Tennessee must mediate with prisoners over hepatitis C drugs

Jul 22, 2019

Credit tn.gov

NASHVILLE, Tenn. (AP) — A federal judge on Friday ordered the state of Tennessee to mediate with a group of prisoners who are demanding treatment for their hepatitis C infections.

The order by Chief U.S. District Judge Waverly Crenshaw came after a four-day trial that included emotional testimony from a mother whose son died of complications from hepatitis C while in state custody.

Tennessee prisons saw at least 56 hepatitis C-related prisoner deaths between 2013 and 2017.

At issue is treatment with antiviral drugs that promise to cure most patients within weeks, but at a cost of $12,000-$23,000 per patient. Because of the high cost of the drugs, the Tennessee Department of Correction will only provide them to the most seriously ill prisoners.

Dr. Kenneth Williams, the department's chief medical officer, likened it to operating an emergency room where you treat someone with a gunshot wound before someone with a cold.

Similar cases have played out around the country where states have prioritized treatment to save money. After a lawsuit, Michigan agreed to provide antiviral treatment to all Medicaid patients with hepatitis C by the fall.

Until this month, Louisiana limited antiviral treatment for Medicaid patients and prisoners. It now offers unlimited access thanks to an agreement with a drug provider where the state will pay a flat fee for unlimited medication for five years.

At the Tennessee trial, expert witnesses for the state argued that there is no evidence that early treatment with antivirals improves patient outcomes down the road, and some patients fight off the virus without treatment.

Dr. Zhi Yao, an infectious disease specialist at East Tennessee State University, testified for the prisoners that the current standard of care is to treat anyone infected with hepatitis C with the antiviral medications, regardless of how sick they are. He said waiting to provide treatment can put patients at greater risk of cirrhosis, cancer and death.

Prisoners testified in court that even when they are severely ill, and qualify for treatment under Department of Correction rules, it can still be difficult to get medication. That's because prescriptions must be approved by a committee that, until recently, met only once per month and approved an average of eight patients for medication at each meeting.

Williams testified that he is improving the process and hopes the committee will be able to consider 160 cases per month in the near future. Williams said around 4,700 Tennessee prisoners are known to have hepatitis C, although not all prisoners have been tested.

Prisoner Scott Spangler said he was taught to trust authority, so he has been disillusioned by the prison's refusal to treat his infection even though he is seriously ill.

"I realize I'm in prison. I realize that," he said. "But I come from a military family, and I was raised to believe that the people above us help us and take care of us."

Deborah Powell struggled to testify through tears as she told the judge she did not know her son Shane Powell had hepatitis C until he was on his death bed.

"He suffered tremendously," Powell said. "When he did come out of the coma, I said, 'Honey, I'm so sorry,' and he said, 'Mom, you have no idea.'"

In ordering mediation, Crenshaw said it was clear that some aspects of the Correction Department's guidelines need improvement.