By Taylor Knopf
Three state prisoners sued the N.C. Department of Public Safety this month arguing that they were denied treatment for their Hepatitis C virus (HCV).
The men claim that there is no medical reason to justify denying them medical treatment for HCV, a highly contagious virus that targets the liver. It’s spread by contact with infected blood, and the most common way people get it today is through injecting drugs.
“DPS refuses to provide medically necessary treatment simply to avoid the associated costs,” reads the lawsuit, filed by the American Civil Liberties Union of NC and Prisoner Legal Services on behalf of the three prisoners.
In the past, HCV treatment wasn’t always effective. But now it’s curable thanks to newer drugs which effectively eliminate the virus.
Denying an inmate medical service violates the Americans with Disabilities Act and the Eighth Amendment to the U.S. Constitution which bans cruel and unusual punishment, according to the ACLU of NC.
Of every 100 people infected with hepatitis C, about 75-85 cases will turn into a chronic infection, and 10-20 will develop cirrhosis over the course of a few decades, according to the Centers for Disease Control and Prevention.
And out of 100 people with hepatitis C and cirrhosis, each year 3-6 will develop liver failure and 1-5 will get liver cancer, says the CDC.
How the hepatitis C virus (HCV) infects the liver from Michailo Lubeznyj on Vimeo.
“The Department takes seriously screening and treatment of Hepatitis C (HCV) in its incarcerated population,” said DPS communications director Pamela Walker in an email to NC Health News.
Suffering now
“Treatment is provided to all inmates at stage F2 or higher, as well as screening for all at-risk inmates and also to those upon request for screening,” Walker said.
The amount of liver scarring, or fibrosis, is ranked on a scale of F0 through F4. DPS policy states that a person with a score of F2 or higher should be referred for treatment of their HCV. Anyone with a lower score should be monitored and tested annually, the policy says.
But the plaintiffs argue that they are suffering now and want treatment.
Plaintiff Lloyd Buffkin, an inmate at Scotland Correctional Institution in Laurinburg, was diagnosed with the virus in August 2017, according to the lawsuit. His latest medical records show his HCV score is in the F1-F2 range. Buffkin says he has HCV symptoms, including fatigue and atopic dermatitis, a form of eczema that can be extremely itchy. But his current lab results don’t qualify him for treatment under DPS policy.
Roger Elks, housed at Greene Correctional Institution in Snow Hill, was diagnosed with HCV in March 2006. The lawsuit states that he “does not qualify for treatment under DPS guidelines despite suffering from swelling in his legs, abdominal pain, and an enlarged liver.”
The DPS screening guide for HCV outlines eight criteria which increase a person’s likelihood of having the virus, such as prior injectable drug use, tattoos performed in jail or prison, or a blood transfusion before 1992. The policy is to test an inmate for HCV if he or she meets one of these criteria or requests a screening.
An estimated 110,000 North Carolinians are living with hepatitis C, and about 75 percent of those people don’t even know it.
The number of acute hepatitis C cases has increased fourfold since 2009, according to Zack Moore, state epidemiologist with the N.C. Department of Health and Human Services.
There are two classifications of hepatitis C: chronic and acute. Until January 2017, the state only tracked acute hepatitis C, cases that are newly identified with active symptoms.
Historically, the virus wasn’t always curable, the medications were expensive and treatment took up to a year to complete. But that has changed. There are new medications, known as direct-acting antiviral drugs, that completely cure HCV; insurance companies, as well as Medicaid and Medicare, are covering it.
NC Health News has reported patients spending anywhere from $8 to $50 for their HCV treatment after insurance.
Anyone who has ever been incarcerated should be tested for HCV, according to screening guidelines from the Infectious Disease Society of America and the American Association for the Study of Liver Disease.
‘No medical justification’
The lawsuit also takes issue with circumstances that make an inmate ineligible for treatment under the DPS policy.
DPS policy states that it would hurt the patient if HCV treatment occurred under any of the following circumstances.
- If the inmate doesn’t have enough time to complete the treatment. DPS sets that standard at 12 months.
- If an inmate has an unstable medical or mental health condition.
- If an inmate refuses treatment.
- If his or her life expectancy is estimated to be less than 10 years due to a co-occurring illness.
- If someone has infractions related to alcohol or drugs in the last year.
The ACLU attached an affidavit from a medical professional who found issue with a number of these conditions.
As for the policy not to treat inmates with 12 months or less remaining on their sentences, Muir noted that current HCV treatments only take eight to 12 weeks to complete.
A person’s mental health status also shouldn’t be a prohibiting factor for HCV treatment, according to Muir. He wrote that those safety measures only applied to one of the older medications, an interferon-based treatment which could induce psychiatric side effects. Muir said the newer direct-acting antiviral drugs (DAA) treatment is safe to treat patients with mental illness.
[sponsor]And finally, Muir wrote that it is not the standard of medical care to exclude someone from treatment if they have a life expectancy of less than 10 years. He wrote that during that time a patient could progress to cirrhosis, irreversible liver damage, and “die from the awful complications of portal hypertension or liver cancer.”
The power of knowing
In western Madison County, health department workers have been screening inmates in the county jail for Hepatitis C for a year.
County Health Director Marianna Daly received a grant from Gilead Sciences, Inc. to screen more people for HCV. Gilead is one of the pharmaceutical companies that’s manufacturing next-generation cures for the disease.
Daly included jail inmate screenings in the health department’s grant application to the company. And she just received the green light on a grant renewal and a possible expansion to include HCV screenings in the Rutherford County jail.
The goal is to screen inmates who will be at the jail for more than three days.
Rachel Potter, who facilitates the grant, said the health department isn’t treating inmates while in jail because they are often released or transferred to other facilities.
But as Potter visits the inmates to draw blood for the HCV test, she educates them about harm reduction and takes their contact information so she can follow up with their test results. If the inmate is still at the jail when the test results come in, Potter visits him in-person to share results and provide HCV education.
She has screened 145 inmates in the last year and about 23 percent tested positive.
“Just screening and finding out your status can change behavior and break the cycle of behavior,” Potter said.
“From speaking to my patients who have been active drug users, they said people who know they have a positive status are conscious about it and tell others,” she said. “They don’t try to be malicious and infect other people.”
According to the national Harm Reduction Coalition’s HCV counseling guide, “participants will leave a counseling session with questions about how they can protect others from being infected with Hepatitis C, how they can look after themselves and what they can or should do now.”
In the past 6 months, Potter said more people in jail have refused HCV screenings because they already know their status. More places like syringe exchanges, primary care offices, methadone clinics and some prisons and other jails have ramped up screening for HCV, she said.
Potter said she tries to track people with HCV after they leave the jail to help connect them to treatment. The number of people she’s gotten into treatment so far is low though.
“Hepatitis C isn’t a priority. It’s not pressing, because they don’t always feel bad,” she said. “For some people it can take 30 or 40 years for symptoms to really start bothering you.”
Two of the people she’s worked with have been interested in treatment and taken the first steps.
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