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Virginia Settles Suit Over Prisoner’s Death from Untreated Hepatitis C for $700,000

by David M. Reutter

On April 5, 2023, a settlement was reached between the estate of a Virginia prisoner who died from untreated Hepatitis C and his physician with the state Department of Corrections (DOC). The agreement, which provided a $700,000 payout, followed a ruling by the U.S. Court of Appeals for the Fourth Circuit on December 15, 2022, affirming denial of qualified immunity (QI) to the physician, Dr. Laurence Shu-Chang Wang, in the 2018 death of Danny Pfaller.

Pfaller was imprisoned by DOC in 1999 and first tested positive for Hepatitis C in 2007. That same year Dr. Wang began working at Green Rock Correctional Center, where Pfaller later arrived in 2012. Direct-Acting Antiviral treatment for the disease became available in 2015, but Dr. Wang twice failed to follow DOC’s Hepatitis-C treatment Guidelines with Pfaller between then and 2018; on those occasions, “Pfaller tested into the middle tier of the Guidelines criteria and therefore qualified for fibroscan testing to determine the extent of any fibrosis,” the Fourth Circuit later recalled. “But Dr. Wang did not refer him.”

On May 7, 2018, Dr. Wang finally requested a fibroscan, after a blood test found Pfaller exceeded the criteria for additional testing. “By then, it was much too late,” the Court said. Dr. Wang thereafter saw “Pfaller for numerous physical examinations showing increasingly severe signs of liver disease,” the Court continued, and by late June 2018, “Pfaller’s abdomen was distended, and he was retaining fluid—symptoms of liver disease.” Yet while Dr. Wang knew Pfaller was on the list for a fibroscan, he took no further action to ensure testing occurred. It was not until July 11, 2018, that Dr. Wang reissued his order for a fibroscan “ASAP.” Testing occurred six days later, and a follow-up CT scan revealed a mass on Pfaller’s liver.

Pfaller was diagnosed in early September 2018 with untreatable liver cancer. He died less than a month later, on October 3, 2018. On behalf of his estate, his son, Jacob Pfaller, sued in October 2019. At the end of discovery, Defendants moved for summary judgment, but the federal court for the Eastern District of Virginia denied the motion. Defendants appealed.

Taking up the case, the Fourth Circuit agreed with the lower court that a reasonable jury could conclude Dr. Wang knew Pfaller qualified for additional testing but failed to do anything about it. The Court noted Dr. Wang was aware of, and certainly read, the six revisions to the treatment Guidelines—in fact he offered a self-serving statement that he mistakenly believed Pfaller did not qualify for treatment, attempting to defeat the estate’s contention that he was deliberately indifferent to the prisoner’s serious medical need.

The Court rejected that argument. Finding the right to Hepatitis C treatment was clearly established at the time, it affirmed denial of QI to Dr. Wang. However, it reversed denial of sovereign immunity to him on state-law malpractice claims because he was a state employee. The Court also reversed denial of QI to Dr. Mark Amonette, the Chief Physician who authored the Guidelines, saying it was not clearly established when he did so in 2015 that prisoners had a right not to be subjected to a treatment regimen that prioritized antiviral treatment for those with the most advanced level of fibrosis.

Pfaller’s estate was represented by attorneys with HDR LLC in Atlanta, with its case argued at the Court by attorney John M. Shoreman with McFadden & Shoreman in Washington, D.C. See: Pfaller v. Amonette, 55 F.4th 436 (4th Cir. 2022).

The settlement amount was the only thing not redacted from the copy of the agreement provided to PLN in response to its public records request. It seems a paltry sum for a wrongful death, but it is among the first payouts in the country for a fatality resulting from denying a prisoner Hepatitis C treatment.  

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Related legal case

Pfaller v. Amonette