Institutes HCV Treatment Protocol
by John E. Dannenberg
In a major milestone along the Southern Poverty Law Center's (SPLC) march towards gaining humane medical care in Alabama's prisons, a Settlement Agreement was signed in June, 2004 that commits the Alabama Department of Corrections (ADOC) to providing constitutionally adequate medical care for ADOC prisoners at St. Clair Correctional Facility. St. Clair, a maximum security prison, is one of the largest in the state and houses some of the most severely ill prisoners, including prisoners with cancer, Hepatitis-C (HCV), and on kidney dialysis. One major breakthrough is that for the first time, ADOC will now treat hepatitis-C (HCV), based upon a protocol mirroring an evolving standard reported earlier in PLN for other states. (See: PLN , May 2004, and this issue].
The Alabama case, Baker v. Campbell , along with six other lawsuits, was reported in PLN (Oct. 2003, p.5) when a preliminary injunction issued to abate Alabama's sordid prison conditions and medical care resulting in death rates triple that of neighboring states. While the Baker case focused initially on the named plaintiffs, the Settlement Agreement expanded the plaintiff class to include all St. Clair prisoners, expressly providing for immediate treatment of four.
One major success for the named plaintiffs was the reverse colostomy provided to James Freeman, who was forced to wear a colostomy bag to collect his bodily waste for the past seven years because the DOC refused to pay for the surgery.
But the settlement's requirement that plaintiff Darrell Mullins be given proper treatment for his cancer came too late he died from testicular cancer shortly after the agreement was signed.
The foundation of the Settlement Agreement is an addendum entitled "Agreement of Experts." This addendum addresses what treatment is to be provided for specific illnesses, timeliness of such care, staffing types and levels, the formulary, performance measures and a quality control program. Monitoring is provided by Dr. John Robertson, a correctional medical expert and former director of New Mexico's prison medical system Dr. Robertson, will tour St. Clair at least four times per year over the Agreement's two-year term. The Settlement Agreement shall prevail over any conflict with ADOC's contract medical provider in the event of disputes.
Significantly, the Settlement Agreement is agreed not to be a consent decree and is not enforceable in federal court. While plaintiffs may seek enforcement in state court only, pursuant to 18 U.S.C. § 3636(c) (2) (B), they are also free to bring a new federal action in the event of non-compliance. Finally, the Agreement requires ADOC to pay SPLC $30,000 in attorney's fees and costs.
The eleven page Agreement of Experts goes into great detail as to what ADOC prisoners are now entitled. It begins with definitions of "serious medical need" and "medical necessity." Next is a list of seven major disorders for which ADOC must develop and implement chronic care guidelines, per nationally accepted medical standards.
Elements of what constitutes "adequate care and treatment for inmates with serious medical needs" is spelled out in great detail, specifying timeliness, level and frequency of care, and access to outside specialty care. All specialty care must be from a physician. The plan requires ADOC's medical provider to maintain a detailed data base to provide for prompt follow-up and monitoring. Prostheses (including dental) and devices such as hearing aids shall be timely repaired/replaced. Prisoner co-payments may not be charged for care required by clinical guidelines or that requested by physicians, including follow-up care. And co-payments shall be waived for control of communicable diseases and for reports of laboratory tests. Sick call shall conform to prisoner work schedules. Physicians shall be credentialed, and qualified in their specialty. Dental care shall focus on timely treatment of emergencies, restoration of teeth in lieu of extraction, and on dental hygiene including regular cleaning.
The policies and procedures to be developed by ADOC include nurse screening protocols, HCV/chronic disease treatment guidelines, blood and airborne pathogen control, and MRSA (a highly contagious and deadly quasi-bacterial organism) control.
A lengthy section deals with required quality control procedures. It covers nursing sick call, urgent care, and clinical guidelines for chronic TB, hepatitis, asthma, diabetes, HIV, and hypertension. Guidelines are also specified for specialty care areas, including heart, eye, gynecology, neurology, orthopedics, podiatry and pulmonary. Time limits are placed on reporting of X-rays and laboratory tests.
Of interest to many PLN readers is the protocol for ADOC's HCV treatment plan. It provides for 100% screening at intake; those with high risk factors will be given the HCV anti-body blood test. In patients with known immune deficiency (e.g., HIV), advanced tests are required. Once HCV is confirmed, treatment eligibility will be determined. Absolute exclusion will occur upon de-compensated liver cirrhosis, less than 24 months sentence remaining, or a history of a solid organ transplant or of active TB. Relative exclusion criteria include Hepatitis-B co-infection, poorly controlled diabetes, alcohol/illicit drug use within the past twelve months, or life expectancy less than ten years. A liver biopsy is optional based upon HCV genotype. The treatment shall be pegylated interferon and ribavirin combination therapy.
The St. Clair settlement agreement should take ADOC prisoners out of the medical care Dark Ages. No relief, however, could be provided for the principal plaintiff, lung disease patient Jerry Baker. After having been denied his prescribed medications, the 63 year-old Baker dropped from 155 to 115 pounds, finally dying of malnutrition at St. Clair on May 16, 2003, just a few weeks after the lawsuit was filed. See: Baker v. Campbell , USDC ND AL, Case No. CV-03-C-1114-M, Settlement Agreement, June, 2004. A copy of the agreement and other pleadings are available at www.splcenter.org.
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Related legal case
Baker v. Campbell
|Cite||USDC ND AL, Case No. CV-03-C-1114-M|