Hepatitis C in the NYPD
Meet Michael, a police officer so tired he sometimes naps at work. A slight man in his late forties, Michael is sick with hepatitis C. Ten years ago, before the viral illness set in, he used to jog five miles a day. "Now, if I can walk around the block, I'm doing good," he says. And in addition to feeling nauseated, sleepy, and "all-around lousy," Michael is afraid. The fear of having his disease discovered and facing retribution from the department for speaking out is so great he insisted on using a pseudonym for this article. And he is also angry, because the police department is refusing to provide him with benefits he says he deserves.
Michael thinks he became infected with hepatitis C in the early 1980sbefore the blood-borne virus was even discovered, much less recognized as the source of an epidemic. He was on duty in Brooklyn, driving a couple around to look for the guy who had robbed them just minutes before. They spotted the mugger "in a numbers joint," Michael remembers. "So, brazen meI was a young cowboy at the timeI just went in after him. As I approached, he swung at me. I remember it was raining, and we rolled right into the middle of Nostrand Avenueand this guy was a lot bigger than me." By the time backup arrived and pulled Michael and his "perp" off each other, both were bloody. "In those days, they didn't hand out gloves," he recalls. "And I had a big bite mark on my hand."
It shouldn't be Michael's job to document how he got hepatitis C. In 1999, under pressure from angry cops, the state passed a law requiring the police department to assume, unless it can prove otherwise, that members of the force with HIV, tuberculosis, and hepatitis have contracted the infections on the job. "Line of duty" disability pensions provide retired cops with three-quarters of their highest salary, as opposed to standard disability benefits, which are only half. Even though it may be impossible to know for sure that someone got infected through a bloody fistfight rather than through dirty needles or unprotected sexby far the more common paths of transmissionthe so-called "presumption law" shifts the burden of proof from sick cops to the department.
But infected cops and and their advocates say the police department isn't following the new law. "It sounds great on paper, but the medical board is not finding the membership disabled, even when they are," says Jeff Goldberg, a lawyer representing four New York City police officers who have been unable to retire with disability benefits despite being infected with hepatitis C. "They're avoiding giving out these pensions," Goldberg says of the department. "Their fear is that if every cop is tested, they'll open up the floodgates."
The police department insists it does grant disability benefits to cops with hepatitis C when appropriate, but Goldberg knows of only one officer who was granted a line-of-duty pension since the law passed. (The department wouldn't say if more have been approved.) And others applying for disability benefits still face a rigorous investigation.
"Each individual case is assessed by a review board from a medical division," says NYPD spokesperson Jennara Everleth, who declined to comment about specific cases. "When the investigation is concluded and the officer's condition is determined to be contracted in the performance of duty, the officer will receive a line-of-duty pension."
In Michael's case, the board has determined that he has hepatitisbut won't release benefits. He has gone before the medical board four times and has even produced the records of his fight with the robber. If it is plausible that this was the route of transmission, the NYPD is supposed to accept his claims. Instead, it has questioned him extensively about his sex life and exposure to drugs.
Such interrogations contradict the spirit of the law, which was designed by the officers' union after several infected members were denied disability pensions. While investigations of standard disability claims are limited to three months, line-of-duty investigations can drag on. The timetable is "whenever they're good and ready," complains Goldberg.
Indeed, according to some veteran cops, Michael may have a long wait. "I went before the board 39 times, and they denied me 39 times," says John Croston, a detective who says he was infected with hepatitis C in 1982 during a fight in a shooting gallery on 118th Street in which he, too, was bitten. Croston fought the department over his disability designation for nine years before the "presumption law" was in place, and was only granted it after he had a liver transplant as a result of his infection. Since then, he's also had both kidneys replaced and, in the course of one of those transplants, contracted another form of hepatitis.
"It's been a long haul," says Croston, who says the experience has taught him that he is "just a number" to the police department. "I learned that they don't really care."
Some 4 million Americans are infected with hepatitis C, which causes cirrhosis and liver cancer. Every year, about 10,000 of them die as a result of the diseaseversus about 15,000 a year for AIDS. And the number of hepatitis C deaths is expected to triple in the next decade. Yet misinformation, fear, and ignorance are still adding to the considerable physical burden of the disease, making it unnecessarily difficult to get diagnosed and treated.
