By Bob Needham
Michigan Law
The prestigious Journal of the American Medical Association has published an article on hepatitis C testing in the criminal justice system, drawing on a white paper by the Civil Rights Litigation Clearinghouse.
Both the journal article and the white paper were co-authored by Civil Rights Litigation Clearinghouse Managing Attorney Tessa Bialek and Matthew J. Akiyama, of the Albert Einstein College of Medicine in New York.
The white paper, released last year, argues for expanding testing and treatment for hepatitis C in US prisons and jails. The hepatitis C virus is a large and growing problem in the carceral system—and one that affects our broader society as well, as the white paper explains.
“This new article in the Journal of the American Medical Association builds on the white paper to push for scaling up hepatitis C testing and treatment as a vital elimination strategy not only in carceral settings but also in community supervision and alternatives to incarceration programs,” Bialek said.
The new article calls for universal opt-out testing for hepatitis C, linkage to care in community and alternative to incarceration settings, and exploration of strategies to fund expanded access to direct-acting antiviral (DAA) treatment in all settings.
“I’m grateful to Dr. Matthew J. Akiyama, my white paper co-author, for initiating this follow-on piece in JAMA, which we hope will reach a broad, complementary audience and emphasize, as the white paper does, the public health opportunity to scale up hepatitis C testing and direct acting antiviral treatment in various criminal justice settings,” Bialek said.
An estimated one in three people with the hepatitis C virus (HCV) will spend time in a jail or prison in a given year.
“Yet most people who are in jail or prison are not going to be there forever; as the saying goes, prison health is public health. Even if you are doing everything you can outside of the carceral setting to treat hepatitis C, leaving this enormous subset of the population out of an elimination plan is going to ensure its failure,” Bialek said when the white paper was released in 2023.
Both articles argue that widespread testing for hepatitis C—along with treatment by DAA drugs across various carceral and community settings—will be essential to eradicate the disease.
However, a full course of DAA treatment can cost $20,000 or more, which, among other barriers, has limited DAA treatment in carceral settings.
“Cost can be hugely prohibitive. To treat everyone in custody with hepatitis C at that price point could outstrip a system’s entire health care budget,” Bialek noted.
“That said, even at this price point, treatment is ultimately cost-effective. And, of course, essential to ensuring that individuals with HCV receive a safe and effective cure for this serious disease.”
Established case law requires that under the Eighth Amendment’s “cruel and unusual punishments” clause, state and local governments must provide adequate medical care for those in prison (and, under the Fifth and Fourteenth Amendment due-process clauses, to pre-trial detainees).
Bialek said courts have been split on whether that requirement means that DAA treatment must be provided to all hepatitis C patients.
“The states that have been most successful in scaling up testing and treatment are ones that have had lawsuits that have gone well for the plaintiffs in the early stages and have ultimately settled. The settlement leads to expanded testing and treatment and also the needed money from the legislature to support this expansion.”
The Civil Rights Litigation Clearinghouse, which was founded by Professor Margo Schlanger and is housed at Michigan Law, collects and presents documents and information from large-scale civil rights cases across the United States. The white paper draws from relevant litigation documents in the clearinghouse collection, including settlement agreements in cases seeking expanded HCV testing and treatment, supplemented by conversations with experts and advocates and current medical guidance. Based on those resources, the white paper recommends a series of policies for prisons and jails to scale up HCV testing and DAA treatment, including:
• Offering universal opt-out screening in jails and prisons for HCV
• Providing medical evaluation and consultation for all patients testing positive
• Offering near-universal DAA treatment at all stages of the disease and providing linkage to community care
• Educating patients during incarceration and upon release
• Maintaining records of testing and treatment
• Ensuring sufficient staffing and staff training
• Regularly updating guidelines and protocols
“One recommendation I would emphasize is to be really proactive about building community partnerships with state and local health organizations and with other health care providers in the community,” Bialek said. “Those partnerships are going to be essential in maximizing the number of people that you can help.”
The white paper was the second in a series called Learning from Civil Rights Lawsuits. The series looks at the tens of thousands of litigation documents in the clearinghouse collection to explore promising practices and develop model policies for criminal justice reform. The first paper in the series, released in 2022, was “Effective Communication with Deaf, Hard of Hearing, Blind, and Low Vision Incarcerated People.” The third in the series, “Criteria and Procedures for Meaningful Parole Review for People Sentenced as Youth,” was released in May 2024.
