Inmates Suing Prisons Over Failure to Treat Hepatitis C

Prison inmates in several states who are infected with hepatitis C are suing prison systems over allegations that they "are being denied treatment" for their condition, the New York Times reports. A study to be submitted to Congress this fall estimates that approximately 18% of state prisoners in the United States have hepatitis C, although the rate is much higher in some individual states. Hepatitis C, which causes liver disease in 20% of those infected, can be treated with drug therapies costing between $10,000 and $25,000 per patient per year. But these treatments are effective in only 15% to 45% of cases, have "serious side effects" and "sometimes even make the patient sicker," the Times reports. Some state prison systems are "waiting for better treatments" before administering therapy to prisoners, while others are already treating inmates. Dr. Anne De Groot, a Connecticut prison doctor and editor of a newsletter on infectious disease in prisons, said that prisoners with "identical" cases of hepatitis C are "being treated differently in different states," adding, "If you're in Pennsylvania you will get treated, but if you're incarcerated in other states in the Northeast you will not. It's ridiculous we don't have a standardized approach." Dr. Robert Greifinger, a senior fellow for the CDC and lead study investigator, said that there are still "legitimate scientific questions about who the treatment will ultimately benefit," adding, "I just don't think it's very clear yet how to manage the problem."

State Suits
Inmates in several states, including New York, are suing prison systems over treatment guidelines that they say are preventing them from receiving therapy. Edward McKenna, an inmate in New York, is suing the state for denying him treatment on the grounds that he would be eligible for parole in less than one year, as the state's treatment guidelines, which are patterned after NIH guidelines, say that "only people who will be available for a full year of intensive care should be treated." McKenna was later denied parole and sentenced to an additional two years in prison. Jack Beck, a lawyer for the Legal Aid Society who is advising McKenna, said that prison doctors "used parole board appearances as a pretext for denying [prisoners]" costly hepatitis C treatment. "It's definitely a rationing protocol. It's very expensive and they clearly don't want to treat people," Beck said. He added that the expiration of an inmate's sentence -- not the earliest anticipated release date -- should be taken into consideration when deciding on treatment because "the chances of a violent offender being released by the parole board [are] slim." But Dr. Lester Wright, chief medical officer for the New York Department of Correctional Services, said that the state's guidelines "met national standards" and that prison doctors "did not use inmates' parole board appearances to deny treatment."

More Education Needed
Doctors and health officials are concerned that prisoners will spread hepatitis C through intravenous drug use once they are released from jail, the Times reports. Studies have shown that 3% to 21% of inmates say they use IV drugs in prison, and 44% of those who say they inject drugs also say they have shared needles. Doctors and health officials say that the high rate of hepatitis C infection in prisons "creates an opportunity" to educate prisoners on halting transmission of the disease. Since the "vast majority" of inmates will eventually be released, doctors hope to instruct them on how to avoid contracting the disease and how to keep from spreading it to others if already infected (Rohde, New York Times, 8/6).