Does this make sense:Prisons to reduce hepatitis treatment??

[NRSKarenRN, BSN, RN]

posted on thu, jul. 24, 2003

prisons to reduce hepatitis treatment

fewer pa. inmates will be eligible, due to budget issues. officials say the candidates will be better targeted.

by mark fazlollah

inquirer staff writer

http://www.philly.com/mld/inquirer/6369952.htm

faced with looming state budget problems, pennsylvania prisons this fall will begin reducing by about 75 percent the number of inmates being treated for the potentially deadly hepatitis c virus.

pennsylvania now has 8,030 state inmates infected with hepatitis c and is treating 550, said fred maue, chief of medical services for the department of corrections. he said those 550 would get their medicines, which cost $16,000 per patient for a 48-week course of treatment.

but beginning in september, he said, prisons will apply stricter rules for treating infected inmates. he estimated that 130 a year would receive medicines and that that number eventually might be cut to fewer than 100. he said the number of infected inmates is likely to remain constant - about 23 percent of the prison population.

"we were facing medical cutbacks. we were faced with having to live with a limited budget," he said. "we felt that we needed to prioritize our budget."

maue said much of the treatment would be focused on prisoners with a highly curable form of hepatitis c - about 15 percent of those infected.

he stressed that the reduction in treatment was justified because the state was doing better at targeting patients who could benefit from the medicine.

thomas shaw-stiffel, a specialist at pittsburgh's center for liver diseases, said that approach might get more bang for the buck.

"it's to the patients' benefit to be more focused," said shaw-stiffel, who worked with the university of rochester's hospital when it was treating new york inmates with hepatitis c. "on the surface, [the reduction] may look ominous, but it may be beneficial."

the new guidelines are in line with national prison standards.

more than three million americans are infected with hepatitis c, with a huge portion rotating through the correctional system. an estimated one million infected inmates leave jails and prisons each year, the u.s. centers for disease control and prevention says.

nationally, hepatitis c is the leading reason for liver transplants. it has become one of the leading causes of death among pennsylvania inmates.

the reduction in treatment comes at a time when the medications are more successful in effectively curing the disease - prompting some criticism that the state is going in the wrong direction.

"it's disappointing," said lawyer angus love, director of the pennsylvania institutional law project, when told of the state's new rules. "it's not surprising, given the budgetary constraints."

despite the reductions in treatment, pennsylvania will still be providing more care than many states. new jersey, for example, is treating 33 inmates - a dramatic change from last year, when it was treating one. officials do not know how many inmates are infected because new jersey prisons do not conduct widespread testing.

under govs. tom ridge and mark schweiker, pennsylvania developed one of the nation's most aggressive treatment programs. in the past, the state's secretary of corrections had boasted that his department was saving lives of inmates. the secretary, jeffrey a. beard, also said that treating the disease in prisons made inmates less likely to spread it after their release.

maue said his department last year was "over our budget," spending about $8.8 million for treating hepatitis c.

he estimated that for this year, "top dollar would be $6 million," with treatment costs even lower next year.

maue said prisons would require that inmates have at least 18 months remaining on their sentences before consideration for medication. in the past, inmates were required to have a year left on their sentences.

inmates also will be required to undergo liver biopsies before being considered for treatment.

[sjoe]

"Does this make sense:Prisons to reduce hepatitis treatment?? "

Yes, it certainly DOES make sense.

Over 50% of the 4500 inmates in the last prison I worked in tested positive for Hep C. Hep C treatment cost is in addition to the $25,000-$40,000 spent annually on EACH of the two million people presently incarcerated in the US.

We are talking bankruptcy here to give all these people in state prisons and other kinds of prisons and jails such expensive treatments (and they would NOT be getting it "on the outside," believe me), particularly since it is not useful for most of them, as pointed out by Maue ("Maue said much of the treatment would be focused on prisoners with a highly curable form of hepatitis C - about 15 percent of those infected.")

Is THIS how you want YOUR tax money to be spent? Not me!

[legsmalone, RN]

Living in an area heavily laden with prisons (central valley in California) I worry about the public health impact decisions like this will have. Not all of these inmates will be incarcerated for life, and more often then not, their familes, girlfriends, SO's, etc. move to where their loved one is incarcerated. When they are released, they tend to settle in the same area.

I am in Bakersfield, and we easily have 8 correctional facilites in this area that feed to local hospitals, we have higher rates of Hep B, Hep C, TB and HIV in this area of the state then anywhere else. To not treat these patients seems to me to be condeeming not only the inmates, but their families to infection and sequela. Then we as taxpayers are not only left to treat the inmates, but perhaps their enitre family.

[sjoe]

"To not treat these patients seems to me to be condeeming not only the inmates, but their families to infection and sequela."

Don't you think that these family members are already infected? Do you think conjugal visits are limited to inmates free of all infections? Do you think these people are and have been any wiser about their own healthcare than the inmates are? And you would be happy to see your tax money going to treat the vast majority of Hep C inmates who WON'T be helped by that expensive treatment?

Makes no sense to me. The same tax money can much better be utilized for more adequate public health programs, childhood immunizations, and community health clinics in your area which is presently VERY short-changed and inadequate in all these areas, as well as others. And it's only going to get worse with the budget shortfalls now and over the next several years.

It is only wise to put money where it is most likely to do the most good and squandering it on the 85% of Hep C inmates who will not benefit from it is only foolishness.

