Attorneys want all NC prison inmates tested for hepatitis C
Lawyers say North Carolina has its head in the sand over a public health crisis. They want more robust treatment, but it's expensive.Posted — Updated
They want universal testing for the virus and a treatment protocol that doesn't wait on inmates to get sicker before drugs are prescribed.
Those drugs are an effective but expensive cure. The lowest price for a full course quoted during a Monday court hearing was $25,000.
The hepatitis C virus is slow but lethal if unchecked. Even when cured, patients remain at risk for liver cancer if treatment doesn't come soon enough.
Attorneys asked a federal judge Monday to order the state prison system to implement a protocol more consistent with medical norms from the private sector. They also hope to turn their lawsuit against the state Department of Public Safety into a class-action case, potentially representing thousands of inmates, something U.S. District Judge Joe L. Webster will hear arguments on next week.
"What we're dealing with is a public health crisis in North Carolina prisons with hepatitis C," North Carolina Prisoner Legal Services attorney Dan Siegel said. "We have well over 10,000 people that have this deadly virus, but they haven't been diagnosed, and they're not getting treated."
Attorneys for the state defended the prison system's protocol, saying the plaintiffs want a "utopian gold standard" of care, in Senior Deputy Attorney General Amar Majmundar's words. The state standards may fall short of the private sector, but that doesn't make them unconstitutional, and it doesn't empower a federal judge to order changes, Majmundar said.
"The preferred method of treatment, your honor, is not required," he said.
Webster did not indicate when he plans to rule on the preliminary injunction requested, and the case could take months, even years, to play out.
To convince the judge to take quick action, the plaintiffs put Dr. Andrew Muir, who specializes in liver disease at the Duke University School of Medicine, on the stand Monday. He said treatment should begin shortly after diagnosis and that the drugs used to do it are more than 90 percent effective. He said prison system regulations are outdated, particularly since some of them seem to assume an older, less effective, treatment would be used.
Among other things, that treatment exacerbated mental health problems, making it inadvisable for some inmates.
The state also waits for a certain amount of liver scarring to take place before starting treatment, and the test used to determine how much scarring is present is unreliable, Muir testified. He said the same vial of blood that the prison system uses to test inmates for HIV can be used to test for hepatitis C.
The system has mandatory HIV testing for all inmates.
Like HIV, hepatitis C passes through the blood or sexual contact. Needle-sharers are at risk. In the outside world, simply having been incarcerated is considered a risk factor.
Muir said patients may not show outward symptoms for a long time, but the end stage is horrific. The body swells, and blood leaks through cracks in the skin.
Studies have found anywhere from 16 percent to 41 percent of prison populations have the virus, according to attorneys for Prisoner Legal Services and the American Civil Liberties Union, which is also part of the case.
No state prison systems have adopted the full protocols the groups are demanding, attorneys for the state said.
"We're not treating as many people as they like," Assistant Attorney General Orlando Rodriguez said. "We're not treating them as fast as they would like."
North Carolina's Medicaid program, though, recently authorized earlier treatments than the prison system, attorneys for the other side said. They said the virus' prevalence in prisons makes them the perfect places to attack it, and since most infected people will eventually get out, this is a health crisis on both sides of the wall, Siegel said.
"It's the deadliest infectious disease in the country," he said. "So, we can either deal with it now, or we can keep kicking the can down the road."