6th Circuit: OK to ration hepatitis C treatment to prisoners

NASHVILLE, Tenn. (AP) — In a split decision, a panel of the 6th U.S. Circuit Court of Appeals on Monday upheld Tennessee's rationing of life-saving hepatitis C drugs to prisoners as constitutional.

The 2-1 decision found that officials did not act with deliberate indifference to prisoners' medical needs and it was reasonable to prioritize the sickest patients for treatment given the Tennessee Department of Correction's limited resources. In a dissent, U.S. Circuit Judge Ronald Lee Gilman wrote that officials may not refuse to treat a patient with a serious medical need “merely to avoid paying the bill.”

Before 2011, there was no good treatment for hepatitis C, but that year the U.S. Food and Drug Administration approved new antiviral drugs that are highly effective against the liver-damaging virus, curing most people after two or three months. Although the cost of the antivirals has dropped sharply since 2011, Tennessee says the average cost for treating a prisoner is still $17,000.

Other states have grappled with how to provide the expensive treatment. After a lawsuit, Michigan agreed to provide antiviral drugs to all Medicaid patients with hepatitis C last fall. Louisiana began offering unlimited access to antivirals around the same time thanks to an agreement with a drug provider where the state paid a flat fee for five years of unlimited medication.

The 6th Circuit's majority decision relied on the expert testimony of Dr. Zhiqiang Yao, an infectious disease specialist at East Tennessee State University, who testified on behalf of the prisoners at the trial. Yao told the court the current standard of care is to treat anyone infected with hepatitis C with the antiviral medications, regardless of how sick they are. Waiting to provide treatment can put patients at greater risk of cirrhosis, cancer and death,...