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Prisoner Education Guide

Tennessee: High Cost of Drugs Cited as Reason to Deny Prisoners Hep C Treatment

by David M. Reutter

Tennessee prison officials “turn a blind eye” to the medical needs of prisoners infected with the hepatitis C virus (HCV), a class-action lawsuit filed in July 2016 alleges. While it is likely that almost half of all Tennessee state prisoners have the disease, prison officials cite costs as a reason to deny care to all but the sickest.

HCV, which has infected between 2.7 million and 3.9 million people nationwide, kills more Americans than HIV and dozens of other infectious diseases, according to the Centers for Disease Control and Prevention. Researchers at Emory University estimate that at least 17% of the nation’s 1.3 million state prisoners have HCV, on average. That is an epidemic level when compared to the estimated 1% of the general population infected with the disease.

Prison officials in Tennessee were, at one time, determined to identify prisoners who have HCV.

“We started for a while doing a hepatitis panel on everybody. And we stopped that because we found out there were too many people who had hepatitis C, and then if you’re going to do that, you’re going to have to do something about that [by providing medical care],” said Donald Willie, who was a Tennessee prison nurse for 14 years.

Of the 901 prisoners tested for HCV in 2015, 424 tested positive, said Neysa Taylor, spokeswoman for the Tennessee Department of Correction (TDOC). An investigation by the Tennessean found that 3,669 prisoners were known to be infected with HCV as of November 2016, but prison officials were treating just seven for the disease.

The face of HCV treatment changed in 2013 with the introduction and approval of a new generation of direct acting anti-viral drugs. Previously, treatment involved the use of interferon, which had a treatment course of up to a year, included serious side effects and was only effective in curing the disease about 65% of the time.

The new drugs, such as Gilead Sciences’ Sovaldi and Harvoni, AbbVie’s Viekira Pak and Merck & Co.’s Zepatier, have cure rates above 90% while reducing side effects and cutting treatment times to about three months. However, they cost around $1,000 per pill and a full course of treatment can cost over $80,000, depending on the drug manufacturer.

The TDOC argued it was adequately treating prisoners by routinely drawing blood to monitor the progression of their HCV.

“The department is committed to providing the community standard of care to all inmates,” said TDOC spokeswoman Alison Randgaard – though blood draws are not the community standard of care for people with hep C.

“Without knowing specifics, blood draws may be part of the evaluation of the condition, but it would not count as treatment of [HCV] in my view,” countered Dr. Arthur Kim, a national expert on hepatitis C.

At a budget hearing in November 2016, the TDOC asked the legislature for $4 million to fund HCV treatment. That, however, was grossly inadequate, according to critics – and the governor approved only half that amount.

“I think it’s great that [they] asked for $4 million to go toward actual treatment, and that’s wonderful,” said Jeannie Alexander, director of the Nashville-based No Exceptions Prison Collective. “But we’re talking about around 4,000 people who have hepatitis C ... we’re talking about a medical crisis and hundreds of millions of dollars. I think they have a social, moral and constitutional obligation to treat people who have hepatitis C with an actual drug regime.”

The class-action suit, filed by Tennessee state prisoners Charles Graham and Russell L. Davis, also claims the TDOC denies treatment to prisoners as a result of disciplinary actions, prison placement and the amount of time they have left to serve, which “creates the risk of an HCV pandemic” among the general public when infected prisoners are released.

The district court granted class-action certification in the case on May 4, 2017. “Plaintiffs are not simply disagreeing with a doctor’s course of treatment for a particular person,” the court wrote. “They are attacking TDOC’s statewide policies and procedures applicable to all inmates with hepatitis C.”

The case remains pending, with the plaintiffs represented by the Tennessee ACLU, attorney Karla M. Campbell and Disability Rights Tennessee. A bench trial is scheduled in December 2018. See: Graham v. Parker, U.S.D.C. (M.D. Tenn.), Case No. 3:16-cv-01954.

Hepatitis C infections have reached epidemic levels in some state prison systems, resulting in an increasing number of failure-to-treat lawsuits being filed – including in Minnesota, Pennsylvania, Massachusetts and Florida, in addition to Tennessee. [See, e.g.: PLN, July 2017, p.1; Aug. 2015, p.22; July 2014, p.20].

Recently, a federal district court in Florida ordered prison officials to provide treatment to prisoners infected with HCV, using the latest generation of anti-viral drugs, pending resolution of a class-action lawsuit in that state. [See related article in this issue of PLN]. 

Additional sources: The Tennessean, www.wsj.com

Related legal case

Graham v. Parker


 

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