Hepatitis C is not all that difficult to treat. A class of drug called direct-acting antivirals, or DAAs, has been proven at least 90 percent effective in curing the condition. Just 1 percent of the U.S. population typically lives with hep C — but that rate is far higher, up to 17 percent, among state and federal prisoners.
Despite that high rate and the proven medical treatment available, a class-action lawsuit filed by a Miami civil rights law firm Thursday claims the Florida Department of Corrections has refused to provide those new drugs to its inmates and is potentially leaving thousands of people to languish in pain and possibly die from the virus.
"Florida has the third-highest prison population, which brings some responsibilities to the Department of Corrections," said Erica Selig, a lawyer for the nonprofit Florida Justice Institute, which filed the suit on behalf of three plaintiffs. "They can’t ignore this."
According to the institute, just five of the 5,000 Florida inmates with diagnosed hepatitis C (also known as HCV) received DAA treatment. The suit says that because many inmates don't know they have the illness, there are likely far more people with hepatitis serving time in the state prison system: There might be anywhere from 14,000 to 41,000 cases, the lawyers say.
According to the suit, at least 160 Florida inmates have died of liver problems since 2013. The Justice Institute warns that many likely suffered from hepatitis, whether they knew it or not.
"Since HCV is the most common cause of liver failure in the United States, it is likely that most of these deaths were due to chronic HCV," the suit says. "Upon information and belief, past and current practices of the Defendant are resulting in deaths that could have been prevented through treatment of HCV."
A spokesperson for the corrections department said the DOC had not yet been served with the lawsuit, and could not comment. DAA treatment for hepatitis-positive prisoners remains a national issue: In January, the Wall Street Journal reported that states across the nation are reluctant to begin administering DAA drugs, mostly because of the high cost: A full DAA treatment runs anywhere from $55,000 to $75,000 per person, depending upon the state. With anywhere from 5,000 to 41,000 hepatitis-positive inmates in Florida, the cost adds up fast.
The Justice Institute, however, maintains that the state is discriminating against hepatitis patients because medication for other illnesses, such as HIV, is regularly covered. Likewise, treatment advocates say that if hepatitis cases go untreated, prisoners end up getting rushed to the hospital — which could cost more money than treatment.
"If you or I are not getting the right medical care through our doctor, we can go elsewhere," Randall Berg, the Florida Justice Institute's executive director, tells New Times. "These guys can’t. The state has a duty to provide that health care for their inmates."
Previous investigations have painted the state prison system as mismanaged and willing to cover up gross signs of neglect: Miami Herald reporter Julie K. Brown's George Polk Award-winning series Cruel and Unusual led to multiple rule changes and resignations in the system. The series also forced the state to reopen the investigation into Darren Rainey, a schizophrenic inmate whom many said was scalded to death in a jerry-rigged prison shower as punishment.
The Justice Institute is representing three hepatitis-positive patients in the case: Carl Hoffer, a 70-year-old who has been serving a life sentence since 1988 (and is currently housed in the Suwanee Correctional Institution); Ronald McPherson, a 53-year-old serving a five-year nonviolent sentence; and Roland Molina, 51, who has been incarcerated since 2004.
All three men say they're suffering from extreme complications from hepatitis — which could have been prevented if the state were simply to administer DAA drugs to inmates with confirmed cases of the illness. Hoffer, for example, didn't know he had hepatitis until 1999, when he was already behind bars. The suit says he asked for treatment at each of his regular checkups but was denied every time. Instead, the suit says, his legs and feet began to painfully swell around eight years ago, an obvious hepatitis symptom. The suit claims he was still denied DAA treatment, which could have reversed the damage.
"In May and June of 2015, Mr. Hoffer’s feet, ankles, calves, knees, thighs, testicles, and stomach became painfully swollen," the suit says. "His shins were cracked and leaking white liquid." Hoffer was eventually transferred to a prison clinic, where he was simply given antibiotics and placed on a liquid diet. Instead of getting better, he developed severe ascites — a medical term for fluid buildup in the chest or abdominal cavity, which can cause difficult breathing or even death.
Hepatitis is typically transmitted through contact with infected blood, which means most inmates who have the disease contracted it through sexual contact, intravenous drug use, or prison tattoos.
The Justice Institute's Berg tells New Times he's been dealing with complaints about hepatitis C treatment from prisoners since at least 2002, when one inmate who'd previously been cleared of the virus found out his hepatitis had come back.
"We attempted to get him retreated through the inmate grievance procedure, but they denied that," Berg says. 'We had made some phone calls, pleading with them to retreat him, but they said it was impossible for him to be successfully retreated. We ended up filing a federal lawsuit." That inmate was eventually given his medication. Berg says that a decade ago, treatment for hepatitis was far more invasive, worked differently depending upon your genes, and sometimes involved needles to the liver.
"But in 2013, the new DAAs came out, which were much more successful," Berg says. His group then began looking for ways to hold the state to a higher treatment standard. In the meantime, he says, he continued receiving letters and phone calls from inmates suffering from the illness.
One of them was McPherson, serving five years on a nonviolent offense. In 2013, McPherson told the prison medical staff that he was both hepatitis- and HIV-positive. The prison system administers his HIV medication but does not provide DAA drugs for his hepatitis. Instead, the suit claims, prison doctors haven't even told him how advanced his hepatitis has become.
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"Beginning in May of 2014 and continuing through the present, Mr. McPherson has filed numerous grievances and appeals, complaining about his HCV-related symptoms and requesting treatment," the suit says. "They have all been denied."
In August 2016, a prison doctor even recommended McPherson be treated with Harvoni, a DAA drug, because his blood-platelet levels had dropped to dangerously low levels. But that request was denied. A follow-up request in 2017 was also denied. This past February, a prison nurse simply told McPherson to "avoid injuries" to prevent his condition from worsening.
The lawyers now say McPherson worries he might not survive his prison term. He has passed out four times in the past six months. His blood has stopped clotting properly.
"Dying of hepatitis C is very, very painful," Selig tells New Times. "Liquid starts collecting, and it can press up against your lungs." Thankfully, Hoffer, McPherson, and Molina have survived so far. Others haven't been as lucky.