is therefore subject to lawsuits," Barry Wickman, head of the department's bureau of fiscal management warned the House Appropriations Subcommittee on Corrections.
Like HIV, Hepatitis C is spread through blood-to-blood exposure. Before 1992, when screening of the blood supply began, it sometimes was spread through transfusions. Many contracted it by sharing needles or by having unprotected sex. It also can be spread through tattooing and sharing razors and toothbrushes.
The disease progresses slowly, often taking more than 20 years for symptoms to appear. Ten to 20 percent of those exposed to hepatitis C develop serious liver disease that can be fatal. There is no vaccine to prevent it, but it can be successfully treated.
But treatment isn't cheap. The standard drug therapy costs $11,000 a year for each patient, corrections officials estimate. Untreated, the only cure is a liver transplant, which can cost $250,000.
The U-M Clinical Law Program receives 500 to 600 letters a year from inmates pleading for help. In the past, most proclaimed their innocence. In recent years, the majority complain of inadequate health care, Santacroce said. Of those, most are from inmates who have hepatitis C.
The U-M law students have filed several lawsuits for the inmates, and a pattern has emerged: The students sue, the Corrections Department begins treating the inmate, and the lawsuit is dismissed.
"It's only because we're forcing them," Santacroce said. "As soon as they give us what we're asking for, we drop the case. They (Corrections Department officials) drag their feet as long as possible. I can't file a lawsuit for every one."
If members of the public aren't concerned about the disease in the prisons, they should be, Santacroce said. About 95 percent of the inmates eventually will be released, posing a potential health threat to others.
Hitting close to home
"It spills out," he said. "They're the kind of people you bump into in the grocery store. They're the people who date your sons and daughters."
In an office in the university's law library, Santacroce opened a drawer filled with file folders, each representing a Michigan prison inmate with hepatitis C.
"This is probably 150 people," he said. "There are probably another 300-400 in storage. I could file a new hepatitis C case every week, and my guess is I'm seeing a very little bit of it.
"Jeffrey's was one of these letters."
That letter from Jeffrey Muller was Santacroce's introduction to hepatitis C. Muller grew up in Grand Rapids' North Park neighborhood, dropped out of Creston High School in the 1960s and began using drugs.
"It was such a waste," said his mother, Martha Gabrick, of Newaygo. "I always said he was so smart, but he didn't have a bit of common sense."
He was in and out of prison, mostly for stealing things to support his drug habit, she said.
"As soon as he'd get in prison and was away from the drugs, he'd swear he'd never do it again," she recalled. "Then he'd get out, and he'd be right back in it."
By the time Muller learned he had hepatitis C in 1996, his disease had caused cirrhosis, severe scarring of the liver. He never knew how he got it. His only hope was a transplant, but he was denied a place on the waiting list.
In November 2001, after he sued the state, the University of Michigan Medical Center agreed to put him on the list if he remained drug free. Ten days later, a prison guard arrived at Muller's cell to collect a urine sample. The test came back positive for THC, the active ingredient in marijuana, prompting the hospital to drop him from consideration for a transplant.
'Draw your own conclusions'
Muller insisted he had not used marijuana, but almost no one, not even his family, believed him. The U-M law students asked that they be allowed to have the urine sample tested, but corrections officials insisted it no longer existed.
But the law students tracked it to a Texas laboratory and had the DNA compared with a sample of Muller's blood. The test showed the urine was not Muller's. His attorneys claimed someone deliberately switched the urine sample to keep Muller off the transplant list.
"You can draw your own conclusions," Santacroce said. "I'm saying I don't understand how else it could happen."
After repeatedly being denied parole, Muller was released from prison in the fall of 2002 and came to live with a niece in Grand Rapids. While in prison, he had earned a bachelor's degree in behavioral science, and he hoped to get his master's in social work at Grand Valley State University.
"I'd like to think I might have 10 or maybe 15 more good years where I could be productive in some socially acceptable fashion," he said in a 2003 interview with the Metro Times, a Detroit weekly alternative newspaper. "If it doesn't come to pass, then it doesn't."
It didn't.
In March 2003, his older brother, John, drove him to Ann Arbor for a doctor's appointment. On the way home, Muller became so ill his brother turned the car around and returned to the hospital.
"That was the end," said his mother, Martha Gabrick, 83. "When the liver got to the point it didn't work anymore, it was quick."
He slipped into a coma and died. He was 51.
More than three years later, Martha Gabrick, a retired nurse, still believes her son could have been saved with proper medical care.
Santacroce knows it's not easy for the public to feel sympathy for someone like Muller, who was in and out of prison for burglary, carrying a concealed weapon and armed robbery.
"It wasn't a life sentence," he said. "But in the end, by denying him this treatment, they were sentencing him to death for a robbery.
"That, to me, was tremendously unjust."
Send e-mail to the author: pshellenbarger@grpress.com