Tag Archives: Department of Corrections

Linkages to Care for Current/Former Incarcerated Citizens Living with Hepatitis C

HEAL Blog is the recipient of the ADAP Advocacy Association’s 2015-2016 ADAP Social Media Campaign of the Year Award
By: Marcus J. Hopkins, Blogger

On Wednesday, April 26th, 2018, Elizabeth Paukstis, Public Policy Director for the National Viral Hepatitis Roundtable (NVHR), joined me in Washington, DC to deliver presentations about Linkages to Care for Current/Former Incarcerated Citizens Living with Hepatitis C. This was the second such meeting held by the Community Access National Network (CANN) in as many years dedicated to the topic of correctional healthcare.

My presentation – Viral Hepatitis in Correctional Settings – included original research conducted by CANN that attempted gather the testing protocols for Hepatitis B (HBV) and Hepatitis C (HCV) from Departments/Divisions of Corrections (DOCs) in all fifty states and the District of Columbia. The findings of this research are as follows:

  • Only fourteen (14) states publicly post specific protocols on their state DOC websites
  • Twenty-five (25) states require or offer HBV testing during intake
  • Thirty-two (32) states require or offer HCV testing during intake
  • Only seven (7) states follow the Federal Board of Prisons’ (BOP) recommendation of offering HBV testing using an Opt-Out delivery model (informed refusal)
  • Only fifteen (15) states offer HCV testing using an Opt-Out delivery model
  • Twenty-three (23) states only test for HBV on inmate request or if they meet clinical criteria (e.g. – inmate has HIV, contact with someone who has HBV, injection drug use)
  • Seventeen (17) states only test for HCV on inmate request or if they meet clinical criteria (Hopkins, 2018)

My report can be found here.

State/Federal HCV-Related Lawsuits Involving Prisons (2017-2018)

Photo Source: CANN

Ms. Paukstis’ presentation – Hepatitis C and Incarceration: Policy Proposals and Challenges – focused on treatment statistics within prisons, the challenges prisons face when procuring prescription drugs, provided a case study regarding Mississippi’s myriad issues related to HCV in their prison populations. Highlights of this presentation include:

  • An estimated 17% of inmates in U.S. state prisons are infected with HCV
  • Less than 1% (0.89%) of those known to have HCV were receiving treatment in 2016
  • The Federal BOP receives at least a 24% discount on HCV drugs – a discount to which state prisons are not privy
  • State prisons are not eligible for discounts under the Federal 340B Drug Pricing Program
  • Incarcerated persons face an additional risk of having their sentences extended if they are charged with “endangerment by bodily substance” (causing a correctional employee, visitor, or another inmate to come into contact with blood, seminal fluid, urine, feces, or saliva)

Download Elizabeth’s report.

References:

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Disclaimer: HEAL Blogs do not necessarily reflect the views of the Community Access National Network (CANN), but rather they provide a neutral platform whereby the author serves to promote open, honest discussion about Hepatitis-related issues and updates. Please note that the content of some of the HEAL Blogs might be graphic due to the nature of the issues being addressed in it.

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Class Action Correctional Malpractice

HEAL Blog is the recipient of the ADAP Advocacy Association’s 2015-2016 ADAP Social Media Campaign of the Year Award
By: Marcus J. Hopkins, Blogger

Inmates in Oklahoma prisons must have advanced liver disease before they become eligible for treatment for Hepatitis C (HCV). This means that their livers must manifest significant scarring before they’re even allowed to receive the curative treatment that will prevent further damage (Botkin, 2018).

A class action lawsuit has been filed in the state of California alleging that doctors within the prison system have denied them treatment because their liver disease isn’t advanced enough, that their disease is too advanced, and/or the drugs are too expensive (Locke, 2018).

A class action lawsuit in Missouri alleges that only five out of thousands of Missouri inmates have received treatment for HCV, desite between 10-15% of the incarcerated population being infected with HCV (Margolies & Smith, 2017).

Idaho says that nearly 1/3 of its prisoners have HCV, and it needs $3M to treat them (Boone, 2018). An inmate diagnosed with HCV while in a Mississippi prison has filed a suit alleging they’ve refused him treatment on at least nine separate occasions (Wolfe, 2018).

Inmate looking out window with bars on it

Photo Source: thedenverchannel.com

Each of these instances is indicative of a few major points: (1.) We have a growing number of prisoners within our justice system who are infected with HCV; (2.) Prison systems and/or state Departments of Corrections (DOCs) are refusing or delaying treatment; (3.) This is unconstitutional.

In last week’s HEAL Blog (“Cruel and Unusual” Neglect in Prisons), we introduced the concept of “deliberate indifference,” a measure introduced by Estelle v. Gamble (1976). This week, there’s another take – does being literally unable to afford the cost of treating inmates qualify as deliberate indifference?

The answer to that question really depends on the judge who hears the case. In 2017, U.S. District Court Judge Mark Walker in Tallahassee, Florida ruled in favor of three inmates who filed a class action lawsuit against the state of Florida, requiring the state to treat a significant portion of its 98,000 inmates (total population; not HCV-infected population) for HCV (Klas, 2017). Similarly, in Pennsylvania, a U.S. District Court Judge Robert D. Mariani ruled in favor of Mumia Abu-Jamal, an inmate who gained notoriety for his shooting of an officer who had stopped his younger brother in a traffic stop (Mayberry, 2017). Both Federal judges found that prisons are required to provide treatment for HCV, regardless of the cost.

