What would you do to resolve this issue? Please don’t focus on the fact that inmates are human beings and have a right to medical care. We already know that and every inmate does have access to medical care. The issue is that it does vary with jurisdiction. Why? Why do they have a right to medical care (which amendment is involved)? What is the difference between inadequate medical care and deliberate indifference? This one should really get you thinking about the reality of medical care in an institution. It is interesting to study this kind of a question from an academic perspective and I can assure you that it is stressful making decisions like this when the buck stops at your desk. I faced similar issues with HIV testing among several others.

QUESTION

Inmate medical care is one of the most important issues you will deal with as a top administrator. This is a complex policy arena with some very passionate stakeholders involved on all sides of this issue. California has been one of the highest profile states and is under “management” by a court master who reports to the judge regarding progress in court order compliance. This has created a lot of friction and litigation between the DOC and the court system. Everyone has an opinion on inmate medical care and many of those positions are uneducated. This is an area where the head administrator (you, hopefully) will be involved in personal testimony and often personal liability. Don’t take an upper level job until you understand the issues involved in inmate medical services.

For this week, I want you to focus on a real and emerging ethical, legal and fiscal issue you would have to weigh in on as an administrator. It can’t get any more current or real than this. All systems screen for infectious disease so let’s not waste time there. Hepatitis C has come into focus in the last 10 years or so and it is an incredibly slowly progression disease. It may take 30 years to have a serious effect on the body which is perhaps why it was hard to recognize and isolate. We are also learning that a significant percent of the population have contracted this through medical transfusions as well as risky behaviors and until recently there was a high mortality rate associated with this disease. New screening tools can identify this disease even in the earliest stages. There are two extremely effective drugs out there from AbbVie (Vie Kira Pak, which is a cocktail of drugs) and Gilead Sciences (Harvoni). The retail cost is approximately $83K and $94K for a 12 week regimen of treatment.

Here is the issue: do you prescribe these drugs to inmates? If you do, under what conditions? Let me explain some of the parameters of the issue for you to make sure you understand the nature of this debate. If you provide it to every inmate who tests positive for Hep C, you will go broke. The states do not have enough money to pay for this cure for everyone who tests positive. You may have someone who enters the system who tests positive and it is in the earliest stages and won’t require serious treatment for many, many years. During that time, he pay die from many other mortal conditions. He will probably be covered by federal or private insurance at a future time who can deliver the medication must more cost effectively. New drugs may arrive on the market. The copyright will be gone and generics may come into play. You start to see my point here. On the other hand, you may have someone on the precipice of death who needs it now and not later.

Your agency has to make a decision as to when and if to prescribe and budget certainly is going to play a part in this. Some might argue you should stop testing for this so the decision isn’t there. That course of action has legal as well as ethical peril as well. All inmates who are identified with this disease will want treatment right now and not later. Additionally, it is infectious so failure to treat has risks there as well. No matter what your decision is with the exception of treating everyone, you will end up in court with a constitutional issue. How do you balance the issue of how much medical care one provides inmates.

What would you do to resolve this issue?

Please don’t focus on the fact that inmates are human beings and have a right to medical care. We already know that and every inmate does have access to medical care.

The issue is that it does vary with jurisdiction. Why?

Why do they have a right to medical care (which amendment is involved)?

What is the difference between inadequate medical care and deliberate indifference?

This one should really get you thinking about the reality of medical care in an institution. It is interesting to study this kind of a question from an academic perspective and I can assure you that it is stressful making decisions like this when the buck stops at your desk. I faced similar issues with HIV testing among several others.

ANSWER

Balancing Inmate Medical Care: The Complex Issue of Hepatitis C Treatment

Introduction

Inmate medical care poses significant challenges for administrators, requiring careful consideration of ethical, legal, and fiscal factors. The emergence of Hepatitis C as a critical health issue among inmates presents a dilemma for administrators: whether to prescribe expensive yet highly effective drugs to all affected inmates or adopt a selective approach due to budget constraints. This essay explores the parameters of this issue and proposes a resolution that balances the need for medical care with practical considerations.

Understanding the Issue

Hepatitis C and its progression: Hepatitis C is a slow-progressing disease, often taking several decades to cause serious harm to the body. Early-stage infections may not require immediate treatment, as other mortal conditions may be of more immediate concern.

Cost of treatment: Highly effective drugs from AbbVie and Gilead Sciences offer a cure for Hepatitis C, but their retail cost is prohibitively high, posing significant budgetary challenges for correctional facilities (Shepard et al., 2005).

Time and potential advancements: Over time, an inmate’s medical insurance coverage may change, making the treatment more affordable through federal or private insurance. Additionally, new drugs may become available, including generic alternatives as the copyright expires.

Constitutional issues: Regardless of the chosen approach, legal challenges are likely, as the provision of medical care to inmates involves constitutional rights and potential claims of deliberate indifference.

Proposed Resolution

 Risk-based approach: Adopt a risk-based approach to prioritize treatment. Assess the severity of the disease, considering factors such as the stage of infection, presence of coexisting conditions, and the potential impact on an inmate’s overall health.

Assess potential for transmission: Identify inmates who are at a higher risk of transmitting Hepatitis C to others within the correctional facility (Kabyl et al., 2020). Consider factors such as behaviors that may lead to exposure (e.g., sharing needles) or medical procedures that may increase the risk of transmission.

Collaboration with healthcare professionals: Engage medical experts to develop guidelines for treatment eligibility based on medical evidence, cost-effectiveness, and potential risks to public health.

Regular reassessment: Continuously evaluate the criteria for treatment eligibility based on the evolving medical landscape, availability of new drugs, and changes in the cost of treatment.

Consideration of financial resources: Acknowledge the limitations of available budgets and explore potential avenues for funding, such as partnerships with pharmaceutical companies or seeking grants dedicated to inmate healthcare.

Public health education: Emphasize education and prevention programs within correctional facilities to reduce the prevalence of risky behaviors that contribute to the spread of Hepatitis (Chatters et al., 1998).

Conclusion

Balancing the provision of Hepatitis C treatment for inmates requires a comprehensive and pragmatic approach. By prioritizing treatment based on the severity of the disease, potential for transmission, and available resources, administrators can make ethically sound decisions that consider both the immediate needs of individuals and the long-term sustainability of inmate medical care. Collaboration with medical experts, regular reassessment of treatment eligibility, and public health education efforts will contribute to mitigating the challenges posed by Hepatitis C within correctional facilities. While these decisions are undoubtedly stressful, administrators must navigate the intricate intersection of ethics, law, and fiscal responsibility to ensure the well-being of the inmate population.

References

Chatters, L. M., Levin, J. S., & Ellison, C. J. (1998). Public health and health education in faith communities. Health Education & Behavior, 25(6), 689–699. https://doi.org/10.1177/109019819802500602 

Kabyl, A., Yang, M., Abbassi, R., & Li, S. (2020). A risk-based approach to produced water management in offshore oil and gas operations. Chemical Engineering Research & Design, 139, 341–361. https://doi.org/10.1016/j.psep.2020.04.021 

Shepard, C. W., Finelli, L., & Alter, M. J. (2005). Global epidemiology of hepatitis C virus infection. Lancet Infectious Diseases, 5(9), 558–567. https://doi.org/10.1016/s1473-3099(05)70216-4