More than 1,000 people in U.S. prisons died of complications related to Hepatitis C from 2013 to 2019. This was revealed by State News’ data analysis of 27,674 prison death records from 2013 to 2019.
Untreated Hepatitis C causes chronic liver disease, liver failure and cancer, all of which result in death. The Hepatitis C virus, or HCV, is treatable with the antiviral drug Sovaldi made by Gilead, so it is shocking that few prisoners received this treatment.
Available in the U.S. since 2013, Sovaldi has been hailed as a miracle drug, as it is able to cure Hepatitis C in as little as 12 weeks with just one pill a day. It was developed by doctors Harvey Alter, Michael Houghton and Charles Rice, and all three share a Nobel Prize for its development.
Sovaldi is designed to prevent HCV from replicating by inhibiting the RNA-dependent polymerase. About 10% of the time patients experience mild headache, fatigue or nausea. While the drug has been praised for its efficiency, its primary drawback is cost. A 12-week course of treatment cost $84,000 when it was first released.
In recent years, other pharmaceutical companies have developed similar drugs, but costs are still prohibitive in the U.S. In sharp contrast, Gilead allowed several companies in India to manufacture a generic version of the treatment, which was selling for $4 per treatment in 2016.
The general U.S. population has an HCV rate of less than 2%. In comparison, state prisons report an average rate of 10% and as high as 70% among incarcerated persons who report intravenous drug use. Treating the latter group can be extremely cost prohibitive for limited prison budgets.
The cost of HCV treatment drugs is not the only concern that needs to be considered. If long-term inmates are not treated and their HCV infection progresses, they will suffer significantly higher long-term treatment costs.
The average annual total health care cost of a patient with end stage liver disease is over $60,000. If a liver transplant is involved, those numbers quickly skyrocket.
To reduce health care expenses, some facilities have attempted to defer treatment until the inmate can be paroled. However, the costs for treatment once the patient reenters society still must be paid, which usual involves the Medicare or Medicaid systems.
Such actions put the health of the prisoner at risk and potentially increase the total costs for taxpayers, as the patient likely will require more extensive treatment due to additional health complications resulting from deferred treatment.
The question of required medical treatment for prisoners came before the Supreme Court of the United States after a Texas prisoner suffered back and chest pains from loading and unloading cotton bales in 1973. He filed suit the following year.
In 1976, SCOTUS ruled in his favor in Estelle v. Gable, arguing that the deliberate failure of prison authorities to provide for the medical needs of inmates constitutes “cruel and unusual punishment,” violating the Eighth Amendment. Unfortunately, the ruling was unclear about what constituted “reasonable medical care.”
Courts have been split in recent years with regard to the treatment of Hepatitis C. While some courts favored treatment, others have ruled that the decision only to test and monitor the virus is constitutional.
The American Association for the Study of Liver Diseases recommended for years that treatment is only indicated if significant liver damage has already occurred. The AASLD has changed its position in recent years and now recommends that all people seek treatment for the virus. Some court rulings indicate that judges have not caught up with this change.
While the plight of prisoners needing medical care is often overlooked, a growing number of people are beginning to take notice.
In August, a federal judge held the Illinois Department of Corrections in contempt of court for failing to provide better care for its inmates. The suit, originally filed in 2010, alleges that over 50,000 prisoners were suffering needlessly. In 2019, the court required the IDOC to develop a comprehensive plan to care for its prisoners. Court-appointed monitors claim that the correctional system has not met the requirements.
The medical treatment of prisoners is both a pragmatic and a moral issue.
Pragmatically, it is in a state’s and in the nation’s best interest. As the vast majority of inmates will be released and return to public life, it is a good idea that they return as healthy as possible. If not, public funds will be forced to pick up the tab.
Failure to provide medical treatment does not help the newly released to be productive members of society and will most likely contribute to a return to incarceration.
From a moral point of view, providing appropriate medical treatment to prisoners is compassionate and humane. No matter the reason for their incarceration, providing appropriate medical care is obligatory.
Withholding available care for financial benefit – which is a critique that should be levied against both the manufacturer and the prison system – is immoral.
Senior Staff Chaplain and Clinical Ethicist at the Baptist Health Medical Center in Little Rock, Arkansas.