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Permanent Injunction for Hepatitis C Treatment Entered for Florida Prisoners

by David M. Reutter

A federal district court chastised the Florida Department of Corrections (FDOC) for its “long and sordid history of neglecting” prisoners infected with hepatitis C (HCV). Finding a “risk of such deliberate indifference reoccurring in the future,” the court entered a permanent injunction that requires the FDOC to treat all prisoners with the disease.

PLN previously reported that the district court had issued a preliminary injunction on November 17, 2017. [See: PLN, Dec. 2017, p.24].In the 15 months since that order was entered, the FDOC screened 55,348 prisoners for hepatitis C, identified 7,185 as having chronic HCV, and began or completed treating 4,901 prisoners with direct-acting antivirals (DAAs).

The court was presented with cross summary judgment motions that sought a permanent injunction. The FDOC wanted the relief restricted to that contained in the preliminary injunction, while the class members sought additional relief. 

The district court sided with the prisoners and added additional requirements. It noted the FDOC had admitted it “was not adequately monitoring all inmates with chronic HCV prior to the preliminary injunction,” and that failure “was due to a lack of funding.” Prison officials acknowledged and the court found that chronic HCV is a serious medical need. Thus, the FDOC had admitted deliberate indifference.

After finding the class members had succeeded on the merits of their Eighth Amendment claim and there were no material facts in dispute, the district court turned to the relief it should grant. It found that “something must change” in regard to how the FDOC identifies prisoners with HCV. Only about seven percent of state prisoners have been diagnosed with the disease, but the FDOC’s own expert believed that about 20 percent were infected.

Thus, the court ordered the FDOC to implement opt-out testing for HCV or opt-in testing with peer education. It also required prison officials to make the option of elastography, which is a more accurate means of identifying the severity of HCV infection, available to medical staff. The preliminary injunction required the FDOC to treat prisoners with level 3 and 4 chronic HCV infection, and ordered treatment for prisoners with level 1 and 2 infections within two years.

It also prohibited the FDOC from denying treatment to prisoners with disciplinary issues unless the denial was medically indicated. Further, it ended the exclusion of HCV treatment if a prisoner had only 12 to 18 months left to serve.

The FDOC’s continued opposition to the requested injunctive relief indicated that its deliberate indifference to the medical needs of HCV-positive prisoners could recur. To ensure that the FDOC does not “relapse[ ] to its sordid past,” the district court’s April 18, 2019 order included a “trust but verify” monitoring schedule. State officials filed a notice of appeal in May 2019. See: Hoffer v. Inch, U.S.D.C. (N.D. Fla.), Case No 4:17-cv-00214-MW-CAS.