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New Prison HIV Medication Rules Subject of Massachusetts Suit

Cost reduction is the “real reason” behind a new policy in Massachusetts prisons that prohibits prisoners from receiving their HIV medication through the Keep On Person (KOP) program, according to a federal civil rights lawsuit. Under the policy, HIV-positive prisoners will have to go to the medication line daily to receive their life-saving drugs rather than being allowed to keep a larger supply on hand.

The complaint was filed in November 2010 by attorneys with Prisoners’ Legal Services, and was joined by the AIDS Action Committee (AAC) of Massachusetts. It seeks class-action status to obtain declaratory and injunctive relief for alleged violations of the Eighth and Fourteenth Amendments, the Rehabilitation Act and the Americans with Disabilities Act.

A governor’s advisory board was convened in the 1990s to analyze HIV care in the state’s prison system and to recommend and enact policies to improve such care. The board recommended that prisoners receive their medications through the KOP program, which only requires a prisoner to report to medical once a month to obtain a renewal of prescribed medications.

UMass Correctional Health (UMCH), a program of UMass Medical School, has the contract to provide Massachusetts prisoners with medical care. In November 2008, UMCH announced a blanket policy change that required KOP renewals every 15 days rather than monthly. Two months later, UMCH eliminated HIV medications from the KOP program and required prisoners receiving those drugs to come to the medication line at the Health Services Unit for each dose. Only HIV drugs were removed from the KOP program.

“The removal of HIV medication from the Keep On Person program is callous and extremely short-sighted, as patients who refuse or are unable to go to the med line, or who miss doses because of the chronic effects of the med line process, will become more sick,” the complaint states.

The reasons for the policy change, according to the lawsuit, “are irrational and pretextual,” and the reduction in access to HIV medicines is intended to cut costs. While only two or three percent of the prison population is prescribed HIV drugs, the money spent on such drugs accounts for at least 20% of the overall $15 million spent annually on medications for prisoners.

The KOP program makes prisoners self-reliant and allows them to take their medications with food or before going to bed, which mitigates the side effects of the multiple drug combinations commonly prescribed as part of an HIV treatment regimen. The medication line, by contrast, is held at times that require prisoners “to endure side effects,” and some prisoners are too sick to pick up their drugs multiple times a day.

Additionally, the medication line has problems with privacy. Requiring prisoners to obtain their drugs via the med line allows other prisoners to infer the nature of their medical condition, and guards often reveal the fact that a prisoner is HIV positive after they hear verbal exchanges between the nurse and patient, by reading the patient’s chart or medication packaging, or by recognizing the pills that are administered.

Moreover, prisoners can miss receiving their drugs for reasons beyond their control. A medical emergency, altercation, staff shortages, the refusal of guards or work supervisors to release prisoners, or transfers may cause prisoners to miss going to the medication line.

“Even brief disruptions in treatment can result in emergence of viral resistance to one or more of the agents [HIV drugs] in use. Such resistance may have far-reaching implications, as some of these resistant mutations may result in the loss of entire classes of antiviral agents,” the lawsuit states. “This loss would restrict future treatment options to more complex and more expensive agents that have more significant side effect profiles, resulting in the need for additional medication management of these side effects.”

The AAC noted that such problems “are serious and [have] potentially dire consequences.” On September 30, 2011, the district court denied the plaintiffs’ motion for a preliminary injunction requiring prison officials to reinstate the KOP program for HIV medication. The case remains pending. See: Nunes v. UMass Correctional Health, U.S.D.C. (D. Mass.), Case No, 1:10-cv-12013-RWZ.

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Related legal case

Nunes v. UMass Correctional Health