Make no mistake, however – these rulings are few and far between; the primary issue is that it’s difficult to prove “deliberate indifference” without detailed and voluminous documentation. Even then, the measure is specifically designed to be difficult to prove (as are all burdens of proof). And the primary reason why prisons refuse or delay treatment has little to do with indifference, so much as the cost. HCV Direct-Acting Antivirals are prohibitively expensive for regular consumers; prisons, however, have even less wiggle room, as they are largely unable to negotiate on drug prices.

Where we are, at the moment, seems to be a holding point: until the drugs to treat HCV get exponentially cheaper to purchase (right now, the least expensive 8-week treatment regimen – Mavyret (AbbVie) – goes for $26,400, roughly 1/3 the cost of the cheapest drug in 2013), prison systems are unlikely to make any substantive efforts to treat HCV-infected inmate. Moreover, until the Federal government requires states to both screen and treat inmates for infectious diseases, it’s likely that HCV will continue to spread among inmates and the general population.

References:

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Disclaimer: HEAL Blogs do not necessarily reflect the views of the Community Access National Network (CANN), but rather they provide a neutral platform whereby the author serves to promote open, honest discussion about Hepatitis-related issues and updates. Please note that the content of some of the HEAL Blogs might be graphic due to the nature of the issues being addressed in it.

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An Imperfect Prison Health System

HEAL Blog is the recipient of the ADAP Advocacy Association’s 2015-2016 ADAP Social Media Campaign of the Year Award
By: Marcus J. Hopkins, Blogger

One of the primary issues for people in America’s vast prison system is the issue of healthcare rights and treatment. In fact, prisoners are the only Americans who are Constitutionally guaranteed the right to treatment for health conditions under the 8th Amendment, specifically the “cruel and unusual punishments” clause (Estelle v. Gamble, 1976). This ruling has been used since 1976 to ensure that inmates who are infected with HIV, and now, Hepatitis C (HCV), receive the appropriate medical treatment to which they are guaranteed under that decision. Additional arguments can be made that using a “Treatment as Prevention” (TAP) model in incarceration settings will help to stem the spread of various Sexually Transmitted Diseases (STDs) and Infection (STIs), including both HIV and HCV.

Over the past two years, HEAL Blog has covered various aspects of the HCV treatment provision for inmates in various states. Several states, including Tennessee, Nevada, Missouri, Washington state, and Pennsylvania, are currently facing lawsuits brought my inmates and advocates in state and Federal courts to force their respective Departments of Corrections to provide treatment to HCV-infected patients. Unfortunately for the states – and more specifically, their budgets – courts have seemed inclined to agree with both advocates and inmates: providing treatment and a cure for HCV is mandatory, regardless of the expense.

Nurse administer care to an inmate.

Photo Source: Prison Protest

The primary argument used by states and their respective Departments of Corrections is that the high cost-per-patient/per-cure is simply an unreasonable expenditure, given the long-term nature of the disease (meaning the length of time from gestation to serious illness to death). The cheapest Wholesale Acquisition Cost (WAC) of the newer Direct Acting Agents (DAAs) to treat HCV – Zepatier (Merck) – is $54,600 for twelve weeks of treatment, before any discounts, rebates, or pricing agreements struck between states and the drug manufacturers. Viekira XR (AbbVie) and Epclusa (Gilead) cost $83,319 and $74,760, respectively, which makes treating inmates with HCV incredibly expensive in one go.

Gilead and other manufacturers have argued – with only moderate success – that the short-term high cost of a cure actually ends up costing less in the long-term, when compared to both the co-infections and –morbidities (co-existing conditions) that can accompany untreated HCV infections, and the long-term cost of treating other serious chronic illnesses, which over a course of several years, account for far more money being spent to treat them. While this argument may look great on paper for the manufacturers, for government employees and elected representatives who are tasked with prepared, appropriating, and allocating funds in a budgeting process, it’s simply not a feasible one. By their way of thinking, long-term illnesses represent costs that can be spread out over time, while HCV manufacturers expect a cure, right up front, set at a budget-breaking price.

States have found a unique way of getting around the 8th Amendment statute that courts have ruled guarantees treatment: they simply fail or refuse to screen incoming and existing inmates. Many states require that inmates only be screened for HIV during the intake process, allowing prison officials to essentially feign ignorance about their prisoners’ health – if they don’t know, they don’t have to treat. Unfortunately for the state, prisoners are getting wise to this tactic, and are taking them to court to force treatment. Nevada, for example, reported 593 inmates with HCV, including just two who were receiving treatment (0.34%) in 2015 (Botkin, 2017). By March 2016, a total of only nine inmates were receiving treatment.

Given the vast budget constraints placed upon states, we at HEAL Blog understand that the cost of treating every HCV-infected inmate is a potentially financially disastrous proposal, and a non-starter in virtually every state. Attempting to get around those costs by ignoring the problem is simply an unacceptable way for state and Federal prisons to operate. Yes – treatments are expensive; but, when lives are at stake, trying to get around a Constitutional obligation to treat is simply unacceptable.

References:

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Disclaimer: HEAL Blogs do not necessarily reflect the views of the Community Access National Network (CANN), but rather they provide a neutral platform whereby the author serves to promote open, honest discussion about Hepatitis-related issues and updates. Please note that the content of some of the HEAL Blogs might be graphic due to the nature of the issues being addressed in it.

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