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Court orders NC to expand treatment of hepatitis C in state prisons

(Corrected at 2:45 p.m. on March 22. See details in the story.)

A federal judge has ordered North Carolina prisons to expand treatment for hepatitis C, which kills more American than any other infectious disease.

The injunction follows a class-action lawsuit filed by three inmates who say thousands of incarcerated people in North Carolina are going undiagnosed due to a lack of universal hepatitis C testing. Hundreds with the liver infection are developing health complications while the state denies them potentially life-saving medication, the lawsuit states.

U.S. District Judge William Osteen Jr. issued a ruling Wednesday that calls for the N.C. Department of Public Safety to stop withholding treatment if an inmate has a recent drug infraction, a life expectancy under 10 years, or less than a year on his or her sentence.

The ruling also calls for the state to stop using what the plaintiffs called an outdated and unreliable test to determine whether the disease has progressed enough to qualify for modern drugs that could cure the disease.

This story has been corrected to show that the judge denied the plaintiffs request for universal screening.

The judge’s order, however, doesn’t set out a new treatment policy or standard. The judge also denied a request for universal hepatitis screening in prisons.

The Department of Public Safety will comply with the court’s order, wrote spokesman John M.R. Bull. Changes to treatment guidelines will start Monday.

“Treatment decisions will now be based on a variety of clinical criteria which are reviewed by a multidisciplinary committee at Prisons Health Services,” Bull wrote.

Medical treatment is specific to each person, he wrote, and treatment and other variables make it “impossible” to say how much the changes will cost.

Civil rights groups, including North Carolina Prisoner Legal Services and the American Civil Liberties Union of North Carolina, filed the federal lawsuit in June on behalf of three people diagnosed with hepatitis C who weren’t receiving treatment. Since then, at least one has received treatment. Osteen’s injunction called for the remaining two plaintiffs to receive treatment.

The order issued this week was a preliminary injunction requiring the state to take specific actions, but the lawsuit could take years before it is resolved.

The lawsuit argues the state policy violates the Americans with Disabilities Act and the U.S. Constitution’s ban on cruel and unusual punishment.

“This ruling is an important step toward combating a major public health crisis that leads to the suffering and death of thousands of people both inside and outside prison walls,” said Emily Seawell, staff attorney for the ACLU of North Carolina, in a statement. “The vast majority of people who are incarcerated will one day reenter the community, and medical experts have made it clear that to combat the hepatitis C epidemic, we must provide treatment as quickly as possible.”

Blood-borne virus

Hepatitis C is a liver infection caused by a virus, according to the Centers for Disease Control and Prevention. Most people become infected with the blood-borne virus by sharing needles.

Hepatitis C kills more American than any other infectious disease, including nearly 20,000 people in 2017, the CDC reported..

Hepatitis C can be short-term, but 75 to 85 percent who have the virus will develop a lifetime chronic infection that if left untreated could cause cirrhosis, liver cancer and other damage, according to the CDC.

Under the state’s current policy, some inmates diagnosed with Hepatitis C, including the three plaintiffs, have had to wait for their liver scarring to reach a certain stage, which is determined by the unreliable test, before they can receive treatment, the lawsuit states.

The standard of care for the disease changed after anti-viral drugs became available in 2013, the lawsuit argues. The drugs are taken orally for eight to 12 weeks and cure 90 to 95 percent of the patients, the lawsuit states.

Plaintiff Robert Parham, who was housed at Scotland correctional Institution in Laurinburg, has had a hepatitis C infection for more than 20 years. He started serving a life sentence in state prison in 2008.

A test indicated that Parham’s level of liver scaring doesn’t meet the state standard for treatment, but his symptoms are consistent with advanced stages of the disease, including cirrhosis, the lawsuit states.

“It is extremely difficult for him to know that the disease is gradually scarring his liver, but he cannot receive the cure until the disease progresses to where he is at greater risk of severe injury and suffering,” the lawsuit states.

Painful way to die

Dr. Andrew Joseph Muir, chief of the Division of Gastroenterology at Duke University Hospital, testified in October that the virus’ initial signs are often silent and don’t surface until significant and often painful symptoms, such as debilitating fatigue, have occurred.

The virus can still be cured at a later stage, but the damage puts patients at a high risk for liver cancer, a painful way to die, he said.

The state’s test on whether the disease has progressed is flawed and only accurate about half the time, Muir testified.

The lawsuit asks that all inmates be tested since a higher concentration of people with hepatitis C are in prisons and jails. Some estimates range from 17 to 33 percent, the lawsuit states, meaning between 6,599 and 12,553 state inmates could be infected.

Paula Smith, a former medical director for the adult correction department, said 1,543 state inmates have hepatitis C, according to the lawsuit. Of those, Smith said, 589 inmates had completed the anti-viral treatments and another 72 had been approved for treatment.

In an affidavit for another case, Smith said, treating all the inmates predicted to have the disease would cost $76.5 million to $140.3 million for eight weeks of treatment and $117.4 million to $210.4 million for 12 weeks of treatment.

The lack of testing creates a public health risk because the majority of those affected will be released, the lawsuit states.

“This places the general population at greater risk, especially if a released prisoner doesn’t know that he has [hepatitis C virus] – an event that seems all too likely given DPS’s outdated, scattershot approach to screening,” the lawsuit states.

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