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NC prisons must test and treat inmates for hepatitis C under class-action settlement

illustrated graphic showing the interior structure of HCV along with how the surface appears
Diagram of the Hepatitis C virus. Graphic courtesy: Centers for Disease Control and Prevention.

By Taylor Knopf

Inmates in North Carolina prisons will now receive testing and treatment for hepatitis C, as well as education about how the virus spreads, according to a federal class-action lawsuit settlement on Monday.

In 2018, three state inmates sued the Department of Public Safety saying they were denied treatment for their hepatitis C virus because they weren’t sick enough to receive medication under the prison system’s former criteria.

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Hepatitis C is a highly contagious virus that targets the liver. It’s spread by contact with infected blood and today most people get it by using unclean needles to inject drugs, according to the Centers for Disease Control and Prevention. The disease can also be transmitted through sharing personal items contaminated with blood (such as razors or toothbrushes) and unregulated tattooing, which can occur in prisons. More than half of those infected with hepatitis C will develop a chronic condition, which the CDC says can be serious conditions, such as cirrhosis and liver cancer.

The disease is the most commonly reported bloodborne infection in the U.S., and the CDC now recommends hepatitis C testing for all adults.

In the past, hepatitis C treatments were expensive and not always effective. But since 2011 it’s curable in almost every patient due to new medications, direct-acting antiviral drugs called protease inhibitors. Although the new treatments were wildly expensive when they were first introduced, the prices of hepatitis C treatment drugs have been coming down as generic forms enter the drug market.

Federal and state law requires DPS to provide health care to inmates in their custody. By not providing treatment, civil rights attorneys argued that DPS was in violation of the Americans with Disabilities Act and the Eighth Amendment to the U.S. Constitution, which prohibits cruel and unusual punishment.

“DPS refuses to provide medically necessary treatment simply to avoid the associated costs,” read the 2018 lawsuit, filed by the American Civil Liberties Union of NC and Prisoner Legal Services on behalf of the three prisoners.

DPS agreed to settle the class-action lawsuit last year, and those within the “class” — inmates within the state prison system — were notified and given a chance to respond, according to ACLU of NC senior staff attorney Em Seawell. A federal judge formalized the settlement agreement on Monday.

According to the agreement, DPS will offer education on hepatitis C and spread awareness on how the virus is transmitted. Hepatitis C is more prevalent among the incarcerated population. As the rate of heroin use has increased in North Carolina over the past few years, the rate of hepatitis C infection has also risen.

Any inmate can now be tested for hepatitis C by asking for it through a sick call or during a routine medical appointment. Under the settlement agreement, DPS will test all inmates when they come into prison, after being transferred to another facility within the prison system and during routine physicals.

Any person in DPS custody who tests positive for chronic hepatitis C and has time to complete the course of treatment before their release date will now be eligible to receive treatment. If an inmate tests positive too close to their release date, DPS will arrange a connection to treatment in the community, according to the settlement. Hepatitis C treatment with protease inhibitors takes from 12 to 24 weeks depending on the severity of the disease.

The settlement will have the force of a court order and be enforceable over the next five years, according to Seawell. DPS must report progress on testing and treatment every six months during that time.

“This will establish a new status quo. It’s easier to keep this treatment going,” Seawell said.

Previously, DPS policy was to screen “at-risk” inmates for hepatitis C and only to treat inmates once they had reached a certain level of fibrosis, or liver scarring. The policy also disqualified inmates from treatment for other reasons for which the lawsuit claimed there was “no medical justification,” such as a mental health condition or fewer than 10 years of remaining life expectancy.

“What the Department of Public Safety wants most of all is healthier offenders in our facilities, who return to their communities in better health — just as the plaintiffs were seeking,” said Tim Moose, DPS chief deputy secretary for Adult Correction and Juvenile Justice, in a press release Monday. “This compromise ends more than two years of litigation and provides a blueprint for reducing this virus among the people in our custody.”

According to the terms of the settlement, DPS will treat at least 2,100 inmates with hepatitis C in the next five years.

“The five-year clock begins ticking 30 days after state Prisons resume normal operations following the COVID-19 emergency,” DPS officials said in a press release.

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