Prisoners sue state, faulting treatment for hepatitis C

Two Massachusetts prisoners, their livers hardening as a consequence of hepatitis C infections, are suing the state, saying officials have failed to give them drugs that could reverse the course of their illness.

According to the lawsuit filed last week by inmates Emilian Paszko and Jeffrey Fowler, the Massachusetts Department of Correction denied inmates in the later stages of the disease the most effective drugs on the market. Other prisoners are not being afforded the necessary testing to determine whether they should receive treatment, the lawsuit says.

“As is the case with many of our clients, they’ll get a response that’s not a response — ‘You’ll have an appointment soon. We’re putting in a request for you to see,’ ” said Joel Thompson, the prisoners’ attorney. “They’ll put you in the next step of the process, but the process seems unending.”

Darren Duarte, a spokesman for the Department of Correction, said that because of pending litigation, “we are unable to comment at this time.”

According to the class-action lawsuit, the exorbitant cost of medication “encourages systemic delay.”

“Over 1,500 state prisoners in Massachusetts have hepatitis C, but as of the present time only three are being treated for it,” the lawyers write in the complaint, filed last week against state correction commissioner Carol Higgins O’Brien and the prisons’ medical contractor, Massachusetts Partnership for Correctional Healthcare.

The leading cause of liver cancer, hepatitis C is spread through practices such as unsafe tattooing and intravenous drug use, making it common in the prison population.

To clear the virus from a patient, treatment with the most effective drug costs about $84,000.

Although the costs are formidable, Thompson said that Paszko and Fowler’s case is only the most recent iteration of a decades-long decline in funding for treatment of the disease within the correction department. In 2009, the state spent just over $1 million for hepatitis C medications for the entire prison population; this year, Graham says, the state is on track to pay about $400,000.

“It’s not a case of saying, ‘Hey, we have this money budgeted for hepatitis C treatment, but it doesn’t go as far as it used to,’ ” Thompson said. “They’re not spending as much as they used to.”

But today’s treatments are also dramatically more expensive.

Federally approved last year, the drug Harvoni, made by Gilead Sciences, cures up to 99 percent of patients within 12 weeks, a kind of miracle cure for the disease. Old medications such as interferon fail 50 percent of the time for some patients, and come with debilitating side effects.

At $1,000 a pill, Harvoni could be a budget-buster for the state prison system, and has stoked a debate about who needs it.

In the medical community, opinions vary on what stage of the disease requires treatment. At the earliest stages of hepatitis C, people infected with the virus often have no symptoms.

But infectious disease specialist Dr. Camilla Graham contended that early eradication of the disease can prevent even costlier treatments such as liver transplants and the development of liver cancer.

“You could take someone who had it, turn them into someone who never had it,” said Graham, of Beth Israel Deaconess Medical Center. “If you wait until it’s advanced, then, even if you cure them, you have to screen them for liver cancer every six months for the rest of their life.”

Jonathan Shapiro, who is handling the case for the National Lawyers Guild, said both plaintiffs are clearly at a stage of the disease requiring treatment with the most powerful drugs. Shapiro argues that the inmates would be entitled to the medication from publicly funded health plans if they were not in prison.

According to Michelle Hillman, a spokeswoman for the state’s Executive Office of Health and Human Services, MassHealth covers “all of the drugs available to treat hepatitis C,” though the specific clinical guidelines vary across the different health programs. MassHealth is the state’s Medicaid program for low-income people.

Graham said that treating the disease before it spreads is not only medically necessary, but also benefits the economy and society more broadly.

“Our ultimate goal as a society needs to be that we test people for it, find out who has the infection, and we get them prepared for treatment, and then we treat them, and we try to cure them,” she said.