Luis Edward Gama arrived at California Correctional Institution in Tehachapi in 2016. While being processed, he tested positive for hepatitis C, but because he had 15 months left on his sentence, California Correctional Health Care Services (CCHCS) denied his treatment.

Seven years later, Gama returned to prison and was diagnosed with cirrhosis of the liver—a condition caused by his untreated hepatitis C—while being processed at the Wasco State Prison-Reception Center. Before Gama could start treatment, he was transferred to San Quentin, where his cirrhosis continued to go untreated.

It would take until February 2024 for Gama to find out definitively that he would not receive treatment for his hepatitis C or cirrhosis. His primary care doctor at San Quentin said he was being denied treatment because he was due to be released in April. Gama now fears for his long-term health.

“Starting treatment now would reduce the chances of becoming terminally ill,” he said.

Gama is not alone. Other incarcerated individuals at San Quentin diagnosed with hepatitis C are experiencing delayed treatment or outright being denied treatment. While the CCHCS claims it’s updated its policies regarding treatment, incarcerated individuals at San Quentin say they’ve remained untreated.

If left untreated, hepatitis C can develop into cirrhosis, a condition where healthy liver tissue is replaced with permanent scar tissue, increasing the chance of liver failure. Other complications also include high blood pressure, swelling of the abdomen and spleen, liver cancer, and death.

Failure to treat hepatitis C within prison walls can also lead to greater transmission among the general population once infected incarcerated people are released. According to the Centers for Disease Control and Prevention (CDC), hepatitis C impacts 1% of the general U.S. population but at least 17% of the prison population. In 2018, the state of California allocated more than $150 million to treat the disease for 22,000 individuals within the state prison system. Hepatitis C treatment drugs made available in 2013 have a success rate of more than 95%, though many state prisons cite their expensive price tag—anywhere between $24,000 to $84,000 per treatment—as reason to deny treatment.

As of January, CCHCS said a person’s release date is no longer considered for a patient’s hepatitis C treatment plan. However, this statement is not representative of the reality of incarcerated individuals at San Quentin. The majority of the residents at San Quentin who are impacted by the disease say that submitting a grievance for medical care often leads to a dead end. The grievance process can take anywhere between 15 and 30 days before an interview takes place, and even then, they aren’t guaranteed to receive the care they need. Impacted incarcerated residents at San Quentin also say that denying someone medical care due to a release date just creates another hurdle for them to juggle while they manage reentering their communities post-release.

In 2022, before being transferred to San Quentin, Miguel Gaxiola tested positive for hepatitis C when he arrived at the Wasco Reception Center. Gaxiola remembers feeling uneasy awaiting treatment for the disease, and he was skeptical of the length of time it would take to receive medication and care. After waiting two months to be approved for treatment by the chief medical examiner at Wasco, Gaxiola was transferred to San Quentin, where he waited another three months before his medication and treatment were approved by the chief medical examiner at San Quentin. Finally, seven months after his initial diagnosis in 2022, Gaxiola was cleared of hepatitis C by his primary care physician.

Anthony Galloway, another resident at San Quentin, tested positive for hepatitis C in 2017. Knowing the complications of the disease if left untreated, he requested to be treated promptly. However, doctors delayed Galloway’s treatment, claiming he had not suffered enough liver damage to begin treatment. This was especially alarming as many health experts urge those with hepatitis C to seek treatment as early as possible to prevent or limit irreversible complications. For more than two years, Galloway waited in fear of his health deteriorating, worried he would develop cirrhosis, before finally receiving treatment in 2020 when doctors determined his liver had sufficiently been damaged enough to justify treatment.

“It’s an experience I never want to go through again, especially having to rely on [California Department of Corrections and Rehabilitation] doctors for a timely treatment response,” said Galloway.

For many incarcerated individuals impacted by hepatitis C, availability and access to treatment continue to be unreliable or absent, with prisons doing nothing to change regulation qualification and disqualification procedures. Without treatment, many fear their lives will continue to hang in the balance as they await release from prison.

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