[Pnews] ‘You’re Going to Let Me Die From This’: Prisoners Fight to Access a Hepatitis-C Cure

Prisoner News ppnews at freedomarchives.org
Fri Jan 25 12:54:50 EST 2019


https://www.thenation.com/article/prisons-hepatitis-c-treatment/


  ‘You’re Going to Let Me Die From This’: Prisoners Fight to Access a
  Hepatitis-C Cure

By Elizabeth Weill-Greenberg - January 25, 2019
------------------------------------------------------------------------


    Inmates are being denied treatment, and it’s creating an epidemic.

On May 15, 2017, after serving 37 years, David Maldonado 
<http://fairpunishment.org/wp-content/uploads/2016/03/FPP_JLWOP_philadelphia_r601.pdf> 
was released from prison. He had been sentenced to life 
<http://pa.findacase.com/research/wfrmDocViewer.aspx/xq/fac.19850503_0042688.PA.htm/qx> 
for a murder he committed when he was 16. But for Maldonado, getting out 
was about more than freedom; his release might have also saved his life. 
In 1997, Maldonado was diagnosed with chronic hepatitis C—a disease, now 
curable, that the state of Pennsylvania had refused to treat. “Society 
really didn’t care whether I lived or died,” he told me recently.

Hepatitis C is caused by a virus that infects and inflames the liver 
<https://www.cdc.gov/hepatitis/hcv/cfaq.htm#A3>; it’s spread through 
blood, most often via intravenous drug use. Between 75 and 85 percent 
<https://www.cdc.gov/hepatitis/hcv/hcvfaq.htm#a3> of those infected with 
hepatitis C develop chronic hepatitis C, which can lead to liver 
scarring, liver cancer, cirrhosis, and death. It’s the most deadly 
infectious disease in the United States, killing around 20,000 people a 
year—more than the next 60 infectious diseases 
<https://www.cdc.gov/nchhstp/newsroom/2016/hcv-press-release.html> 
combined.

Prisons are at the epicenter of this epidemic; an estimated 20 percent 
<https://www.hcvguidelines.org/unique-populations/correctional> of 
incarcerated individuals carry the virus, compared to about 1 percent of 
the general population, according to American Association for the Study 
of Liver Diseases and the Infectious Diseases Society of America 
(AASLD/IDSA).

“A huge concentration of people who have it are [incarcerated], and if 
we don’t cure people in prison, then they’ll be released and it will 
make it more prevalent on the outside of prison,” said Mandy Altman, the 
director of the National Hepatitis Corrections Network, an organization 
that provides hep-C resources to those working in jails and prisons.

In 2011, the Food and Drug Administration started to approve 
direct-acting antiviral (DAA) medications 
<http://abolitionistlawcenter.org/wp-content/uploads/2018/09/Dr.-Trooskin-report-signed.pdf>, 
which now have a more than 95 percent 
<https://www.who.int/news-room/fact-sheets/detail/hepatitis-c> success 
rate. The medications have few side effects and require taking as little 
as one pill a day for eight to 12 weeks 
<https://www.cdc.gov/hepatitis/hcv/hcvfaq.htm#a3>. Previous medications 
<http://www.who.int/hepatitis/news-events/hepatitis-c-guidelines-2016-story/en/> 
cured about half of those who were treated, required weekly injections 
for months, and could have fatal side effects. Yet, despite having a 
cure, about 97 percent of prisoners 
<https://khn.org/news/state-prisons-fail-to-offer-cure-to-144000-inmates-with-deadly-hepatitis-c/> 
with hep C have not received treatment, according to a survey released 
last year.

Maldonado told me that he first learned of the cure when he saw a TV 
commercial. But when he asked the Pennsylvania Department of Corrections 
(PA DOC) for DAAs, he was denied: “I said, ‘My sentence is life 
imprisonment, not death.… You’re going to let me die from this.’”

While Maldonado was incarcerated, he wrote several handwritten pleas to 
prison officials. “I’m serving a life sentence so I don’t have the 
option of getting out and seeking treatment at other places,” he wrote 
in 2015. PA DOC responded that the drug had not yet been approved for 
use by the Bureau of Health Care Services 
<https://www.cor.pa.gov/About%20Us/Documents/Overview.pdf>, a PA DOC 
entity that oversees medical, dental, and food services.

Maldonado’s correspondence echoed the words 
<https://supreme.justia.com/cases/federal/us/429/97/> of US Supreme 
Court Justice Thurgood Marshall: “An inmate must rely on prison 
authorities to treat his medical needs; if the authorities fail to do 
so, those needs will not be met.” In 1976, Marshall wrote for the 
majority in /Estelle v Gamble/ 
<https://supreme.justia.com/cases/federal/us/429/97/> that “deliberate 
indifference” to prisoners’ serious medical needs constituted cruel and 
unusual punishment.

