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Court Certifies Class of Missouri Prisoners Denied Hepatitis C Treatment

by Matt Clarke

On July 26, 2017 (two days before World Hepatitis Day), the ACLU of Missouri and the MacArthur Justice Center (MJC) announced the certification of a class of Missouri Department of Corrections (MDOC) prisoners who have been denied treatment for hepatitis C (HCV) under the prevailing standard of care.

With the assistance of ACLU attorneys Gillian R. Wilcox and Anthony E. Rothert, and MJC attorney Amy E. Breihan, three MDOC prisoners – Michael Postawko, Christopher Baker and Michael Jamerson – filed a class-action federal civil rights suit against state prison officials and Corizon, the MDOC’s for-profit health care provider, seeking treatment under the prevailing standard of care for prisoners infected with HCV. According to court documents, the standard of care endorsed by the Centers for Disease Control is treatment of all HCV-infected persons with direct-acting antiviral (DAA) drugs.

DAAs work quicker, cause fewer side effects and are more successful at treating chronic HCV infections than the previous treatment standard using interferon and ribavirin. They are also more expensive, a justification the MDOC uses to treat only a few HCV-infected prisoners. The additional cost is offset by a cure rate of over 90%.

Untreated HCV infections can cause liver inflammation, impaired liver function, scarring of the liver, liver cirrhosis, liver cancer and a torturous death as the body slowly poisons itself. In the United States, 19,000 people die of HCV infections annually, and it is the leading indicator for liver transplants.

Although the Centers for Disease Control recommends that anyone with a history of drug use or incarceration be tested for HCV, the MDOC does not routinely test state prisoners. Once it determines someone has HCV, the MDOC uses a test that results in 50% false negatives to determine the severity of the damage caused by the disease. Those results are used to decide whether the prisoner will receive treatment. Due to this practice, the MDOC treats only 0.11% – just five prisoners – out of the 4,736 MDOC prisoners known to be infected with HCV.

“With their shameful disregard of this potentially deadly disease, particularly in light of advancements in treatment over the last several years, the [MDOC] has demonstrated indifference to the lives of those in their custody,” said Breihan. “They are basing treatment decisions on cost, rather than need, and inmates are paying the price.”

“Not only are inmates not receiving this universally accepted standard of care, but MDOC and Corizon, its medical provider, are relying on inaccurate, arbitrary methods to determine who even warrants care,” she added. “This includes outdated methods of testing for fibrosis and cirrhosis and requiring advanced liver damage to qualify for treatment.”

The lawsuit, which was brought under 42 U.S.C. § 1983 and the Americans with Disabilities Act, seeks an injunction to compel the MDOC to formulate and implement an HCV testing and treatment program that conforms to the prevailing standard of medical care. The state appealed the class certification ruling in September 2017, and the appeal remains pending. See: Postawko v. Missouri Department of Corrections, U.S.D.C. (W.D. Mo.), Case No. 2:16-cv-04219-NKL.

This ruling was one of several recent developments in litigation involving prisoners’ access to the latest and most effective HCV treatment. [See: PLN, April 2018, p.28]. 

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Related legal case

Postawko v. Missouri Department of Corrections