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“The only thing necessary for these diseases to the triumph is for good people and governments to do nothing.”

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HEPATITIS C AND POLICE WORK

By Leslie Gibbenhuck

Hepatitis C is an epidemic, affecting over 200 million people worldwide. Why then, is so little known about this insidious disease?

There have been many articles published on the risks of transmission of hepatitis C. All "emergency workers" are high risk. Not only do police officers work with the sector of the population most at risk (prison, drug users, drunks) but they are also first responders to motor vehicle accidents and domestic disputes.

Police officers have also been known to use physical force to restrain and/or arrest. It is common to come in to contact with blood and bodily fluids, either through direct contact with individuals or through gathering evidence in the course of an investigation. Blood and other bodily fluids are usually crucial evidence and are actually sought out by police officers.

Until recently no police officer was advised to wear gloves (nitrile are best—as viruses may permeate wet latex gloves), protective eye wear, or to create barriers (masks and protective clothing) between themselves and their customers.

Transmission may occur with exposure to blood (100% of the time), saliva (48%), seminal/vaginal fluid (24%) and urine (7%). If there is any risk of transmission, the employer has a legal and moral obligation to safeguard its employees by whatever means reasonably possible. It is far more responsible to err on the side of caution, than to dismiss the facts.

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2. Are police officers told...?

- Unlike HIV, hepatitis C can live outside the body for 7 days (although it has also been reported to live up to 6 weeks on a hard surface!)

- There is no vaccination for hepatitis C - you are not immune!

- If you have hepatitis C, you should be vaccinated for hepatitis A and B.

- To get tested annually for all other possible work acquired viruses or at least after exposure to any blood or bodily fluids.

- About the guidelines to officers about work-acquired illnesses. Are they told to have themselves tested, to follow-up (daily) exposures to hazardous situations?

Canada Labor Code

The Canada Labor Code provides employees with three rights

1) the right to know

2) the right to participate, and

3) the right to refuse dangerous work.

This puts police officers in an awkward position, almost all of their work can be classified as "dangerous." "Through provisions of the Code, employees have a right to know about known or foreseeable hazards in the workplace and to be provided with the information, instruction, training and supervision necessary to protect their safety and health."

3. Employers' Responsibilities

The onus should not be on the individual but on the employer to inform police officers of known or foreseeable hazards—when infection can occur without their specific awareness. Hepatitis C is a preventable disease. There is no effective treatment, no vaccination and no cure!

The employer has a duty to protect the health and monitor the health status of police officers. Have officers been tested as part of an annual physical?

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In the absence of such vigilance (regular testing) the employer cannot reasonably argue its members should have been monitoring their status, so as to be able to pinpoint a specific incident.

*When Hepatitis C blood work was added to the annual physicals of Orange County firefighters, fire officials and state health experts were alarmed at the high rate of infection.

Dr. Jeremy BROWN

Dr. Jeremy BROWN had a paper published in the Journal of Clinical Forensic Medicine in 1995 on Risk to Police Officers from Biohazards Encountered in Police Work. Although he has little to say about hepatitis C, he does warn of "the virus' propensity to cause serious conditions including chronic hepatitis, cirrhosis and hepatocellular carcinoma. The consequences are severe."

He also reports conflicting observations about the increased risk among health care workers but does add that hepatitis C can be transmitted through accidental needle stick and the risk is moderate—between that of HIV (low) and hepatitis B (high).

4. Nevertheless, transmissions by needlestick and bite are documented. Dr Brown warns of the necessity for police forces to remain abreast of all developments in research and awareness. Keep in mind this paper was written in 1995, almost four years ago, when very little was known about hepatitis C or its transmission.

Developing a Protocol—as described by the CDC, Atlanta, Georgia: Issues that need to be considered when developing a protocol for the follow up of workers occupationally exposed to hepatitis C.

1) Limited data about the occupational risk of transmission

2) Limitations of available serologic testing for detecting infection and determining infectivity

3) Poorly defined risk for transmission by sexual and other exposures

4) Limited benefit of therapy for chronic disease

5) Cost of follow up

6) Medical and legal implications

7) Immediate vaccination for hepatitis A & B

A national survey of U.S. and Canadian paid fire departments found that 90% of all firefighters provide some level of medical care in the community. On average 77% of the fire departments in U.S. and Canadian cities with populations of 1 million or more provide first-responder services, 80% basic life support, and 50% advanced life support. This applies to police officers as well.

5. Although no case studies have been done to support the allegation that there is a higher rate of infection among police officers, there has not been mandatory testing to deny this claim either.

