Barring HCV Treatment

HCV treatment for prisoners is entangled in bad policy and stigma

by Larry Buhl

Last fall the New York State Department of Corrections and Community Supervision (DOCCS) ended its policy of excluding prisoners from any hepatitis C treatment due to a substance use or addiction.

The change was a response to a lawsuit, Corris v. Koenigsmann, filed last year by Prisoners’ Legal Services of New York on behalf of thirty-eight-year-old Adam Corris, who was denied treatment for hepatitis C while he was in state prison.

A drug test revealed Corris had used buprenorphine (Suboxone), a drug used to mitigate withdrawal symptoms from opioids, without a prescription. It was DOCCS policy, as with the vast majority of correctional institutions, that hepatitis C treatment would only be available to prisoners who hadn’t used drugs in the past six months. The facility also placed Corris in solitary confinement for using the drug.

According to the lawsuit, Corris had a severely damaged liver and suffered symptoms consistent with late stage liver disease.

The settlement mandates that prisoners with a history of drug or alcohol abuse must be made eligible for treatment if they otherwise medically qualify for hepatitis C treatment and monitoring.

DOCCS is now committing to monitor all prisoners with hepatitis C for disease progression. Though ending its blanket policy of denying hep C treatment to those who have used drugs, it will continue its policy of triage; that means, considering prisoners with the most advanced infection first, regardless of their history of drug use or abuse.

Triage is a policy that many state Medicaid programs also follow, many times to the dismay of patients and their doctors.

“Discriminatory” policy
With the policy change, New York becomes one of the few states in the nation to not exclude inmates with addiction histories for hepatitis C treatment.
Brad Brockman, executive director for the Center For Prisoner Health and Human Rights, says the policy is all about money.

“Treating hepatitis C is an expensive proposition,” he tells A&U.

“In some cases where the disease isn’t advanced, it may make some sense to wait. But past drug addiction is not a good reason not to treat [a patient].”
For perspective, the average cost to house an inmate in the U.S. is just under $30,000 a year. A single course of treatment with new antiretroviral drugs is more than twice that (though falling).

Brockman and other prisoner advocates point out that corrections facilities are constitutionally mandated to provide adequate healthcare to prisoners. The Eighth Amendment prohibits prisons from demonstrating “deliberate indifference” to prisoner well-being, and courts have not been swayed by corrections’ claims of lack of money.

But it’s not clear, from a strictly legal perspective, whether the newer, more effective drugs constitute a medical necessity when older—and much less effective and less tolerated—are available.

Rich Feffer, correctional health programs manager at the Hepatitis Education Project, says triaging patients would be much less discriminatory than a policy excluding those with substance abuse histories.

“Denying hep C treatment for inmates with substance abuse is an artificial way to save money [for corrections] and it overreaches,” Feffer tells A&U. “It’s part of a stigma against drug users. We as a society still see drug abuse as a moral failure rather than a health issue.”

Feffer admits that some clinicians have legitimate concerns about substance abuse among hepatitis C patients, both in and out of corrections. He points out that drug addiction could make it more difficult for the patient to adhere to a treatment regimen and it could open the door to re-infection.

Corrections: Ideal place to treat hep C?
The prevalence of hepatitis C in prisons is high, with studies estimating rates up to one-third of prison populations versus one percent to two percent in the overall U.S. population.

Feffer says that—because the vast majority of prisoners will be released at some point—corrections could be the best place to treat a hep C patient with addiction issues.

“From a community health standpoint it makes sense to treat someone who is going to be released, because they are less likely to transmit the virus back into the community,” Feffer says. He adds that risk mediation counseling should go hand-in-hand with hepatitis C treatment for those with addiction issues, whether in corrections or the population at large.

Feffer says the DOCCS policy change might not represent a wave of reversals of similar policies around the country. But he is hopeful that lower costs of new regimens, plus reduced restrictions on treatment in community environments, could benefit prisoners with hepatitis C.

“Prisons are held to a community standard,” Feffer says. “If barriers to treatment continue to be lowered, as they are here in Washington state, that would put greater pressure on corrections facilities to do the same.”

Larry Buhl is a radio news reporter, screenwriter, and novelist living in Los Angeles.