NASHVILLE, Tenn. -- A federal judge in Nashville ruled this week that Tennessee's treatment of prisoners with hepatitis C is not grossly inadequate but warned the state to make good on its promises to treat more patients more quickly.
In a Monday ruling, U.S. District Judge Waverly Crenshaw noted that Tennessee has made a number of changes to improve treatment of the sometimes deadly disease within the past few months.
Despite the availability of antiviral drugs that often cure the disease, prisons across the country have struggled to get funding for the drugs, which cost more than $10,000 per patient. Tennessee prisons saw at least 56 hepatitis C-related prisoner deaths between 2013 and 2017.
Prisoners testified at the July trial that even after they became severely ill, and qualified for treatment under Tennessee Department of Correction rules, they were not given the crucial drugs. That's because a committee must approve all prescriptions for the expensive antiviral medications
Around 4,700 Tennessee prisoners are known to be infected with hepatitis C, but until recently the committee only considered the cases of about eight prisoners each month. The department is now working to increase that number to 160 per month.
Crenshaw acknowledged the prisoners' testimony in his ruling but noted the recent changes that corrections officials have made, including new guidelines for care released in May.
Under the previous guidance, the committee would not even consider treatment for patients with hepatitis C viral infections, sometimes called HCV, unless they were already very sick.
Dr. Zhiqiang Yao, an infectious disease specialist at East Tennessee State University, testified for the prisoners that the current standard of care is to treat anyone infected with hepatitis C with the antiviral medications, regardless of how sick they are. He said waiting to provide treatment can put patients with the infectious, liver-damaging disease at greater risk of cirrhosis, cancer and death.
Although the Correction Department's new rules still prioritize the sickest patients, they do not preclude less sick patients from receiving treatment, Crenshaw wrote. He noted that Yao testified that prioritizing care for the sickest patients is understandable where there are limited resources and staffing.
Other states have grappled with how to provide the expensive treatment. After a lawsuit, Michigan agreed to provide antiviral treatment to all Medicaid patients with hepatitis C beginning this month.
Louisiana limited antiviral treatment for Medicaid patients and prisoners until earlier this summer. It now offers unlimited access thanks to an agreement with a drug provider where the state will pay a flat fee for unlimited medication for five years.
Meanwhile, Crenshaw noted that the Tennessee Department of Correction's prioritization guidance mirrors that of the federal Bureau of Prisons.
New antiviral drugs that promise to cure most hepatitis C patients within weeks have only been available since 2011. Since then, the cost of the drugs has dropped from around $80,000 to about $13,000 for the simplest cases, according to the lawsuit.
Dr. Kenneth Williams, the Correction Department's chief medical officer, testified at trial that he recently requested and received enough funding to treat about 1,800 inmates, or more than a third of Tennessee inmates currently known to be infected with hepatitis C.
"Time will tell whether TDOC implements the 2019 HCV Guidance in the dedicated manner it has represented and continues to accelerate approval of inmates for treatment," Crenshaw wrote. He concluded it would behoove the department to do so "lest treatment that is not grossly inadequate today be subject to that renewed claim in the future."