Saturday, September 22, 2012

Tattoo You: State faces rising costs from Hep C treatment

The Texas Tribune yesterday had a story on the rising cost of treating Hepatitis C in prison due to changing standards of care surrounding the disease. Reported Brandi Grissom:
Prison health officials estimate that as many as 50,000 of the state’s more than 150,000 inmates could be infected with hepatitis C. The cost to treat Texas inmates with hepatitis C is expected to soar by as much as 380 percent next year, a result of the growing prevalence of the disease among inmates and a more effective, but more expensive, treatment protocol. Legislators, already facing a strained budget, will have to find millions more dollars to pay for this care.

Not all inmates are tested for hepatitis C when they enter the prison system. They are tested if they have other clinical indicators, like HIV or a history of intravenous drug use. In a 2007 report, health providers for the Texas Department of Criminal Justice said they had identified and were managing care for about 20,000 inmates with hepatitis C.

Dr. Stephanie Zepeda, the director of pharmacy services for University of Texas Medical Branch Correctional Managed Care, which oversees treatment of inmates, said she provided medication therapy for about 400 hepatitis C patients per month, at a cost to the state of about $2.8 million per year. Not all patients with the disease receive the medication, and the therapy can last from three months to a year.

The current protocol is composed of two drugs, and its cure rate is about 40 percent, Zepeda said. But new medical guidelines call for the use of a third medication, which can be one of two different drugs. One of them would increase the cost of hepatitis C treatment in prisons to more than $8 million a year, the other to more than $13 million, Zepeda said.

Zepeda said that adding a third drug raised the cure rate to 70 percent. But the drugs are not only expensive, they are also complicated to administer.

“It’s great from a humanistic standpoint,” Zepeda said. “But it’s, practically, a challenge for the correctional system.”

The new drugs must be administered precisely every eight hours. They must be taken with food, and patients risk developing a resistance to the therapy if they miss doses. In prison, where even small diversions from the regimented schedule require additional work for guards, and where inmates frequently move between units, ensuring that the expensive medications are given correctly could be problematic, Zepeda said.

“It just takes a tremendous amount of coordination to do it right and to do it well,” she said.
Perhaps the biggest source of in-prison transmission of Hep C is unsterilized tattooing. For a while, Canada experimented with placing tattoo parlors in prison, with mixed results (it was abandoned out of an ideological shift in government, not because of problems with the program). It turned out some prisoners wouldn't use the program (which obviously wouldn't do gang tats) and more importantly, they discovered most prisoners acquiring Hep C had done so in the free world, either in regular, licensed tattoo parlors, some of which pose a number of underpublicized health risks, or via IV drug use.

In any event, Texas is unlikely to install tattoo parlors in prison anytime soon, and the GOP champion for free-world needle exchange in the Legislature abandoned the idea after the Bexar District Attorney threatened to prosecute those participating in a legislatively approved pilot. So, since the state appears unlikely to embrace preventive tactics anytime soon, the question remains: Will new, more effective Hep C treatments be deemed medically necessary and thus required under prison medical protocols? If so, it's yet another factor boosting costs for prison healthcare, which the Lege last session underfunded in the budget by nine figures. And since Texas policy toward most prisoners on Hep C has been "don't ask, don't treat," if they ever actually began testing everyone for the disease, those costs would go even higher.


Prison Doc said...

I am not a fan of our current Hep C treatment program, it may or may not be better than nothing... but there are lots of things to say in its favor.

First of all, Hep C isn't very treatable: as Zepeda said, success rates are very low under the best of circumstances. Many inmates refuse the necessary testing and workup phase, or abandon it halfway through. Side effects of medicines are common, almost routine--as a patient told me, "you feel like you have the flu all the time" so many abandon treatment after it is started. The present system used in our prisons has a very unfavorable cost-benefit ratio, for it requires a tremendous amount of employee-hours, laboratory costs and monitoring for a pitifully small yield of successful treatment. Whether this cost-benefit curve will improve with the addition of newer more expensive drugs remains to be seen.

I personally think the "clean needle" mirage is nonsense--recent research has shown that contaminated tattoo inks may be as big a factor in transmission as dirty needles; stick a clean needle into dirty ink and you get the same result.

Unfortunately tattoos seem to be here to stay for a few decades, both in the free world as well as in prison.

Unknown said...

There are two pieces of information in the post about Hep C in the prison system that are not correct. There is NO CURE for the disease. The treatments can slow the progression of the disease but, they do not cure it. Next thing that will happen is the relatives of inmates will be demanding that TDCJ cure there imprisoned family members of the disease because, they think there is a cure.
The post also stated that not all inmates are tested for Hep C when they enter the prison system. Yes they are.

