STARKVILLE — Tears well up in Donna Steelman’s eyes as she looks out at her flower garden, wilted from the first November frost, remembering her three closest friends. 

One passed away from cancer two years ago. Another is currently battling a terminal illness. The third is incarcerated in a facility 80 miles away, with an infection she fears could one day kill her, though it is highly curable. Steelman prays her friend — “one of the few I’ve got left alive” — will be released from prison, but worries her homecoming will be bittersweet. 

“I’ll probably have to take care of her, and watch her suffer, too,” Steelman said.

Her friend, Colleen, who asked that her name be changed due to a fear of retaliation from within the state’s prison system, is incarcerated at Delta Correctional Facility, a women’s prison in Greenwood. Medical records show that the 56-year old woman has chronic hepatitis C — an infection that can be cured in more than 95% of cases with an eight- to 12-week course of medication — but she has not received the treatment. She was diagnosed nearly two years ago. 

Medical staff told Colleen that her condition is not severe enough to warrant treatment, she said to Mississippi Today. Delaying treatment runs counter to recommendations from the Centers for Disease Control and Prevention and the Federal Bureau of Prisons.

Most people with hepatitis C do not have symptoms, making the infection difficult to detect and hampering opportunities for early precautions to prevent its spread. The disease progresses slowly and about 1 in 4 people will spontaneously clear the infection without treatment, providing little incentive for prisons to administer treatment — which can cost tens of thousands of dollars for a single course — to patients when they are first diagnosed.

But left untreated, hepatitis C can wreak havoc on the immune system, yellowing skin and the whites of eyes from jaundice, bringing blood vessels that resemble a spider’s web to the surface of the skin and causing joint pain that renders some people immobile. Its long-term health consequences, such as liver failure and cancer, are life-threatening.

“It’s curable, but if you don’t offer treatment, for many people, it’s a death sentence,” said Lara Strick, a clinical associate professor at the University of Washington who also oversees the hepatitis C program in Washington’s state prison system.

Colleen is one of hundreds of people incarcerated in Mississippi diagnosed with hepatitis C who have not received treatment. A Mississippi Today report published earlier this year showed that only a fraction of over 800 people with documented hepatitis C diagnoses — less than 6% — received treatment between January and March of this year. 

House Corrections Committee Chairwoman Rep. Becky Currie, who has spent the past year pushing for reforms to health care in Mississippi prisons, previously called the prevalence of untreated hepatitis C in carceral facilities “a public health crisis.” 

At Delta Correctional Facility, there were 72 people with documented diagnoses of a total population of about 450 people — or 1 in 6 people — during that three-month period, according to public records. Across the entire state prison system, only 48 people received treatment out of about 19,000 people incarcerated by the state.

And in private, officials have sometimes cited a much higher caseload than public records show — as many as 5,000 prisoners and staff living with hepatitis C. Records from early 2025 show 845 people living with the disease, suggesting that documents may reveal only a sliver of a more widespread hepatitis C problem in Mississippi’s prisons. 

The Mississippi Department of Corrections did not respond to a request for comment for this article. But spokesperson Kate Head previously told Mississippi Today that the company the agency contracts for medical services “is responsible for providing appropriate medical treatment to inmates with all medical conditions, including Hep C.” 

Kansas-based VitalCore Health Strategies, LLC, the company that holds a three-year, $357 million contract to provide medical care to Mississippi prisoners, did not respond to a request for comment. 

Colleen said she does not know when, or if, her condition will merit treatment. 

“I just don’t want it to be too late,” she said. “I don’t want to die in here.” 

Left in the dark

Steelman and Colleen became fast friends when they were just 19. They spent their days smoking marijuana and riding around town together, according to Steelman, a routine that came to a halt when she graduated from a radiography technology program and moved to Jackson to work at a hospital. Colleen stayed in Starkville, and the friends lost touch. 

The women reconnected in their 30s when Steelman moved home. In the years leading up to Colleen’s prison sentence, they were inseparable. 

“She’s one of those people when you see her, it’s like you were with her yesterday,” said Steelman. “It’s not like it’s been a couple years or something.” 

But their time together was cut short. Colleen went to prison in 2023 after receiving a 20-year prison sentence for selling drugs. About four months into her sentence, she was diagnosed with hepatitis C. 

Hepatitis C abounds in state prisons in the United States, where its prevalence is about nine times greater than the general population. This is due in part to the fact that risk factors for the infection, like injecting drugs, are the same as those that make people more likely to face incarceration, Dr. Anne Spaulding, an associate professor of epidemiology at Emory University’s Rollins School of Public Health who studies hepatitis C in prisons, previously told Mississippi Today. 

Colleen said she does not know how much damage the infection has caused to her liver. Medical staff do not share information about the disease’s progression, she said, leaving her largely in the dark about her condition. She receives “chronic care” check-ups every three months. 

In a year, she lost over a fifth of her body weight — a dramatic decline documented in her medical records — falling to 120 pounds in July. Colleen said her weight loss has continued since the summer.

“What are they going to do when I get down to 98?” she asked.

Weight loss is a possible symptom of hepatitis C, but it can be caused by a number of other factors. The only way to determine if a symptom like significant weight loss is connected to hepatitis C is to treat the infection, Strick said. 

