Tag Archives: Oklahoma

Cherokee Nation Hospital Faces Questions About HIV, Hepatitis C Exposure

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

The Cherokee Nation in Tahlequah, Oklahoma is once again in the news, though now, for much less laudatory reasons. John Baker, the son of Principal Chief Bill John Baker, resigned from the tribe’s employ on May 1st, 2018, due to actions he took while performing his duty as a nurse at W.W. Hastings Hospital. During his time as a nurse, Baker used the same vial of medication and the same syringe to inject more than one IV bag (though no patients ever had direct contact with the needle).

If this sounds like an egregious breach of protocol, that’s because it is. Tribal councilman David Walkingstick stated in an interview:

“I hope that this was accidental, but Nursing 101, this is common sense. The other side of it is, was it intentional?  Was he out to harm people?  Or was he out to get the extra medicine?” (Newcomb, 2018)

As a result of his “lapse in protocol,” 186 people were possibly exposed to HIV and Hepatitis C (HCV). As of the June 18th, 2018 article detailing this exposure, 118 were tested, with no resultant infections being discovered (News On 6, 2018).

Cherokee Nation Medical Facility

Photo Source: KOTV News On 6

This incident comes on the heels of several positive evaluations of the Cherokee Nation’s efforts to combat the spread of HIV and HCV within the tribe’s borders, which we have covered twice within the past year. Despite these strides, the actions of Baker have sparked fears amongst its members. Native American tribes have, for several centuries, been the victims of various crimes committed against them by governmental and medical authorities, which has fostered a culture of distrust of medical providers within the members. How can tribe members be expected to trust going to W.W. Hastings Hospital if these kinds of “lapse[s] of protocol” – ones that are some of the very basic universal precautions taught to nursing students – are allowed to occur?

The Cherokee Nation has established a panel to investigate what happened, and more importantly, what happens next. If past exposure incidents serve as any indication, Baker may face any number of charges, many of which could be increased if any of the identified patients test positive for HIV or HCV. That said, because the Cherokee Nation has sovereignty – a Federally-recognized status recognized by treaty and law – there is a question concerning whether or not he will face state or Federal charges.

HEAL Blog will continue to monitor this issue and report as the story develops.

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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Hepatitis C in Native American Populations

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

In August 2017, HEAL Blog covered efforts by the Cherokee Nation to proactively combat Hepatitis C (HCV) within the tribe’s boundaries in Northeastern Oklahoma (Hopkins, 2017). The program, started three years ago, comprised several steps, including compulsory screening of all tribe members aged 20-69, expanding screening locations to include dental clinics, establishing a Syringe Services Program (SSP) within the tribe’s borders, and using Direct-Acting Antivirals (DAAs) to treat those infected with HCV. The tribe, itself, is absorbing the costs of treating its citizens (Juozapavicius, 2018).

Photo Source: HHS

Map of Cherokee Nation

According to the most recent report released by the Centers for Disease Control and Prevention (CDC), deaths related to HCV have been decreasing in every demographic since 2013, including in Native American (NA) populations. That said, NAs still had the highest rate of HCV-related death in 2016, with a rate of 10.75 (per 100,000), down from a staggering 12.95 in 2015 (CDC, 2018). These data indicate that, while the effort by the Cherokee Nation are certainly proving to be effective, there is still a lot of ground to cover.

As with other race demographics, the leading risk for HCV infection is Injection Drug Use (IDU). Doctor Jorge Mira, Director of Infectious Diseases for the Cherokee Nation, indicates in the Juozapavicius article that, over the past two years, he began hearing the word “heroin” more and more, every day. This trend of IDU is in line with other race demographics. The common factors across race demographics are high levels poverty and unemployment. In areas where these factors are present (particularly in rural settings), heroin use and IDU are almost a given.

