Some Nevada inmates frustrated by lack of treatment for hepatitis C

Johanna Hudnall is fighting to get treated for a disease she’s had for two decades.

The 51-year-old female inmate in Nevada’s Florence McClure Women’s Correctional Center says she isn’t getting the treatment she needs to battle hepatitis C, a disease that can be fatal if left untreated. Hudnall is frustrated because in recent years drugs have emerged that have a high rate of successfully curing people of hepatitis C, which can lead to liver failure.

So far, she’s been unable to access that care as a Nevada inmate.

“It’s kind of scary to see and feel and watch my body change because of something they won’t help me with,” she said. “I’m frustrated with it.”

Her situation reflects what advocates and academics say is a widespread pattern throughout the U.S. of inmates facing challenges in getting treated for hepatitis C with effective but expensive drugs. Nevada’s prisons, like many others in the U.S., don’t automatically test all new inmates entering the system for the disease, though they do test for HIV. In Hudnall’s case, she was diagnosed before arriving in the Nevada system.

Hudnall was sent to the Nevada Department of Corrections after her conviction in California in 2003 on seven counts of residential burglary, forgery and possession of a controlled substance. She was sent to Nevada because she had been sexually assaulted by a California prison employee when serving a prior sentence. The assault is the suspected source of her disease.

“What they’re doing is so wrong,” she said of corrections officials.

“I should not have to compromise on my medical condition.”

Hudnall and other inmates with hepatitis C are afraid they’ll end up dying, even though it could be avoided.

“I’ve watched a couple pass away from this disease,” she said. “All of us are in fear of getting to that point, and it’s unnecessary. They could do better testings.”

Hudnall and her attorney Scott Olifant are working on a solution and haven’t ruled out filing a lawsuit to get treated.

“I’m trying to get something done,” she said. “I think 20 years with this disease is a reasonable amount of time.”

CORRECTIONS RESPONSE

A spokeswoman for the Nevada Department of Corrections was unable to comment on the specifics of Hudnall’s case due to privacy regulations.

Spokeswoman Brooke Keast said Nevada state law requires testing for HIV/AIDS but not hepatitis C.

National estimates put the percentage of the prison population with the disease at between 15 percent and 40 percent, though Keast added that “no one knows exactly because the overwhelming majority of prison systems do not test routinely for hepatitis C.”

The disease spreads through sexual contact and intravenous drug use, and rates of hepatitis C infection in the corrections system are higher than outside prison walls.

Keast said treatment with new antiviral medication costs between $36,000 and $60,000 an inmate.

In March 2016, nine inmates were being treated for hepatitis C.

Keast said corrections doctors don’t directly order hepatitis C treatment and send patients to a committee for consideration of treatment and evaluation. In certain cases, hepatitis C may resolve itself or not be discovered because patients don’t show symptoms, she said.

NATIONAL CHALLENGE

In a 2015 national study that surveyed state corrections agencies, Nevada reported 593 inmates with hepatitis C, including two of them, or 0.34 percent, on treatment.

That study, which collected surveys from 41 state corrections systems, found that on average, only 0.89 percent of 106,266 inmates nationwide were getting treated in January 2015.

Nevada’s rate of treatment falls in line with other states, said Gregg Gonsalves, the senior author of the study and an assistant professor of epidemiology at the Yale School of Public Health. Yale and the Association of State Correctional Administrators worked together on the study.

“It’s right in the middle of the states that we surveyed,” Gonsalves said of Nevada’s rate. “The bottom line is that not many prisoners with hepatitis C in Nevada are getting treatment.”

New drugs are a “godsend” for public health, he said, adding that “the big problem is these are really, really expensive drugs.”

With testing, he said, prompt treatment can cure an infection and stop it from spreading to other inmates through means such as illicit drug use.

There are savings in treating inmates early, but sometimes the savings benefit state budgets at large and not the corrections agencies, said Rich Feffer, correctional health programs manager for the Hepatitis Education Project, a national education and advocacy organization based in Seattle.

For example, if an inmate gets treated in the system, then he or she potentially can avoid much more costly treatments like a liver transplant years later.

Overall, he said, the “public health community looks at addressing hepatitis C in corrections systems as a public health opportunity.”

But, he added, “the problem is that correctional institutions are just that. They’re not hospitals. They’re institutions of crime and punishment.”

Contact Ben Botkin at bbotkin@reviewjournal.com or 702-384-8710. Follow @BenBotkin1 on Twitter.