Anonymous said...

Tattoos are a pestilence. Self inflicted skankness.

Anonymous said...

Tattoos in prison are ok as long as they spelled correctly. Trouble is inmates can't spell.

There are numerous ways that the inmates are educated about the risk they take being tattooed. And of course, getting or receiving a tattoo or just being in the possesion of tattoo materials is a major infraction of the rules. Searches are routinely done and tattoo guns are constantly being confisated. All this effort is hardly any deterrent at all because in the end inmates still can't spell.

sunray's wench said...

Perhaps instead of just constantly saying "don't do this", which loses its impact very quickly on a population who are told it all the time, TDCJ could start saying "if you do this, your liver will stop working and here is how that will affect you".

Inmates may not be able to spell (which can be fixed), but they are also underinformed of the actual results of having Hep C (which can also be fixed). One has to wonder why both of those situations exist in a 21st century society.

As prison population numbers go down, it might be an idea to turn a single prison into a Hep C camp, where inmates can be treated consistently with the drugs, and where they can also see what the advanced stages of Hep C does to a body.

Gritsforbreakfast said...

VVG, the person who used the phrase "cure" was the "director of pharmacy services for University of Texas Medical Branch Correctional Managed Care." I'm not a medical expert so you'll have to take it up with her.

And you're simply misinformed that all inmates are tested for HCV. See this analysis from UTMB medical execs which declared, "To identify inmates who are HCV-positive, TDCJ uses voluntary serologic screening targeted at inmates with risk factors for the infection (e.g., history of injection drug use, known HIV seropositivity or high-risk sexual activity). Although some infectious disease experts advocate universal HCV screening, such an approach is probably not cost-effective and would likely decimate the health care budgets of many prison systems."

Unknown said...

I know who Dr. Zepeda is and she is a fine very educated member of the TDCJ system and it is hard for me to believe she would make such an error. So it must be a misunderstanding.
Besides anybody who spends 2 minutes on any medical site on the web would know that information. So, the public reading your blog will know, medical science can not cure any disease caused by a virus. That is why there is no cure for the common cold or HIV.

As to the second point about the Hep C testing, I checked with a CID intake nurse and you are correct. In fact the testing is only done on an order from a provider or if the inmate relates behavior to the nurse in the interview that would put him at risk and requests the test - it can be done.

I jumped the gun on that one and I apologize. I guess TDCJ considers it a waste of money to test for Hep C since it can not be cured. Then again they do test for HIV and that can not be cured either. The treatments given to HIV patients cost the prison system plenty right now. Maybe they just don't want to get into adding the cost of Hep C treatments as well. However, the bottom line for all this is the prison population is pound for pound the most at risk population in the state for Blood Born Diseases. The price tag for slowing the progression of those diseases and prolonging the lives of the inmates who have them is going to cost big bucks if we do it. However, the money spent for that would be more effective in saving lives than paying for A/C and worrying about the far fewer heat related deaths that occur. The state can not lock people up with the idea that they are entitled to every advantage a free person is and be able to pay for it.

Sheldon tyc#47333 said...

The reason why inmate can’t spell is because agencies like tdcj and tjjd/tyc wont educate them. If the inmate were educated they may not be inmates. But that would be a bad thing because of all the tdcj tyc/tjjd employees who need the government entitlement jobs provided by these agencies. The ignorant disdain education. How would that look if top officials at tdcj with the want to be degrees in schadenfreude from Sam Houston had inmates with a eighth grade reading comprehension level that were smarter them. Like David Ruiz. And a shout out to our public schools who loose funding because of these corrupt agencies of government entitlement sucking it all away, well you get what we have in Texas corrections. Inmates who cant spell are a direct result from decades of idiocracy by tdc/tdcj tyc/tjjd. I’m sick of paying for these morons who retaliate against us tax payers every time the Federal government has to step in and remind them to they should act in a civilized Judio-Christian manor. Whose protecting us from them?

Gritsforbreakfast said...

"The state can not lock people up with the idea that they are entitled to every advantage a free person is and be able to pay for it"

VVG, the US Supreme Court has said if the state chooses to lock people up, it must pay for medically necessary healthcare and provide humane conditions. That's where the "entitlement" comes from, and it's not going away any time soon. The state always has the option of locking up fewer people if it doesn't want to pay for their medical treatment.

Unknown said...

I am well aware of the inmate's right to medical care. So, locking up fewer people is the only way to go. Thats what I meant when I wrote that. Medical resourcs are not infinite, there is a limit. In my opinion we have already reached it in the prison system. Also, I think the legislature is not going come up with any reasonable funds for this until a federal judge makes them do it. Still the money won't be there so maybe then they will reduce the prison population.