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Federal Class-Action Lawsuit Seeks Hepatitis C Treatment for Texas Prisoners

by Matt Clarke

A Texas prisoner has filed a federalclass-action lawsuit seeking the current standard of care for treatment of hepatitis C.

Texas Department of Criminal Justice (TDCJ) prisoner Matthew Roppolo, 53, has the hepatitis C virus, a serious illness that can eventually lead to liver failure and death. Despite his diagnosis in the 1990s and repeated requests for treatment, he has never been treated with the drugs that are the current standard of care – Direct Acting Antivirals (DAAs). Aided by Austin attorneys Jeff Edwards, Scott Medlock, Matthew Singley and David James, Roppolo filed suit challenging the rationing and effective denial of DAA treatment by the TDCJ, the Correctional Managed Health Care Committee, the University of Texas Medical Branch Correctional Managed Care (CMC) and various staff of those entities.

The complaint argues that denying DAA treatment for prisoners infected with hepatitis C violates the Eighth Amendment’s prohibition against cruel and unusual punishment as well as the Americans with Disabilities Act and Rehabilitation Act.

It notes that hepatitis C is the third leading cause of death among Texas prisoners, and alleges this is due to the reluctance of the defendants to pay the high cost of DAA treatment – about $64,000 per prisoner, according to testimony by CMC Director Dr. Owen Murray before a legislative committee in 2014. The cost of the treatment has come down since then, but it is still expensive.

According to court documents, Murray, TDCJ medical director Lannette Linthicum and other medical experts testified before legislative committees that DAA treatment for all persons with hepatitis C – regardless of the progression of their disease – was the community standard of care. Prisoners are supposed to be afforded that same standard of care. However, the defendants have continued to treat prisoners with hepatitis C using less effective drugs and have rationed treatment for prisoners, making their placement on a waiting list dependent on the indexed ratio of their AST liver enzyme to their platelets (APRI).

The lawsuit claims that only prisoners with an APRI exceeding 0.5 are considered for treatment, but that threshold fails to identify 19 percent of cases of serious liver scarring (fibrosis) in prisoners who should receive immediate treatment. Further, even having an APRI exceeding 0.5 does not guarantee treatment; rather, it results in a referral to another doctor who often refuses to authorize DAA treatment.

“The doctor I see told me there was nothing she can do,” said one Polunsky Unit prisoner with an APRI over 0.5. “One of the main problems is that we’re uneducated in medical matters. I am enclosing some of the results of my blood work.... This is all the treatment I get for Hep-C. Just blood work, and they tell me the results.”

Rather than using DAAs, which have an over 90 percent cure rate, Roppolo was treated with Interferon, a much less effective drug with serious side effects, about five years ago. He was unable to tolerate the Interferon. Since then, he has been given blood test after blood test but no further treatment.

As previously reported in PLN, prisoners in at least a dozen states have filed lawsuits seeking DAA treatment for hepatitis C. [See: PLN, June 2019, p.44]. Those in Massachusetts, Minnesota, California, Colorado, Pennsylvania and – most recently – South Carolina have been settled in favor of providing prisoners with DAAs. Texas has 18,000 prisoners already diagnosed with hepatitis C and up to 25,000 who have not yet been diagnosed. Whatever the price of DAA treatment, it is less expensive in terms of both costs and lives than waiting until hepatitis C progresses to end-stage liver disease. The case remains pending. See: Roppolo v. Linthicum, U.S.D.C. (S.D. Tex.), Case No. 2:19-cv-00262. 


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Related legal case

Roppolo v. Linthicum