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Deal sets standards of care for hepatitis C in Vt. prisons

VtDigger
Published: 6/20/2021 10:44:49 PM
Modified: 6/20/2021 10:44:52 PM

Guidelines for how the state Department of Corrections will care for incarcerated individuals with hepatitis C are outlined in a settlement agreement in a class-action lawsuit brought over the lack of treatment for many prisoners.

The 18-page document was filed last week in the case brought in May 2019 by the Vermont chapter of the American Civil Liberties Union, the Harvard Law School’s Center for Health Law and Policy Innovation, and the law firm of Costello, Valente & Gentry in Brattleboro.

The lawsuit claimed that the denial of needed medication for incarcerated people with hepatitis C is a violation of the Eighth Amendment, which bars cruel and unusual punishment. The legal action alleged that treatment was offered only to incarcerated individuals whose hepatitis C met a certain standard of severity, while others were regarded as having only mild or early liver disease and ineligible for medication. The settlement agreement requires a judge’s approval.

A motion stating that the parties had reached a settlement was submitted in court last month, but terms of the deal were kept under wraps. The latest filing outlines the conditions of the agreement.

“Under the settlement agreement,” the court filing stated, “defendants agree not to categorically limit access to DAA [direct-acting antiviral] treatment for sentenced inmates who will remain in confinement for more than 4 to 6 months based on disease severity, disciplinary record, or substance use.” Hepatitis C, according to the lawsuit, can lead to permanent liver damage, cancer and death if not treated. To treat hepatitis C, the filing stated, a pill needs to be taken daily for eight to 12 weeks to cure the disease.

In addition, according to the recently filed settlement document, the corrections department agreed to do the following:

■ Screen individuals for hepatitis C upon admission into Department of Corrections custody.

■ Provide treatment and screening data for two years to the attorneys bringing the lawsuit, to allow monitoring of the implementation of the agreement.

■ Notify class members — incarcerated people — of the settlement.

■ Pay $3,000 for costs and attorneys fees to parties who brought the lawsuit.

The deal also calls for the judge to retain jurisdiction of the matter for two years to ensure the terms are met. Rachel Feldman, a spokesperson for the corrections department, said Friday that it’s the department’s policy not to comment on pending litigation. She declined to comment further. Jay Diaz, general counsel for the ACLU of Vermont, also declined to comment when reached Friday.

Kevin Costello, director of Litigation Center for Health Law & Policy Innovation at Harvard Law School, submitted a filing urging the judge to accept the settlement agreement. “Upon commencing settlement negotiations in January 2021,” Costello’s filing stated, “the parties worked through difficult disagreements, and it is my belief that each side dedicated extensive resources to advance their clients’ positions.”

The agreement will also benefit those who do not currently have hepatitis C, according to the filing.

“Prisoners who may have HCV, but remain undiagnosed, may unknowingly transmit the disease to others either in prison or upon release,” the settlement stated. “HCV screening and treatment in the prison population has been shown to markedly reduce the transmission of the disease — and deaths related to the disease — outside prisons.”

Legal actions over hepatitis C treatment for incarcerated individuals have been brought by ACLU affiliates and other organizations in several states. Terms of settlements in those cases have varied.

For example, in Colorado, as part of the settlement, the state agreed to spend a specific amount of money for the treatment of those in state custody with hepatitis.

The treatment of incarcerated individuals in Vermont for hepatitis C was the subject of a legislative hearing in 2018. At the proceeding, witness testimony revealed 258 people in custody in 2017 had the disease, but the corrections department treated just one of them.

According to the lawsuit, the corrections department in 2018 started providing medication to those in state custody on a more regular basis. However, the lawsuit stated, when the complaint was filed in 2019, more than 200 incarcerated individuals remained untreated.

When the lawsuit was filed two years ago, Centurion Managed Care was the health care provider for the corrections department. On July 1, 2020, VitalCore Health Strategies became the corrections department’s contracted health care provider.

Documents filed along with the settlement stated that VitalCore had already updated its policy for treating individuals with hepatitis C. That treatment process will continue to be followed as part of the agreement.

VitalCore’s policy, like the settlement agreement, ensures direct-acting antiviral treatment for incarcerated individuals sentenced to remain in state custody for more than four to six months. Also, the treatment will not “categorically” limit treatment based on factors such as the severity of the disease.

VitalCore’s policy also includes:

— Individuals entering the corrections system are offered opt-out screening for hepatitis C.

— Sentenced prisoners will be treated “as soon as possible” if the course of treatment can be completed during that incarcerated individual’s time in custody, determined to be four to six months.

— “Especially compromised” incarcerated individuals will be referred immediately to a medical provider for assessment and care, even if the person is likely to be held in confinement for less than four to six months.

— Incarcerated individuals with hepatitis C, but without cirrhosis, will be treated by prescribers within the corrections system.

— Those in state custody with cirrhosis will be referred for treatment to an academic medical center.

— People entering the corrections system already receiving treatment will stay on that treatment unless there is a clinical reason to stop it.




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