"There are a lot of ignorant people on the job," says an infected police officer we'll call Nick. "They'll treat you like a leper if they find out." To avoid this fate, Nick has told hardly any co-workers about having the virus. Nevertheless, his illness has been hard to hide. Diagnosed as being in the second of four stages of hepatitis C, which means his liver is already scarred, he says he's been constantly fatigued to the point of being unable to work. After more than a year of feeling under the weather, during which he found himself trapped in a building alongside the twin towers on September 11 ("Try running from the collapsing World Trade Center when you're feeling weak," he jokes darkly) and working as much as 60 hours a week right after the attacks, Nick went out on sick leave in December. But when he went before the medical board in January, it acknowledged his hepatitis infection but denied him a line-of-duty disability designation.
What's more, like so many others with hepatitis C, Nick has been struggling with the exorbitant cost of medication. The newest drug regimena combination of interferon and ribavirin that fully removes the virus in slightly more than half of the patientsis more effective and more tolerable than previous treatments. But the drug combo costs some $26,000 a year, making it a financial burden for some and fully out of reach for others, even among the insured. Police officers, who receive prescription benefits through their union, have a $5000 annual cap on drug costs for each family, a limit Nick says he hit in just two months.
The cost of the new drugs exceeds the limit of many other insurance plans, as well. "The cap is a huge issue," says Douglas Dietrich, chief of gastrointestinal disorders and liver treatment at Cabrini Hospital. Insurance companies "are always trying to find some excuse not to pay for it," Dietrich says. And Medicaid doesn't pay for the test necessary to determine the level of virus in the blood, which costs about $150.
Without much information about the disease or an inexpensive way to be tested, most people with hepatitis C still don't know they're sick. Among police officers, firefighters, and emergency workers, who represent just a tip of the iceberg of New Yorkers afflicted with the virus, there are undoubtedly thousands of infections still undetected. When firefighters in Philadelphia underwent department-wide testing for hepatitis C recently, 130 of 2100 tested positive; at that rate, New York City, which has a police force of nearly 40,000, could have some 2500 infected officers. Both Michael and Nick say they know others on the force who are infected but afraid to come forward.
Indeed, while a dozen police officers with HIV on the job have formed a support group, those with hepatitis have remained largely closeted. The relative obscurity of the disease ends up making it particularly damaging. About 20 percent of people who come in contact with the virus rid themselves of it on their own, but without treatment, the rest develop hepatitis, often without recognizable symptoms. As many as 50 percent of those go on to develop serious liver problems, including cirrhosis and cancer.
Because such deadly outcomes could likely be avoidedor at least delayedby the new drugs, the disease is also ripe for activism. "We're like 10 years behind HIV with hepatitis C," says Dietrich, who blames the lack of attention on the fact that, like HIV, this virus strikes drug users and other disadvantaged groups. "People with hepatitis don't have a lobby like the people with HIV do, even though there are four times as many people with this virus. The huge number of people may be the reason the medical establishment is trying to not pay for this."
Officers with hepatitis have their own theories about why the disease is proving a sticking point within the police department. Some say the reluctance to treat hepatitis C as a real occupational disability is a sign of discomfort with a virus that is often associated with drug use and sex. Others say it is to a simple matter of finances. A more charitable view is that the police department is merely slow to adjust its medical system, which is usually faced with more traditional line-of-duty injuries. "If I had blown out my knee, the city of New York would pay for that, no problem," say Nick. "But when you get an illness, it's usually not job related, so there's no mechanism in place for care."
Whatever the explanation, the fact that some of New York's finest are unable to find sympathy for their condition suggests the even greater suffering endured by the majority of people with hepatitis C. As many as a third of homeless are estimated to be infected, though they are rarely diagnosed, let alone treated. And despite a 2000 ruling that prisoners have a right to the new treatment, Maddy DeLone, a lawyer at the Legal Aid Society's Prisoners' Rights Project, says many still don't get it because of a loophole in New York's policy that requires prisoners to have a sentence of at least a year in order to receive treatment.
On both sides of the law, people with hepatitis C have a common and wily enemy in the disease. His days as a patrol cowboy long behind him, Michael now has his buddies cover for him while he snoozes away part of his time in the offices. Out on sick leave, Nick is now free to sleep as much as he wantsand regularly dozes about three hours during the day. Much of the rest of the time, he spends pondering his illness and his ongoing battle over it with the police department.
"I just don't get it," he says. "Here's an agency that's sworn to uphold the law. And then there's a law on the booksand they're just circumventing it. It's ironic."
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