The Debate Over Hep-C Treatments for Inmates

Apr 14, 2017

Credit Dave Nakayama / Creative Commons

Virginia has about 30,000 people in state prisons, and 15-30% of them could be infected with a deadly disease usually contracted when intravenous drug users share needles.  Treatment costs thousands of dollars, so the state doesn’t provide it to everyone who’s infected.  Now, however, one inmate is suing for the life-saving cure as Sandy Hausman reports.

When 60-year-old Elmo Reid entered prison 30 years ago, he had infections of the liver known as hepatitis A and B. Another deadly form of the disease, Hep-C, had not yet been discovered, but in 2013 Reid learned he had that too.  The state was in no hurry to treat him with a new drug called Harvoni.  Even with a substantial discount, a course of the drug runs about $45,000.

But University of Virginia law professor George Rutherglen says withholding treatment while Reid gets worse is immoral and illegal.

“My client is put on a kind of lottery.  He’s waiting for them to decide he’s sick enough to get the treatment and hoping he’s not so sick that he dies before the treatment takes effect.”

When Reid first complained about the situation, lawyer Rutherglen says he was told that he’s eligible for parole, and it would make more sense for him to wait until he’s released to seek treatment.  The Department of Corrections would not comment publicly on the case, but its chief pharmacist, Trey Fuller, says it might not be wise to begin treating someone who could be released in less than nine months.

“To get into treatment, to get all your lab work, to get your scans done, to do the three months of treatment and then for follow up it’s going to take that much time, and so the risk would be starting treatment on someone and them getting out before we could finish treatment.”

Attorney Rutherglen is not convinced.  Elmo Reid will have a parole hearing, but he was sentenced to life in prison and may never get out.

“My client would be happy to get parole, but it’s one thing to have a hearing, quite another thing to actually get parole.”

And he says there’s legal precedent for demanding treatment as soon as the disease is diagnosed.

“There’s a case in Pennsylvania where a federal court said you cannot ‘respond to’ hepatitis-C simply by monitoring the infected inmate.  You have to treat the inmate.”

That’s because the amount of virus in Hep-C patients keeps growing. The University of Virginia’s Dr. Young Hahn has been studying the disease for twenty years and concludes early treatment works best.

My client is put on a kind of lottery. He's waiting for them to decide he's sick enough to get the treatment and hoping he's not so sick that he dies before the treatment takes effect.

“The amount of virus in the body is smaller compared to chronic infection cases.”

And as patients wait for treatment, they risk long-term damage to their livers.

“They start with a scar on the liver tissue, and then if we don’t control it then it becomes liver cirrhosis, and then it progresses to liver cancer.”

It’s also possible that infected inmates might spread the disease to others – through the illegal use of intravenous drugs, unprotected sex or – perhaps – sharing clothing that’s been improperly laundered.

“I suggest using bleach to inactivate the virus, but still there are a high number of populations that are infected in prison.  We need to be really cautious about that.”

Pharmacist Fuller says the state will face a significant bill if it’s required to treat every prisoner who has the disease.

“Since May of 2015, we’ve spent $11.6 million treating an estimated 200 people.”

Nearly 400 others have been approved for treatment, but Fuller says Virginia Commonwealth University’s medical center, which provides therapy, can’t accommodate all of them right away. The case goes to trial at the end of January 2018.