State prisons across the United States do not treat at least 144,000 prisoners with hepatitis C, a curable but potentially life-threatening liver disease, according to a recent poll and subsequent interviews of correctional services of the state. In response to questions about inmates with hepatitis C, the high price of drugs was cited to deny treatment. Medications can cost up to $ 90,000 for treatment.
Nationally, approximately 97% of inmates with hepatitis C do not receive cure, according to the survey conducted for a master's project at the Toni Stabile Center for Investigative Journalism in Les Lawyers say this ignores a 1976 Supreme Court decision that determined that an inmate's medical care is a constitutional right.
"It does not make sense to wait until we have the effective treatment available." Said Dr. Raymond Chung, Director of Hepatology and Liver Center at the # Massachusetts General Hospital. Chung was a former co-chair of the American Association for the Study of Liver Diseases and the HCV Guidance Council for Infectious Diseases of America, which recommends to all people with Alzheimer Disease. Chronic hepatitis C to have access to treatment.
The District of Columbia was asked how many prisoners have hepatitis C, how many are treated, what drugs are used for treatment, and what are the policies regarding inmates infected with the virus. Almost all states responded with all or part of the requested information. South Carolina and DC refuse requests.
With more than 1.3 million prisoners, state prisons house the largest number of people incarcerated in the country – people at higher risk of virus transmission by sharing bloodshed. needles, razors or toothbrushes. The rate of infection is much higher among incarcerated people than among the general population, in part because nearly one-sixth of the state's inmates serve drug-related offenses.
Never miss the news and analysis that interests you. 19659010] The extensive under-treatment occurs at a time when the rate of hepatitis C infection, or HCV, increases in part because of the opioid epidemic.
Some prisons ignore their own standards of care guidelines. In Florida, at least 181 prisoners who met the treatment criteria did not get the cure, according to the records kept by the Florida Department of Corrections. The ministry has a 13-page policy that states that inmates are eligible for HCV treatment when the disease reaches stage 2, when the liver has mild to moderate fibrosis or tissue scarring.
"The Ministry is committed to ensuring all detainees in our custody are provided with medically necessary treatment that is in line with national standards and our constitutional responsibilities," said Ashley Cook, Press Secretary of the Prison System. from Florida, in an email.
Since the end of 2013, new drugs for hepatitis C success rate of over 95 percent have become available.But they come with 40 sticker prices. $ 000 to $ 90,000 for the eight to 12 week tablet regimen, which replaced previous therapies that cost about $ 70,000 for 48 weeks of treatment with a much lower cure rate.
The Ministry Minnesota Correctional Services processed 58 inmates from 2014 to 2016. Dr. David Paulson, Medical Director of the Minnesota Penitentiary System, says his department does not can not afford to do more.
"We must operate within our means and treat [prisoners] who are the most advanced first," he said in an interview. "When prices go down, we treat more people."
In California, civil servants allocated $ 106 million to next year's budget to care for prisoners with dementia. Hepatitis C.
"Gilead provides public and private payers with substantial discounts and is committed to working with the state's correctional services to help ensure patient safety."
"Mark Snyder, director of public affairs, wrote in an email
. In 2016, Gilead stated in a statement to the BMJ Medical Research Journal that it would "stand behind the"
Another drug manufacturer, AbbVie, said the latest drug The company's anti-HCV, Mavyret, was sold at a higher price. "We continue to work with payers, plan sponsors and providers to ensure that patients have access to the appropriate anti-HCV therapy," said AbbVie's Raquel Powers. According to Brandon Sis, Chief Correctional Pharmacist for the Minnesota Multistate Contracting Alliance for Pharmacy, 2016 HCV drugs cost more than $ 50,000 per treatment and per inmate. , including 15 correctional departments. Sis said the reduced price of HCV drugs available for state prisons has been reduced by about half, to about $ 25,000 per treatment course at the end of 2017.
"This is a Nobody should die of HCV, "said Michael Ninburg, chairman of the World Alliance Against Hepatitis and executive director of the Hepatitis Education Project, a group of advocacy for the rights of those affected by the disease
Barry Michaelson, former prisoner of Minnesota and Terry Riggleman, a current prisoner in Virginia, were among the untreated despite several requests for treatment.
During their sentences Both felt their health deteriorating and were increasingly exhausted.Michaelson said that he had frequent headaches and had white lesions and bumps on his skin. he felt a constant pain in his abdomen and joints. These symptoms are common as the disease progresses.
"We are sick and they are not doing anything about it," Michaelson
in Minnesota, where Michaelson was incarcerated, said only 22 prisoners had received treatment. "If we treat everyone with hepatitis C, it would exceed the total pharmaceutical budget for everything else and there would not be enough budget left to treat patients with other diseases," he said. she adds. Paulson said. "We must do what brings the most benefits to the greatest number of people."
According to Paulson, 15% of the prisoners, or about 1,500, in the state of Minnesota's prisons were infected with HCV in 2017. If treating each prisoner would have cost more than $ 75 million, far exceeding its $ 27 million budget for all health care.
"We have to look at the whole picture. The goal, at least my goal, is to offer treatment based on the risk of side effects of hepatitis C, said Paulson, who wrote a book on hepatitis C in 2000. "Ideally, we would treat"
The constitutional argument on the treatment articulates around the ban of the eighth amendment of "cruel sentences" and unusual ". The prisoners do not have anywhere else to turn to health care. States restrict or prohibit any private or external medical care.
"I'm in a situation where I can not stop myself," Riggleman said in an interview at the Augusta Correctional Center in Virginia.
"An argument," said Michaelson. "Once you have incarcerated people, you must take care of them."
Michaelson and Riggleman separately filed class actions against the penitentiary systems of their states for not treating prisoners with the hepatitis C lawsuit. Michaelson, assisted by a lawyer from outside, was the first trial of the country and Riggleman was one of the most recent.
"The law is clear that we have the right to medical care," Michaelson said. "Then they must treat us, no excuse."
Litigation on this issue is ongoing in Minnesota and Virginia and in at least seven other states, including Alabama, California, Colorado, Florida , Missouri, South Carolina and Tennessee. Each year this means that there could be more than 75,000 people infected with HCV in the general population each year. Those who have not been tested or treated while incarcerated would increase the risk of new infections.
"It is very unfortunate that anyone who is likely to be cured is not treated," Chung said in an interview. "It is even more unfortunate that we can not treat people who are at high risk of spreading the virus to others."
"From a public health perspective, it's a disaster," said Paulson. "If the court decides that the department has to treat everyone, that money must come from the state legislature." That would be the money that would have been spent on roads, bridges, schools, and schools. Child Protection Services. "
Michaelson was released from his Minnesota prison in March 2017, without treatment for hepatitis C. While he was locked up, he had lost 20 When his old clothes were hanging from his body, he left the prison with two cardboard boxes filled with papers from his legal research, and as he was no longer incarcerated, his name was removed from the trial. should begin in September
Riggleman, who was diagnosed 14 years ago and who will not be released before 10 years, is still waiting to be cured.
"I do not have a conviction for life. I have people who interest me and I want to arrange things. I want to live. I have not been sentenced to death. Do not let me die here.
Thanthong-Knight reported this story as part of his master's project for the Center for Investigative Journalism Toni Stabile of the University of Journalism's Graduate School of Journalism. Columbia
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