"Colorado has an immense public-health crisis in its prisons," ACLU of Colorado legal director Mark Silverstein declared in announcing the class-action lawsuit. “Highly-effective treatment is available that could prevent deaths and fight the spread of the virus, but DOC’s cruel and arbitrary standards deny that treatment to all but a select few prisoners."
Nationally, hepatitis C claims more casualties than any other infectious disease, including HIV. Approximately four million Americans have the virus; as many as half of them may not even be aware that they have it, as symptoms can take years to surface. Because the blood-to-blood transmission occurs primarily through shared needles — from intravenous drug use, homemade tattooing and the like — the disease is highly concentrated in the correctional system, with a third of the identified cases surfacing in medical screenings in jails and prisons.
In Colorado, hep C has long been one of the leading causes of death inside state prisons. As we reported in our 2016 feature "The Death Lottery," a Westword review of 823 deaths within the DOC over the past fifteen years found that 161 of those deaths, nearly one in five, were caused by end-stage liver disease and related illnesses. That’s roughly twice the number of suicides behind bars during that same period, three times the number of deaths attributed to drug and alcohol use, and four times the number of homicides.
Until four years ago, the standard treatment regimen for hep C consisted of high doses of interferon, a virus-fighter produced by white blood cells, in combination with another drug, ribavarin. The drugs were expensive (as much as $25,000 per patient), effective in fewer than half the cases, and could cause significant side effects; in addition, the DOC severely limited the number of prisoners eligible for the treatment by requiring that applicants meet various conditions, including a year of drug and alcohol classes, and endure long waiting lists.
A new class of wonder drugs approved by the FDA have effectively eradicated traces of the illness in more than 90 percent of patients treated. Unfortunately, the new drugs are even more expensive — from $50,000 to $90,000 for a full twelve-week regimen — and the hurdles within the Colorado prison system to qualify for treatment have become even more formidable. To qualify for the drugs, inmates must have already sustained measurable liver damage and must take drug classes that can take years to complete, a pre-condition that the ACLU complaint argues has no medical justification.
The DOC initially limited the number of patients eligible for the wonder drugs to just 25 a year; it now treats around seventy prisoners a year. Our 2016 investigation found several prisoners complaining of getting the runaround for years about whether they met criteria for treatment, despite worsening health and deteriorating organs. The ACLU contends that state officials have an obligation to apply the same "standard of care" to prisoners as can be found in the larger community, and in accordance with medical experts' recommendations to treat all hep C patients with the new drugs, whether they've developed serious liver issues or not — even though the projected cost of treating all prisoners in the state could be $100 million or more.
Silverstein insists that treatment is better than inaction, which can burden taxpayers with even greater costs. "Treating this disease in the early stages is the most cost-effective strategy in the long run, far cheaper than liver transplants or chemotherapy for liver cancer," he says. "Denying and delaying treatment allows this communicable disease to spread, thus increasing the numbers who will need treatment as well as the total cost of treating later complications."