In a mass notification prompted by a Philadelphia Inquirer investigation, New Jersey prison officials informed 421 inmates they had hepatitis C. The notification took place in the last two weeks of July, a medical audit shows. More than 1,100 prisoners known to have the disease have now been informed, according to the audit. No New Jersey prisoners are being treated for hepatitis C, and no decision has been made on how to pay for their care.

Correctional Medical Services, the prisons' private medical vendor, said some of the 421 inmates had been told before July, but this had not been noted in their electronic files. Twenty-one people were recently released from prison without being told they were infected. Uninformed patients can spread the blood-borne disease through shared drug paraphernalia, sex, and possibly even blood droplets on shared toothbrushes. State Prison Commissioner Devon Brown and CMS officials said they were trying to contact the 21 infected people who had been released.

Brown said the failure to notify inmates was a grave issue. US courts have a long tradition of ruling in favor of a patient's right to know, which is reinforced by New Jersey's "Patient Bill of Rights."

Even though a federal study revealed that hepatitis C rates behind bars have reached epidemic proportions, only a handful of states, led by Pennsylvania, are treating inmates with the infection. Pennsylvania, which screens all inmates for the virus, has found 23 percent positive for hepatitis C. New Jersey, which only tests at-risk prisoners who request it, has found that 5 percent of inmates have the virus.

Brown has said he wants all prisoners tested and treated for hepatitis C. The state rejected CMS' renewal bid, he said, because it included a 30 percent fee increase but no coverage for hepatitis C. The current CMS contract expires at the end of October, and no other company has bid for the work. Brown said the state must come up with alternatives, such as dividing prisons into different regions to encourage competitive bidding, or putting out another request for bids.

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