Revealed: hep C treatment in prison

Editor’s note: While this blog follows Gideon Walletsky’s time in prison, it’s important to remember that many of his experiences are shared by thousands of inmates across the United States. From time to time, Gideon’s stories will serve as a starting point in examining larger issues in America’s prison system. This installment of Revealed takes a look at the difficulty of getting proper care for hepatitis C in prison.

Getting proper medical care in prison can be incredibly difficult. Gideon has been frustrated by the prison medical system for 20 years. He knows that simple things like seeing a doctor and getting common prescriptions can be near impossibilities.

Gideon is one of a growing number of inmates dealing with hepatitis C, a serious, often-chronic condition that attacks the liver and causes inflammation. If left untreated, it can lead to liver cancer and cirrhosis, and it is one of the most common reasons for liver transplants.

The seriousness of hep C and the lack of transparency in the prison system trouble Gideon and many other inmates. Gideon says the companies that provide health care in correctional facilities often deny prisoners much-needed treatment to avoid footing the bill, despite the potentially lethal consequences to inmates.

A nationwide problem

Hep C is remarkably common in American prisons. About 1% of Americans outside prison walls have the condition, while 17% of prisoners are infected. In New Mexico, a whopping 40% of inmates have hep C. Gideon estimates that the number of infected prisoners in his facility is higher than average—around 30%.

The disease spreads easily, usually through contact with an infected person’s blood. Prison living conditions and culture make inmates especially vulnerable to hep C. In prison, hep C is often transmitted by inmates giving tattoos and piercings to each other and using contaminated needles to inject drugs.

needle

In prison, hep C is often transmitted by sharing needles.

Blood tests are used to diagnose hep C and monitor its effect on the body. Many people with hep C have no symptoms and don’t know they are infected. Some people go years without being harmed by the condition, and many experience only minor symptoms.

The waiting game

Gideon was diagnosed with hep C around five years ago and undergoes yearly tests to keep track of how the disease has progressed. Whether an inmate gets treatment depends on how hep C is affecting the body, he says. Inmates must wait until the disease starts “attacking the body” before getting care.

That approach is also used outside the prison system. Because patients can have hep C for years without experiencing symptoms, many people delay treatment until it becomes necessary. In fact, some patients never require treatment.

In October 2016, the U.S. Board of Prisons (BOP) issued clinical guidance on evaluating and managing hep C in prisons. The guidance puts inmates into three treatment priority groups: high, intermediate, and low.

Still, because transparency is nonexistent in prison and inmates are often denied medical care, delays breed suspicion. Prisoners are kept in the dark intentionally, and they usually have no idea when—or if—they will see a doctor, even when they ask.

Gideon says Centurion Managed Care, the company that provides medical care in his prison, denies inmates treatment for hep C to save money. He has seen drugs used to cure the condition not administered in time, which makes them ineffective.

Gideon recalls one inmate who suffered an especially cruel fate. He was told his hep C had not progressed to the point of needing treatment and was not given drugs. After his yearly blood test was administered, he was told the disease had gone too far and drugs wouldn’t help. The doctor gave him eight months to live, and he later died.

“If you have a three-year sentence, you should have access to the treatment, but that’s not how they’re doing it,” Gideon said. “That’s not right.”

Costs are a factor

Undoubtedly, the cost of hep C drugs is one reason they are rarely provided to inmates. Harvoni and Sovaldi, two common hep C drugs, are incredibly expensive. Harvoni has a 90% success rate, but a 12-week treatment costs $94,500 outside prison.

Fortunately, some state corrections departments are able to negotiate large discounts on the drugs. For states that reported as of September 2015, Michigan paid the highest prices—$94,500 for Harvoni and $84,000 for Sovaldi. Connecticut paid the lowest prices—$45,856 for Harvoni and $43,419 for Sovaldi.

As of January 2015, only 949 inmates were being treated for hep C nationwide. That accounts for .89% of the 106,266 prisoners who were known to be infected at the time.

While treating more inmates would require huge sums of money up front, a 2015 study found increased treatment would be worth it in the long run. Providing treatment to infected inmates would save 12,000 lives and $750 million over 30 years. Researchers concluded that people outside prison would benefit the most because infected prisoners would not be able to spread hep C once released.

How long is too long?

For Gideon, the waiting game continues. His hep C is under control for now, but there are no guarantees. His next blood test could reveal that the disease is progressing and causing damage, which should trigger the prison’s obligation to provide care. But it also could reveal that the disease has caused permanent damage, which could give the prison a reason to deny treatment.

For Gideon and others, the lack of transparency in the prison system adds to the uncertainty. They are told they are receiving adequate care, but medical care is typically denied or barely sufficient. Centurion’s reputation of putting profits before inmates’ well-being and the prison system’s insistence on keeping inmates in the dark make it almost impossible to determine whether prisoners are receiving proper care.

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