The efforts to combat the disease within the Cherokee Nation need to be replicated at the state and Federal levels. The reality is that these problems are not going to go away, and in the areas where they’re most prevalent, they are going to get exponentially worse in the coming years. In the meantime, we can look to the Cherokee Nation for their leadership on the issue, and begin implementing them in small scale at the local level.

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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Cherokee Nation Chooses to Proactively Fight Against 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

Native Americans (NAs) in the United States have largely gotten the shaft. Forced from their native lands, herded into reservations, and the victims of innumerable false promises and broken agreements on the part of the U.S. government, NAs have also had the misfortune of being disproportionately impacted by infectious disease. Such is the case with Hepatitis C (HCV). According the most recent Surveillance for Viral Hepatitis report released, this year, by the Centers for Disease Control and Prevention (CDC), NAs have by several integers the highest rate of HCV per 100,000 people out of any race demographic with a rate of 12.95 (CDC, 2017). The Cherokee Nation – the second-largest NA tribe in the U.S. – has decided to actively come out swinging against HCV.

White House honors CN physician for hepatitis C program

Photo Source: Cherokee Phoenix

Roughly 130,000 Cherokee Nation (CN) tribal citizens live in northeastern Oklahoma within the tribe’s boundaries, and within this community, aggressive measures are being taken to combat the disease. Dr. Jorge Mera (seen in the photo being honored by the Obama Administration for his Hepatitis C program), Head of Infectious Diseases at Cherokee Nation in Tahlequah, OK has worked with various agencies and private partners to create a comprehensive approach to dealing with their HCV epidemic (Taylor, 2017):

  • Using newer Direct-Acting Antivirals (DAAs) to treat and achieve Sustained Virologic Response (SVR) in infected tribe members
  • Partnering with Gilead Sciences (makers of three currently available HCV DAAs – Sovaldi, Harvoni, and Epclusa) to receive funding for screening kits and research through the Gilead Foundation
  • Adopting a proactive compulsory screening policy of screening all tribe members aged 20-69 for HCV (rather than just the Baby Boomer Birth Cohort), as well as offering tests to all children of any mother who screens positive for HCV
  • Expanding screening locations to include dental clinics to screen tribe members who may not access other healthcare services
  • Pushing and receiving approval for the establishment and funding of a tribal Syringe Services Program (SSP – Syringe/Needle Exchange) within the tribe’s territory (Hays, 2017)

This type of aggressive approach to combating HCV is, in fact, the type of action that Viral Hepatitis (VH) advocates have been pushing for years, but the unique circumstances under which tribal healthcare operates allows for more freedom than in the greater U.S. “Because Cherokee Nation citizens, under a treaty right with the United States Government have access to medical care, tracking them, and screening them is slightly easier than might be so for other US populations,” explains Dr. Mera (Taylor). Additionally, since their focus is on a smaller, specific population, the CN is able to focus its care on a smaller pool of individuals, rather than attempting to address the healthcare needs of millions of citizens.

That said, HCV transmission does not occur within a vacuum – tribe members do come in contact with people who fall outside of the tribe’s jurisdiction, meaning that, even if the CN’s efforts to screen, track, and cure all members of the tribe within its boundaries are 100% successful, they are still susceptible to new infections by way of contact with those outside of their community. This means that the types of progressive Harm Reduction, screening, and treatment measures being undertaken by CN need to be replicated in the state of Oklahoma, as well as the surrounding states (and eventually, the entire U.S.) in order for their efforts to not be undermined by failures to provide similar services on the parts of state and Federal governments.

These tactics also serve as a roadmap for dealing with HCV in some of the states hardest hit by the disease, particularly in smaller Appalachian states like West Virginia and Kentucky, where geography and smaller, more remote populations make reaching, screening, tracking, and treating not only HCV, but every health condition more difficult.

The tribe will present its progress at the World Indigenous People’s Conference on Viral Hepatitis in Anchorage, AK on August 08-09, 2017. For more information on that conference, please click on the following link: WORLD INDIGENOUS PEOPLES’ CONFERENCE ON VIRAL HEPATITIS

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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