Michigan Law
The prestigious Journal of the American Medical Association has published an article on hepatitis C testing in the criminal justice system, drawing on a white paper by the Civil Rights Litigation Clearinghouse.
Both the journal article and the white paper were co-authored by Civil Rights Litigation Clearinghouse Managing Attorney Tessa Bialek and Matthew J. Akiyama, of the Albert Einstein College of Medicine in New York.
The white paper, released last year, argues for expanding testing and treatment for hepatitis C in US prisons and jails. The hepatitis C virus is a large and growing problem in the carceral system—and one that affects our broader society as well, as the white paper explains.
“This new article in the Journal of the American Medical Association builds on the white paper to push for scaling up hepatitis C testing and treatment as a vital elimination strategy not only in carceral settings but also in community supervision and alternatives to incarceration programs,” Bialek said.
The new article calls for universal opt-out testing for hepatitis C, linkage to care in community and alternative to incarceration settings, and exploration of strategies to fund expanded access to direct-acting antiviral (DAA) treatment in all settings.
“I’m grateful to Dr. Matthew J. Akiyama, my white paper co-author, for initiating this follow-on piece in JAMA, which we hope will reach a broad, complementary audience and emphasize, as the white paper does, the public health opportunity to scale up hepatitis C testing and direct acting antiviral treatment in various criminal justice settings,” Bialek said.
An estimated one in three people with the hepatitis C virus (HCV) will spend time in a jail or prison in a given year.
“Yet most people who are in jail or prison are not going to be there forever; as the saying goes, prison health is public health. Even if you are doing everything you can outside of the carceral setting to treat hepatitis C, leaving this enormous subset of the population out of an elimination plan is going to ensure its failure,” Bialek said when the white paper was released in 2023.
Both articles argue that widespread testing for hepatitis C—along with treatment by DAA drugs across various carceral and community settings—will be essential to eradicate the disease.
However, a full course of DAA treatment can cost $20,000 or more, which, among other barriers, has limited DAA treatment in carceral settings.
“Cost can be hugely prohibitive. To treat everyone in custody with hepatitis C at that price point could outstrip a system’s entire health care budget,” Bialek noted.
“That said, even at this price point, treatment is ultimately cost-effective. And, of course, essential to ensuring that individuals with HCV receive a safe and effective cure for this serious disease.”
Established case law requires that under the Eighth Amendment’s “cruel and unusual punishments” clause, state and local governments must provide adequate medical care for those in prison (and, under the Fifth and Fourteenth Amendment due-process clauses, to pre-trial detainees).
Bialek said courts have been split on whether that requirement means that DAA treatment must be provided to all hepatitis C patients.
“The states that have been most successful in scaling up testing and treatment are ones that have had lawsuits that have gone well for the plaintiffs in the early stages and have ultimately settled. The settlement leads to expanded testing and treatment and also the needed money from the legislature to support this expansion.”
The Civil Rights Litigation Clearinghouse, which was founded by Professor Margo Schlanger and is housed at Michigan Law, collects and presents documents and information from large-scale civil rights cases across the United States. The white paper draws from relevant litigation documents in the clearinghouse collection, including settlement agreements in cases seeking expanded HCV testing and treatment, supplemented by conversations with experts and advocates and current medical guidance. Based on those resources, the white paper recommends a series of policies for prisons and jails to scale up HCV testing and DAA treatment, including:
• Offering universal opt-out screening in jails and prisons for HCV
• Providing medical evaluation and consultation for all patients testing positive
• Offering near-universal DAA treatment at all stages of the disease and providing linkage to community care
• Educating patients during incarceration and upon release
• Maintaining records of testing and treatment
• Ensuring sufficient staffing and staff training
• Regularly updating guidelines and protocols
“One recommendation I would emphasize is to be really proactive about building community partnerships with state and local health organizations and with other health care providers in the community,” Bialek said. “Those partnerships are going to be essential in maximizing the number of people that you can help.”
The white paper was the second in a series called Learning from Civil Rights Lawsuits. The series looks at the tens of thousands of litigation documents in the clearinghouse collection to explore promising practices and develop model policies for criminal justice reform. The first paper in the series, released in 2022, was “Effective Communication with Deaf, Hard of Hearing, Blind, and Low Vision Incarcerated People.” The third in the series, “Criteria and Procedures for Meaningful Parole Review for People Sentenced as Youth,” was released in May 2024.
