Sick enough for saving?

We are in the midst of a public health crisis. And, perhaps surprisingly to some, our prisons are key to solving the problem.

Over 2.3 million individuals in the United States are living with chronic hepatitis C – an infection of the liver which, left untreated, can lead to (among other things) liver cancer, kidney disease, and death. According to the CDC, hepatitis C kills more Americans than any other infectious disease.

Chronic hepatitis C (hep C) is prevalent among baby boomers (those born from 1945 to 1965), but incarcerated individuals are especially at risk of acquiring the infection. This is often due to intravenous drug use or unregulated tattoos – risk factors that are inflated in a prison setting. The rate of infection within prisons is estimated between 12-35% of imprisoned people. In Missouri, that translates to 4,590 people in Missouri Department of Corrections custody having been diagnosed with hep C. Many of those individuals will be released back into the community where, if not cured of their chronic hep C, they stand at risk to infect other individuals.

The good news is there is a cure. Since 2013 there have been remarkable developments in the treatment of hep C. Pre-2013, the treatment regimen was long (6-12 months), involved painful and significant side effects, and was not guaranteed to generate a cure. Current treatment regimens last between 8-12 weeks, consist of one pill once a day, and are associated with minimal side effects. Best of all, they achieve a cure in over 90% of patients.

The prevailing standard of care calls for every person with a chronic hep C infection to be considered for treatment with these direct-acting antiviral drugs. But this life-saving treatment is being denied to thousands of infected individuals incarcerated in the state of Missouri. People diagnosed with hep C are essentially being told that they are not sick enough for treatment. Imagine being diagnosed with cancer and your doctor telling you that, although there was a quick cure for you, they were going to wait for your tumor to get larger and cause irreversible damage before treating you.

It is cruel and unjust. It is also nonsensical from a public health standpoint. The World Health Organization outlined eliminating hep C as a priority in February of 2016. You cannot eliminate hep C without addressing the high rates of infection in our prisons.

Yet Missouri continues to deny treatment to the over 4,500 inmates in their custody who have been diagnosed with hep C. John Ritchie is incarcerated in Missouri, and has been trying to get treatment for his hep C for years. In 2016 he signed paperwork to start receiving direct-acting antiviral drugs. It looked like treatment might be on the horizon. But now, almost three years later, he still has not received that treatment. In January 2018 he was diagnosed with liver cancer—likely a consequence of his untreated hep C.

Along with the ACLU and the law firm of Wilkinson Walsh + Eskovitz, LLP, we are fighting for Mr. Ritchie and thousands of other Missouri inmates who are being denied life-saving treatment despite their known hep C diagnosis and substantial risk of serious injury or death absent treatment. We have filed a class action lawsuit on behalf of every Missouri inmate with chronic hep C who has not been provided DAA treatment. On August 13 we will go before the court to present evidence in support of our request for a preliminary injunction to order the defendants – MDOC and its private medical provider, Corizon – to comply with the standard of care for inmates with chronic hepatitis C infection. Keep up with the case here.