Maldonado joined a class-action lawsuit, filed in 2015, against PA DOC, 
challenging the denial of DAAs to nearly all inmates with chronic 
hepatitis C. On November 19, a proposed settlement agreement was 
announced that would greatly expand access to DAAs for Pennsylvania 
prisoners. The judge has granted preliminary approval, and a hearing is 
scheduled for February 5, 2019.

“I’m glad the guys in prison are going to get treated. They deserve it,” 
Maldonado told me. He said he hopes that “they didn’t wait too long for 
some.”

In December 2018, out of 4,863 prisoners who had been diagnosed with 
chronic hepatitis C in Pennsylvania, only 130 were receiving DAA 
medication, according to PA DOC spokesperson Amy Worden. Under the new 
agreement, Worden wrote in an e-mail, “the DOC commits to continue to 
expand DAA medication treatment to eligible inmates in the earliest 
stages of infection…over the course of the next three years.”

The settlement deal stipulates that prisoners can receive DAA medication 
if they have at least one year’s life expectancy and at least 20 weeks 
until their release date. Su Ming Yeh, deputy director at the 
Pennsylvania Institutional Law Project, one of the firms that filed the 
suit, said she expects about 5,000 individuals will now be cured.

Guidelines set by the AASLD/IDSA 
<https://www.hcvguidelines.org/evaluate/when-whom> recommend early 
treatment for chronic hepatitis C in nearly all cases. “Universal 
treatment should be the standard for correctional systems,” said Yeh. 
“It’s smart correctional policy to treat everyone.”

Prior to the settlement, Pennsylvania limited treatment to those who 
suffered from severe complications. In January 2017, a federal district 
judge condemned these practices in a case brought on behalf of activist 
Mumia Abu-Jamal, who had chronic hepatitis C and is serving a life 
sentence 
<https://www.npr.org/2018/12/28/680781150/mumia-abu-jamal-granted-right-of-appeal-after-decades-in-prison>. 


“The Hepatitis C Protocol deliberately delays treatment for hepatitis 
C,” Judge Robert D. Mariani wrote 
<http://abolitionistlawcenter.org/wp-content/uploads/2017/01/Memo-Op-Jamal-v-Wetzel-010317.pdf> 
in his order requiring that Abu-Jamal receive DAA medication. 
“Defendants, pursuant to DOC policy, deliberately chose a course of 
monitoring over treatment for nonmedical reasons and are allowing 
Plaintiff’s condition to worsen while his liver function and his health 
continues to deteriorate.”

Since 2015, PA DOC has treated 650 people with DAAs—with the average 
per-patient treatment now costing about $20,000, according to Worden. 
When the medications first became available, it could cost upward of 
$94,000 <https://academic.oup.com/cid/article/61/12/1825/337489> to 
treat one person. With increased competition and negotiations between 
the department and the drug companies, the price dropped for PA DOC 
patients, Worden said. Costs are expected to keep falling, but it’s 
undeniably a significant expense for prison systems.

The unwillingness to cure people is often attributed to the high cost as 
well as the stigma associated with hepatitis C. But Maldonado is not 
alone in fighting for treatment. Across the country, prisoners and their 
attorneys are going to court to demand access to DAAs. Settlements in 
Massachusetts 
<https://www.bostonglobe.com/metro/2018/03/09/prisoners-state-reach-settlement-agreement-for-treatment-hepatitis/erSSmeAdUttvADwC2F6aXI/story.html> 
and Colorado 
<https://www.denverpost.com/2018/09/12/colorado-settlement-prisoner-care-for-hepatitis-c/>, 
as well as a court order 
<https://www.floridajusticeinstitute.org/wp-content/uploads/2017/12/Order-Entering-a-Preliminary-Injunction-07154063xB3B17.pdf> 
in Florida, have all mandated increased access to medication for 
prisoners. In December, a US appeals court upheld 
<http://news.stlpublicradio.org/post/appeals-court-upholds-class-action-status-thousands-missouri-inmates-hepatitis#stream/0> 
a lower court’s ruling that found that prisoners with hepatitis C 
constitute a class in a suit against the Missouri Department of 
Corrections.