When these people are "on the streets," are THEY willing to pay $15K/year for this treatment? No way. Why should taxpayers pay for it when they have been judged to have broken the law and are put in the slammer? (And this is the wrong thread to get into a discussion of laws--right or wrong, or incarceration--right or wrong, etc.)

Do these people care about their own families, sex partners, IVDA partners enough to take appropriate precautions not to pass along Hep C to them? If so, fine. If not, is it the taxpayers' obligation to assume that responsibility (particularly by using a scatter-gun approach which wastes 85% of the money)? Again, no way. Not THIS taxpayer's money.

You may say "Then we as taxpayers are not only left to treat the inmates, but perhaps their enitre family."

This implies that somehow taxpayers are obligated to take care of everyone's healthcare needs. Be advised that we do NOT have a state or national healthcare system. The government is NOT obligated to take care of everyone's healthcare needs and/or wishes.

[renerian, BSN, RN]

I think in a perfect world we would have all kinds of money to treat people like that; However, since we pay so much in taxes already and it will be going up even higher I don't know where we Americans are going to come up with all this money to all the great things we deem are important. Where does the government say we are maxed out unless we hike taxes? What does the state do since they are all in budget crisis?

renerian

[legsmalone, RN]

Perhaps this is my new graduate optimism, but I don't see how we can leave these people untreated. Living in the same state of the Union, I know you are well awre of the budget crisis and upcoming recall election, there is no money to go around. However, I bet you that most of these families, yes are already infected. And i bet you even more that they are already on state assistance in one way or another. So it really doesn't matter whether you want you tax dollars to go to treat them, I bet they already are.

[dawngloves, BSN, RN]

Originally posted by sjoe

[bWhen these people are "on the streets," are THEY willing to pay $15K/year for this treatment? No way. Why should taxpayers pay for it when they have been judged to have broken the law and are put in the slammer? (And this is the wrong thread to get into a discussion of laws--right or wrong, or incarceration--right or wrong, etc.)

Do these people care about their own families, sex partners, IVDA partners enough to take appropriate precautions not to pass along Hep C to them? If so, fine. If not, is it the taxpayers' obligation to assume that responsibility (particularly by using a scatter-gun approach which wastes 85% of the money)? Again, no way. Not THIS taxpayer's money.

You may say "Then we as taxpayers are not only left to treat the inmates, but perhaps their enitre family."

This implies that somehow taxpayers are obligated to take care of everyone's healthcare needs. Be advised that we do NOT have a state or national healthcare system. The government is NOT obligated to take care of everyone's healthcare needs and/or wishes. [/b]

Isn't that what Welfare is? Taxpayers pay for Americhoice.

[renerian, BSN, RN]

Yes many people do not realize they work until April or May to pay their taxes for the year. Hubby and I pay taxes with all our income until May then it our tax debt is paid for the year.

Something to ponder,

renerian

[dawngloves, BSN, RN]

I've been thinking about this topic. Won't inmates and their families be able to sue the state for failure to treat? Or an inmate that dies from complitcations secondary to Hep C, will the family be able to sue the state for wrongful death and/or malpractice (this is PA remember) ?

[sjoe]

dawn writes: "I've been thinking about this topic. Won't inmates and their families be able to sue the state for failure to treat?"

In the US, anyone with the legal status to do so (such as age 18 or older, etc.) can sue anyone else for anything, real or imagined. The question is whether one could win such a suit AND collect damages.

Since most of the people in the US who have Hep C are NOT receiving this treatment, it can hardly be cited as the standard treatment.

Since this treatment is useless for 85% of people with Hep C, it can hardly be called "reasonable and customary."

Perhaps in a state where health insurance companies provided it to all their insured members who had Hep C, such claims could reasonably be presented in court. Don't know about Pennsylvania, but I certainly would doubt that insurance companies in that state squander their funds (profits) in this way.

By the way, a very large proportion of inmates of jails and prisons bring lawsuits against governmental agencies, medical providers, and anyone else they can think of. Why? 1) These cases are customarily handled by public defenders and cost the inmates nothing. 2) They have plenty of time and abundant free advice from cellmates about potential lawsuits. 3) How else are they possibly going to ever leave custody with any money in their pockets?

The results: 1) The vast majority of these cases are thrown out by judges all to familiar with them. 2) Of those remaining, most are settled out of court primarily as nuisances--simply to avoid the cost of trial--with some cash going to the inmate and occasionally to the family. 3) Many suits, when tried, are unsuccessful. 4) The few that inmates win usually result in substantial increases in paperwork, changes in policies and procedures, and increase in future fines and liabilities by correctional facilities--RAISING EVERYONE'S TAXES yet once again.

[BBFRN, BSN, PhD]

I agree with Sjoe. And I would like to add that most of the inmates that I have seen that have tried to bring suit against the prison where I used to work, were the ones who were the least compliant with their med regimens. And there are those out there that openly admit to getting themselves reincarcerated on purpose- for the healthcare benefits provided them in prison. There are many more of those people out there than you can imagine. Go work in a prison, and you will see and hear things you never thought you would. They are worried about themselves, period. If they were worried about their families, they wouldn't have gotten themselves incarcerated in the first place.

[geekgolightly, BSN, RN]

That policy is murder, IMHO.

Non-compliance should be dealt with on an individual basis for those using that as an excuse for this policy.

Our "captive audience" is dependent upon the state to take care of bodily needs. Doing time for a crime does not mean they should be dealt a death sentence. leave that for capital crimes, if that.