How does one know how long they have been infected with hepatitis C? There is no definitive test to determine the moment of infection. The onset of chronic illness varies from person to person. Transmission and symptoms are two of the many puzzling features of hepatitis C.

Most people infected with hepatitis C do not know about their infection because there has been little effort made to notify or educate them or to advise them of treatment possibilities and lifestyle changes.

Precedents Being Set:—James Edward Petrowitz versus City of La Crosse Fire Department

Hepatitis C is contained in the blood of the person who is the carrier. It is possible to have the virus without symptoms. Evidence shows it is very common for a firefighter to be exposed to blood of various people. They will often arrive at the scene of accidents, shootings, child births and other incidents before the ambulance.

The word "firefighter" could be interchanged with "police officer." But police officers have many other exposures as well—add digging through dumpsters and crime scenes, patting down prisoners, attending fights and disputes, arresting and subduing criminals, being spat at, and contact with the prison population (reported infection rate of 78% in recent random Texas testing).

It was found in the case of Petrowitz that hepatitis C infection was work-related and that he was entitled to benefits. While in performance of his duty he contracted the disease, which is permanent and which caused him to retire from his job, prematurely.

6. It has been established that prisoners who throw blood or bodily waste on guards can expect extended prison terms. If they are infected with HIV, hepatitis or TB the penalty can be increased by 5 extra years.

New York correction officers who acquire HIV, hepatitis or TB will be getting a big pension hike under a Governor Pataki bill. This entitles correction officers to tax-free disability pay worth 3/4 of their final salary but more importantly it presumes the disease was acquired on the job!

In November 1998, Senators Snowe and Snyder proposed legislation that would create a presumption that certain veterans contracted hepatitis C during their service. The legislation is to include veterans who, during their service, received tattoos, body piercings, or acupuncture. Depending what center you study the results from between 10 and 20% of veterans randomly tested - tested positive for hepatitis C.

Summary

In 1989, the hepatitis C virus was isolated and cloned. Yet, 10 years later most police departments have no protocol on how to deal with it and have offered no instruction to the officers on its prevention. In all known cases where it is believed police officers were infected on the job, they have been denied a disability pension. Employers are demanding proof that they were infected on the job.

If an officer chooses to disclose they are infected with hepatitis C, they are met with mixed response. Most co-workers choose to keep their distance—not clearly understanding routes of transmission.

Most officers choose to keep their infection to themselves—not telling anyone. They fear questions, ridicule, and a sense of guilt that remains unexplainable. It is as if somehow they allowed this nasty infection to invade their bodies.

7. Had the officer been shot or stabbed she would have received a hero's welcome back. Sadly, most are unaware of the moment of infection. Blood spat at an officer is innocently wiped away. Employers immediately have one answering questions, which sometimes have no answers. As with time, all memories seem to fade. Your employer starts asking personal questions, about your lifestyle. They doubt you and your words.

Even your doctor has more questions than answers. Doctors are undereducated and have difficulty coping with this emerging disease.

What are employers and doctors afraid of? Their own ignorance has caused this problem to mushroom among police officers and the effects will become clearly evident over the next 10 years as officers realize their infection and come to terms with chronic illness. What are employers doing to prevent the further spread of hepatitis C?

If you learn you are infected please:

1) get educated and help educate others

2) tell your co-workers—if you are injured on the job they will not think twice about helping out a downed officer.

3) wear a medic alert bracelet—you must be responsible for not spreading this disease to anyone.

4) use universal precautions everyday.

5) practice safe sex.

6) make yourself available to help fellow officers when they learn of their infection (peer counseling)

7) understand there are normal stages one passes through when their life flashes before them. Just because you have hepatitis C doesn't mean you will die. But you must understand there are steps you can take to remain healthy and possibly live longer. The sooner you are diagnosed the sooner you can change your lifestyle.

8) Stop drinking alcohol—it accelerates liver damage. Diet plays an important role in liver wellness. Learn about your liver and how to keep it in great shape.

Stages of Hepatitis C

1) Diagnosis - disbelief, shock, denial

2) Impact (Attitudes and Expectations) - learning to function with a chronic disease

3) Reorganization - dealing with the facts / lifestyle changes

One surefire way to reduce the emotional dilemma faced when an officer encounters a significant exposure is factual, up-to-date information. This is not simply an issue for the police officer but for the entire family.

It has been said the "C" stands for confusion, and so this tragedy continues.....

Regards,

Leslie Gibbenhuck, President - B.C. Hepatitis Foundation

P.O. Box 21058,

Penticton, B.C. V2A 8K8

(250)490-9054 (250)490-0620

email - bchepc@bc.sympatico.ca