By Buried Alive, February 2006 (Serving a life sentence for a non-violent drug conviction under the three Strikes Law, writer Buried Alive is an inmate at the California Correctional Center in Susanville and a regular contributor to Under Lock and Key)
With a liver destroyed by hepatitis C, Robert Hagenson received, not a new liver, but an early parole. Except in Hagenson's case, release came in the form of a body bag. The end stages of a premature death are never pretty, and the accelerated deterioration of Hagenson hit many of us at the California Correctional Center (CCC) real hard when he died on December 29. Seeing someone pass away is unsettling, especially when they're a fellow prisoner - and friend.
Hagenson, who everyone called "Freddy," was 45 years old when he began serving a sentence of 25 years to life for a San Fernando Valley armed robbery he committed in 1997. Barely over five feet, his body covered in tattoos, and a head shaved clean, he looked every bit the criminal and convict. While Freddy told me many times he expected to die in prison, he never expressed a desire to die from the hepatitis C virus (HCV) just before his fifty fourth birthday.
As cellmates, Freddy and I became friends in 2004. Despite numerous prison terms in a career of crime that spanned four decades, in prison Freddy was just one of the fellas. A blunt spoken old grouch whose rants against god, government and the GOP were generally mean-spirited and belligerent, Freddy was more bark than bite. Though nothing can mitigate the fact he committed robberies to support a vicious heroin habit, the state should be held equally culpable for failing to provide adequate medical care.
Seeking Treatment
Freddy's first real attempt to seek medical attention began back in mid 2004. Even though he hid it well, I knew he didn't feel right. Already thin as a rail, he had lost a few pounds. Sleep came with great difficulty, if at all, and his memory showed signs of failures. Not being trained in medicine, I naively thought the man too ornery to fall prey to illness. Nonetheless, Freddy embarked on a sojourn of appointments, blood tests, and follow ups that were amalgamated with gross medical incompetence.
Providing health care for 167,000 inmates confined in the California Department of Corrections and Rehabilitation (CDCR) is very difficult because a majority have abused drugs, alcohol, and their bodies for years. Such hard lives have this demographic lead that 55 is considered old and roughly 40 percent have contracted HCV. Prison is a breeding ground for all manner of blood borne illness, especially pathogens like HCV. Tainted needles follow the path of contraband drugs like the Angel of Death.
When Thelton Henderson, judge for the United States District Court in San Francisco, placed CDCR's beleaguered health care providers under receivership in June 2005, he opined medical incompetence caused 60 preventable deaths a year. Seeing firsthand how these same doctors provided treatment for Freddy, the circumstances surrounding Henderson's learned opinion hit like a slap in the face. The large number of HCV infected inmates, an ailment that can incubate for decades, requires constant monitoring by experts, not the type of doctors Henderson said cause "an unacceptable degree of suffering and death."
A Broken System
Over the period of a year, beginning in mid 2004, Freddy saw half a dozen different prison doctors, none of whom took the necessary actions to save his life. Rather than a specialist who possess intimate knowledge about a patient's case, HCV inmates will often go months without seeing the same doctor twice. "Every doctor has a different opinion, and they all tell you something different," Freddy told me in the housing unit's dayroom.
Freddy needed treatment for cirrhosis of the liver. An August 2004 blood test showed his liver enzymes were at double and triple the high range. Due to almost half of the population being infected with HCV, the only way the state can meet their specialized medical responsibilities is through the employment of numerous gastroenterologists at every one of the state's 33 prisons. When Freddy's liver enzymes came back at alarming levels, aggressive practitioners might have saved him.
On October 2, 2004, after a slew of unreadable, partial, and lost test results, coupled with empty stares from doctors who respond to pointed questions with more blood tests, Freddy filed an administrative appeal, known as a 602.
"When the sample came back it was unreadable. The doctor ordered another sample and, because I had lost five pounds, ordered another blood work. Three vials of blood were taken. The follow up revealed they could only find two of the three. The two vials indicated there was a problem with my blood, the doctor was concerned I might have HCV, and ordered another blood work. I again gave three vials, and I have not heard anything since," Hagenson wrote.
Since Freddy has shared needles his whole life, he assumed he had HCV like everyone else. This is why he began to grow angry. Yet the chief Medical Officer (CMO), Dr. N. Baron, canceled Freddy's appeal on November 1, 2004. The CMO stated Hangenson waived his right to appeal by refusing to cooperate since he had grown angry at the medical staff at CCC. This is a pattern repeated throughout the annals of prison medical negligence -- heartless prison doctors fixate on an inmate's justified anger, rather than elevated liver enzymes or some other legitimate medical condition. This is exactly why Henderson has placed correctional health care under his jurisdiction.
A January 2005 liver biopsy confirmed Freddy had chronic HCV, which had escalated to severe cirrhosis of the liver. At this point, time is of the essence. A doctor told him he'd soon be starting a regimen of interferon-ribaviron, known as combination drug therapy. While HCV is considered an incurable disease, drug treatment has literally cleared the virus from those with certain strains of the disease and saved the lives of untold others.
Months passed, more blood tests were taken, but not treatment. Then in July, these prison doctors determined Freddy's ammonia levels were too high to receive any treatment whatsoever. Instead they told him they were sending his paperwork to CDCR headquarters in Sacramento. Another round of delays, treatment in the form of another layer of bureaucracy when emergency measures are a matter of life and death. An entire year had elapsed while prison doctors pushed paperwork and treated his condition like a procurement order.
The End
By October 2005, massive gastrointestinal bleeding brought Freddy to death's door. All the doctors can do at this point is patch up the liver one or two times before the inflicted eventually slips into a coma and dies of liver failure. Since so many inmates have HCV, we have seen the combination drug therapy work wonders . . . when they are lucky enough to receive it while the liver still functions. In Freddy's case, any chance to save him in 2004 simply fell into a vacuum of murderous medical incompetence throughout 2005.
Freddy seemed to bounce back for awhile after the first surgery. Some of his old humor and sarcasm had returned, but he barely resembled his former self. He told me he had been given only a couple of months to live. Still unlearned on HCV, I maintained hope he'd somehow beat the disease. Then in early December his liver gave out again, and he made a final trip to a Reno hospital for what would be a last attempt to stave off death. The only thing that could save Freddy at this point was a liver transplant.
Amazingly, Freddy made it back in mid-December. It would be only a few days before he died. In a conversation forever lodged in my mind, Freddy said the doctors at the Reno hospital couldn't believe the medical department at CCC simply left him untreated after the first surgery. To doctors concerned with professional ethics and standards, not to mention malpractice suits, complete inaction when a patient is screaming for treatment is unheard of. The Reno doctors assumed, at the very least, Freddy would have been placed on a diet low in protein and sodium. This alone can add months to a dying patient's life.
Most of us, especially those with HCV, are shocked at how quickly the virus took Freddy. Just a few years ago he played handball and worked out with men half his age. No he's dead. Freddy might have deserved a life sentence for his life of crime, but he didn't deserve a death sentence at 54 because the prison system, according to Henderson, practice "neglect and cruelty" instead of responsible medicine.
"If they got at me 18 months ago, they probably could have saved me," he told his friends. "By the time they did something, it was too late. They killed me."