Relatively few Vermont prisoners who have been diagnosed with hepatitis C are receiving anti-viral drugs, new state statistics show.
But there’s a continued debate about why that’s happening and what should be done about it.
Representatives of the Vermont Health Care Advocate’s office took their case to legislators on Friday, arguing that the state Department of Corrections should be treating more inmates who have the viral disease that can cause severe liver damage.
“We approach this from both an individual rights perspective and a public health perspective,” said Mike Fisher, the state’s chief health care advocate. “This is an infectious disease.”
Corrections officials say they’ve made changes in order to get more inmates into treatment. But they also say a variety of factors, including a prisoner’s length of stay, complicate the issue.
“We’re looking forward to continuing this conversation and working through this and other challenges,” Corrections Commissioner Mike Touchette said.
The hepatitis C issue emerged last year when the Health Care Advocate’s office reported that just one Vermont inmate had been treated for hepatitis C in 2017 even though more than 250 had the disease.
On the surface, new numbers reported Friday by Touchette don’t show a lot of change. Of 275 in-state inmates with a hepatitis C diagnosis, 17 are receiving anti-viral drugs and five others are awaiting those drugs.
Fisher told members of the House Corrections and Institutions Committee that he wants to “strike a balance” and recognize that corrections officials have made progress on the hepatitis C issue. “The treatment protocols, as they’ve been described to us, are significantly better,” Fisher said.
However, “the real point is that we don’t see movement in the numbers,” Fisher said. “And we continue to hear concerning stories of people who are grieving and appealing decisions to not treat.”
Julia Shaw, a health care policy analyst with the advocate’s office, said there tends to be a higher prevalence of hepatitis C in prisons than in the general population. But that’s “a real opportunity, I think, to treat people so that people are going back into the community without this disease,” Shaw said.
Vermont officials have acknowledged that there were delays in their adoption of new treatment standards for hepatitis C. But they also have defended their policies and their contract with Centurion, the prison health care provider.
On Friday, Touchette said there are a variety of factors involved in hepatitis C treatment considerations. One big one, he said, is the fact that 7,000 people cycle through the corrections system in a given year, and the average length of stay is a week or less.
A hepatitis C treatment regimen lasts at least eight weeks, officials said. And Touchette said prisoners with a short stay may not even have time for follow-up testing.
“That’s a really tough population for us … and I think part of our (treatment) numbers right now are a reflection of that overall flow,” Touchette said.
He provided a breakdown of the hepatitis C population showing that 219 of the 275 inmates with the disease are being “monitored” via a chronic care clinic. Of that population, 46 are pre-trial detainees with short stays.
“It’s certainly not enough time to do actual treatment,” he said. “But there may be a window of opportunity to do some (post-release) care coordination in the community.”
Others have been sentenced to prison time, but Touchette said it’s not yet clear whether their sentences are lengthy enough to initiate treatment. He said the department still is gathering data related to the hepatitis C population.
“This is evolving,” he said. “As we find new areas to target, we dig a little deeper.”
It’s possible the department’s treatment numbers will rise. Touchette’s numbers showed 43 inmates in a “pre-treatment” phase, and they are expected to remain behind bars long enough to receive anti-viral drugs.
Corrections officials say they have taken additional steps to bolster hepatitis C care, including clarifying treatment standards and changing payment methodology in the state’s contract with Centurion. But Touchette said the department won’t craft any policy that could inhibit a physician’s ability to provide individualized care.
“It’s not a one size fits all,” Touchette said during legislative testimony on the issue earlier in the week. “It depends on what’s happening with you as an individual, and what the specialists determine to be the appropriate course of care for you.”
Hepatitis C treatment is expensive: Touchette said it costs $13,000 to $17,000 for an eight-week regimen, depending on the drug used. He also said the department has “sufficient funds” to cover the program at this point.
But Rep. Alice Emmons, D-Springfield, chair of House Corrections and Institutions, said lawmakers have been “putting a lot of pressure” on corrections financially. She mentioned the recent expansion of medication-assisted treatment for inmate opioid addiction as one example.
“Then, you put hepatitis C on top of that … and then you also put on top of that the mental health costs, and the aging population costs,” Emmons said. “That’s all on our nickel. So that’s what we’re going to have to balance.”
