Help is on the way for NC prison inmates with this infectious disease. It’s not COVID.

A federal lawsuit settlement will help get more state prisoners tested and treated for hepatitis C, the deadliest infectious disease in the United States before the coronavirus pandemic, people involved with the case said.

Civil rights groups, including North Carolina Prisoner Legal Services and the American Civil Liberties Union of North Carolina, filed the federal lawsuit in 2018 on behalf of three people diagnosed with hep C, who weren’t receiving treatment for the blood-borne illness that attacks the liver.

The lawsuit was later granted class-action status for the issue that is estimated to affect 6,500 to 12,500 incarcerated people in the state, according to court documents. A settlement was reached this month.

‘A huge step’ for public health

Estimates of hep C prevalence in prisons vary. The National Hepatitis Corrections Network reports 12% to 35% of prisoners in the United States have it and that 90% of them will eventually be released.

While the lawsuit was filed two years before the pandemic, COVID-19 has shown the risk of letting an infectious disease go unchecked and how it can affect the communities that staff and incarcerated people go home to, said Emily Seawell a senior staff attorney with the ACLU.

“It’s a huge step,” forward in public health, she said. “On screening we think we are very close. And on treatment we are also very happy with what we were able to get.”

Tim Moose, the N.C. Department of Public Safety’s chief deputy secretary for Adult Correction and Juvenile Justice, said in a news release that the settlement provides a blueprint for reducing the virus among people in prison.

“What the Department of Public Safety wants most of all is healthier offenders in our facilities, who return to their communities in better health — just as the plaintiffs were seeking,” Moose said.

The lawsuit argued the state’s policy for detecting and treating for the disease, which is prevalent in jails and prisons, violates the Americans with Disabilities Act and the U.S. Constitution’s ban on cruel and unusual punishment.

Under the state’s policy, some inmates diagnosed with hep C, including the plaintiffs, have had to wait for their liver scarring to reach a certain stage, which is determined by an unreliable test, before they could receive treatment, the lawsuit states.

The standard of care for the disease changed after anti-viral drugs became available in 2013, the lawsuit argues. The drugs are taken orally for eight to 12 weeks and cure 90%to 95% of the patients, it states.

Education, screening and treatment

The lawsuit asked a federal court to order the N.C. Department of Public Safety to test all incarcerated people for hep C. It also called for an end to a practice that makes many infected inmates ineligible for treatment based on their life expectancy, length of their remaining sentence or whether they had a recent drug infraction.

The settlement., which includes compromises on those requests, includes:

▪ Expanded education on hep C at prisons with regular educational sessions and posters.

▪ More proactive screening for incarcerated people .

Now anytime inmates enter the system, are transferred or have a routine physical, they will be screened, Seawell said.

Previously the state looked for risk factors that experts say are no longer the standard of care, she said.

▪ Enhanced treatment allows anyone who tests positive for hep C and has at least six months remaining before their projected release data will be eligible for treatment with the modern, direct-acting antiviral drugs.

When the lawsuit was filed, the state didn’t treat inmates with hep C until the disease progressed to the second of four levels on a scale.

A new policy will outline a pathway to treatment for all people who are diagnosed, Seawell said.

The process will still depend on the severity of the disease since there are so many people in prison who likely need treatment, working to first treat people at most risk for cirrhosis, which will cause irreversible liver damage, Seawell said.

Also, the settlement adjusts a policy that barred people with less than six months on their sentence for treatment. The change allows treatment consideration if the treatment concludes before that six month period, Seawall said.

Most courses of treatment are eight to 12 weeks. Those who don’t have enough time on their sentence to be treated will be refereed to the N.C. Department of Health and Human Services to help them find free or low-cost treatment once they are released, Seawell said.

Over the five-year term of the settlement, the Department of Public Safety has to treat at least 2,100 people, which is about one-third of the lawsuit class.

While people are waiting for treatment, they will be evaluated by a doctor every six months, she said.