The Department of Corrections’ hepatitis management policy obtained by Mississippi Today says it will provide treatment for people with hepatitis C diagnoses “when indicated.” But the Mississippi Department of Corrections has repeatedly declined to share information about how it determines which cases are worthy of treatment.

The limited information medical staff have shared with Colleen’s condition may be due in part to physicians’ own limitations on assessing the disease’s progression. 

It is difficult for doctors to determine the degree of damage hepatitis C has caused to a patient’s liver based on laboratory results until the disease is advanced, which is one reason it is best practice to treat the infection immediately, Strick said. By the time the test results clearly show liver scarring, the disease can have a higher risk of progressing to liver cancer or failure. 

“At that point, the harm is already done,” Strick said.

With little information about her own health, Colleen said she relies on Steelman, who has worked to obtain a copy of her medical records, researched her condition and contacted lawmakers to tell Colleen’s story in the hopes they might enact policy to help her. 

“She’s like my sister,” Colleen said. “Since I’ve been in here, she’s been my voice out there.” 

A ‘missed opportunity’

Colleen said the burden the infection has had on her mental health has been significant. 

“It makes me feel depressed,” she said. “Because, I mean, if I was at home, I could be treated.”

Untreated illness can also have severe mental health consequences for patients, Strick said, spurring “mental anguish” tied to not knowing what is causing one’s symptoms.

Corrections Commissioner Burl Cain said at a Sept. 24 legislative budget hearing that medical care is an important aspect of ensuring stability for people incarcerated in state prisons. 

“We have to doctor all the people that’s sick,” he said. “We stay on top of them about it because it’s also a stability thing for prison. If inmates are not seeing the doctor, then they’re complaining and griping and they’re upset and their families are, too. So it destabilizes us.” 

But Mississippi Today’s Behind Bars, Beyond Care series has uncovered alleged recurring instances of denied health care in Mississippi prisons, such as an untreated broken arm that resulted in amputation and delayed cancer screenings one woman said led to a terminal diagnosis. 

Incarcerated people also have a constitutional right to health care under the Eighth Amendment, which prohibits “cruel and unusual punishment.” But in Mississippi, prisoners have fought for years for access to the highly effective antiviral medication — a “miraculous” treatment, in Strick’s words — for hepatitis C. 

Not treating illnesses also has consequences after incarceration, spurring more instability for patients when they come home, experts said. 

Dr. Shira Shavit, a clinical professor of family and community medicine at the University of California in San Francisco and the executive director of the Transitions Clinic Network, said failure to treat patients for diseases like hepatitis C while they are in prison is a “missed opportunity” that can help infectious disease spread and undermine a successful reentry process. 

“If people are sick or have medical issues that haven’t been addressed, it really upends their ability to successfully reintegrate into the community,” she said. 

And not treating a highly contagious infection leads to further spread of the disease inside and outside of the prison. At least 95% of people incarcerated in state prisons will one day be released. 

“From a public health perspective, what we don’t want is diseases that may be concentrated with the incarcerated population spilling out into the general population as people come home,” State Health Officer Dr. Daniel Edney said in a presentation to the state Legislature on prison health care in January. 

‘You lose your humanity’

Steelman misses Colleen, who she has not seen in over two years. It’s hard to be so far away from one another, but she said she believes Colleen should be held accountable for what she did. 

“I know it’s wrong. And I had no problem — of course I didn’t want it — but I had no problem with them arresting her and sending her to the pen, because it was against the law, she knew it was and she did it.”

But just as Colleen should be held accountable for her actions, Steelman said she believes Mississippi must uphold its constitutional responsibility to provide Colleen with medical care. 

Watching Colleen suffer — physically and mentally — from the dearth of care she has received has been heartbreaking, Steelman said. It has changed her perspective on law enforcement and the prison system, in spite of her background growing up in a law enforcement family and her deep patriotism. 

“I don’t see what I used to see,” Steelman said. “And I don’t like feeling that way … I did not know that they knew people were suffering. And they didn’t care.”

Steelman has one son and five grandsons. Ever since they were little, she said, she taught them to own up to their mistakes and bear the consequences of their actions. Colleen’s experience in the prison system — which Steelman sees as devoid of grace or forgiveness — has changed that. 

“I don’t tell them that no more,” Steelman said. “Because I know if they go (to prison) and they need even basic medical care, they’ll never get it. Cause you lose your humanity. The whole state, everybody in it, doesn’t even see you as a human being anymore.”

Even with Colleen far away, Steelman thinks of her often. 

She stores a dozen porcelain heirloom “Gone with the Wind” dolls in a closet in her bedroom. They are one of the few possessions Colleen has lugged from house to house — “and trust me … she didn’t stay nowhere long,” Steelman said — to remember her mother, who also suffered from severe liver scarring.

Two years ago, Colleen asked Steelman to sell the dolls and put the money from the sale into her commissary account so she could afford to make phone calls to her family and friends. 

“I just couldn’t sell those dolls. I just couldn’t do it,” said Steelman, who said she knew how much they meant to Colleen.

Steelman, who lives on a limited income, said she sent Colleen $200 — her grocery money — and went to the food bank. 

“When she gets out of prison, I’m going to be there with her doll collection,” she said. 

But Steelman anticipates that day could come with more sorrow. 

Colleen “will be the only long-time friend I have left,” she said. “And I’ll probably have to take care of her and watch her suffer, too. And that’s not right. And then, here she is. Could be fixed. It’s not cancer, it’s something that could be healed.”