This past summer, attorneys DeVaughn Ward and Kenneth Krayeske sued the 
Connecticut Department of Corrections (CT DOC) on behalf of Robert 
Barfield. Barfield was diagnosed with hepatitis C in 2006 and has been 
incarcerated in Connecticut since 2012. His repeated requests for DAAs 
were denied until the suit was filed last year, according to the 
complaint. Since 2016, Barfield has reported a variety of symptoms 
associated with chronic hepatitis C: numbness in his hands and feet, 
weight gain, pain, and loss of hair on his legs.

The CT DOC did not respond to a request for comment, but court documents 
show that it prioritizes treatment for those who have already suffered 
liver scarring.

“The treatment of plaintiff Barfield has been consistent with the 
appropriate standard of care,” wrote assistant state attorneys general 
Steven Strom and Terrence O’Neil. “The standard of care for treatment of 
HCV [Hepatitis C Virus] in correctional settings is not based on any one 
set of guidelines.”

Delaying treatment for hepatitis C, the ACLU argues, causes unnecessary 
suffering. “No one sentenced people in prison to die from lack of 
medical care,” ACLU of Connecticut’s legal director Dan Barrett said. 
“No gavel banged and said, ‘I sentence you to a hole in which your 
medical needs are going to be ignored.’”

In June, the ACLU of North Carolina and North Carolina Prisoner Legal 
Services sued the North Carolina Department of Public Safety (NC DPS) 
for restricting access to DAAs. Prisoners in North Carolina, similarly 
to those in Connecticut, usually must suffer from liver scarring to 
qualify for the cure. Those with a history of mental illness, fewer than 
12 months left on their sentence, a life expectancy of less than 10 
years, and/or a disciplinary infraction for alcohol or drugs in the 
previous year are prohibited from receiving DAAs.

These restrictions, and those like it in other states, are not medically 
justified, according to Raymond Chung, the chief of hepatology at 
Massachusetts General Hospital. “The notion of applying boundary 
conditions on who should receive therapy is probably not well-grounded,” 
said Chung.

Michele Luecking-Sunman, a civil-litigation managing attorney for North 
Carolina Prisoner Legal Services, told me, “The standard of care is to 
treat hepatitis C as soon as chronic hepatitis C is identified. That 
standard applies to people who are in prison and people who are out of 
prison.”

Out of the 1,543 prisoners in North Carolina diagnosed with chronic 
hepatitis C as of April 2018, about 589 had completed treatment and 72 
were currently in treatment or had been approved for treatment, 
according to a legal filing by the NC DPS. But based on estimates of the 
prevalence of chronic hepatitis C, there are likely between 6,500 and 
12,500 prisoners with the virus in North Carolina, according to an 
affidavit by Paula Smith, the former medical director for the Division 
of Adult Correction of the NC DPS.

“There are thousands of people in our prison system who have hepatitis C 
who don’t know it,” said Luecking-Sunman.

The undercount reflects a woefully inadequate screening process. A 
simple blood test 
<https://www.cdc.gov/hepatitis/hcv/pdfs/hepctesting-diagnosis.pdf> is 
all that’s required to test for hepatitis C. The NC DPS policy currently 
advises health-care practitioners in the prison to “discuss risk factors 
and if present, consider testing for hepatitis C.” The policy, however, 
does not specify when or how often this discussion will take place. NC 
DPS deputy communications director Diana Kees declined to comment on 
their hep-C treatment protocol, citing pending litigation.

NC DPS’s practices appear to ignore the recommendations of the Federal 
Bureau of Prisons <https://www.bop.gov/resources/pdfs/hepatitis_c.pdf> 
and AASLD/IDSA 
<https://www.hcvguidelines.org/unique-populations/correctional>, which 
state that prisons implement a universal opt-out testing policy. 
Adopting this strategy nationwide, according to AASLD/IDSA, would 
prevent more than 11,000 
<https://www.hcvguidelines.org/unique-populations/correctional> 
liver-related deaths over the next three decades.

To slow the spread of hepatitis C in the United States, people in prison 
must be screened and treated. “This represents a golden opportunity to 
try to contain the epidemic, identify cases, and treat them, and, at the 
same time, help to stem the spread of the infection,” Chung said.

Altman from theNational Hepatitis Corrections Network emphasized that 
treating the prison population as somehow separate from the general 
population is a mistake. “There’s no difference between people in 
prison’s health and the health of our country. It’s the same people,” 
she told me.

Maldonado said that the core problem was that so many people refuse to 
see prisoners as humans. Maldonado now lives in Philadelphia, where he 
works as a case manager for the homeless. The settlement in his case, he 
said, is welcome news for those still incarcerated. For him, treatment 
made all the difference: “They consider me cured. I don’t have to worry 
about dying from this.”

-- 
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