Advocate staff photo by HILARY SCHEINUK -- The Elayn Hunt Correctional Center in St. Gabriel.

Three separate federal lawsuits by Louisiana inmates with Hepatitis C claim prison officials denied them available, life-saving medicine for more than a year — amounting to a policy to "let them die."

While the three inmates named in the lawsuits are still alive, the latest filing alleges that multiple other inmates with advanced cases of Hepatitis C died in the time period between when the new drugs were federally approved and when the state Department of Corrections began prescribing the medicine. The drugs were much more effective than prior treatments, yet astronomically more expensive.

"The guys that didn’t file suit died waiting for the state to do the right thing," said Joseph Long, the attorney representing the three inmates in their suits. 

Long filed a motion in January to make public the autopsies and death reports of inmates who died during the waiting period, when the groundbreaking medicine was not provided to Louisiana prisoners. He said the reports he has reviewed provide "damning evidence" in those cases. 

"This evidence is critical to prove ... that the State and its actors, defendants in this case, allowed prisoners similarly situated as plaintiff to die rather than pay for the (treatment) that would have saved their lives," Long wrote in his motion asking that the autopsies be unsealed. The autopsies were turned over by the corrections department through discovery, but were filed under seal.

"Plaintiff believes that a jury, seeing what happened to these other prisoners, would realize that there was a policy at Elayn Hunt to let them die," Long wrote in the motion. "It is the essence of cruel and unusual punishment to have the cure for a dying man available and let him die rather than spend the money to save his life."

Department of Corrections officials have denied making any medical decisions on the basis of cost, and dispute claims that they have failed to properly treat incarcerated Hepatitis C patients.

"We've never refused medical treatment or care because of cost," said Jimmy LeBlanc, the secretary of the department, in a recent interview. 

Corrections officials declined to address the specific claims made in the lawsuits, because they remain ongoing. However, in court filings, they opposed making the autopsies public and denied any delay in care for those diagnosed with the infectious disease. 

These lawsuits, however, address an issue that has not just challenged Louisiana, but states across the nation as governments have tried to balance proper care with the price of the new drugs, called Direct Acting Antivirals.

The drugs are about 95 percent effective at curing Hepatitis C — completely transforming treatment methods, which used to be only about 50 percent effective — but initially costed upwards of $100,000 when first approved in 2014. Since that time, the price has since dipped to about $10,000.

Hepatitis C patients relying on Medicaid and in prison have filed lawsuits in several states over this treatment, and in many of these cases, courts have forced states' hand to provide more patients with the costly drugs. States like Indiana, Colorado and Pennsylvania have recently added millions to their budgets for these treatments following litigation. 

But ahead of a ruling on the ongoing Louisiana lawsuits, state officials announced in January their plan to to implement a subscription payment model to expand access of the pricey drug to more Medicaid recipients and prisoners.

According to the Louisiana Department of Health, nearly 35,000 people in Louisiana's Medicaid program had the Hepatitis C virus in 2018, but only 384 Medicaid patients were treated last year. Another 4,000 prisoners have Hepatitis C, and a similar fraction received medication in 2018. 

That planned improvement, however, does not directly affect any of these lawsuits. All three named inmates have either started the new treatment or are scheduled to, a change Long said came only once they filed suit.

And while he is aware similar cases have been litigated in other states, he said that does not get Louisiana officials off the hook. 

“Can we really justify letting people die?" Long said.

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The three lawsuits allege that corrections officials and their medical staff knew about the groundbreaking drugs years before they began prescribing it to inmates, even in the most serious cases.

Hepatitis C slowly damages the liver, often leading to severe scarring, called cirrhosis.  It wasn't until October 2016, according to statements by prison medical staff, that the corrections department instituted a policy to determine which Hepatitis C patients would get the new treatment and then began administering the drugs. 

A Louisiana Department of Health spokeswoman confirmed that some Hepatitis C patients on Medicaid received the treatment as early as 2014. 

Nurse Practitioner Elizabeth Britton, who is contracted to provide care at the liver clinic at Elayn Hunt Correctional Center where inmates with the most serious Hepatitis C cases receive care, talked about how inmates were handled differently than others.

As early as the beginning of 2015, Britton said, her Medicaid patients with the virus outside of the prison were receiving the treatment but she was not yet given the go-ahead by the prison. 

In 2014, 2015 and 2016 — the years from when the drug was federally approved and when it was first prescribed for inmates in Louisiana state prisons —15 inmates died of complications associated with Hepatitis C at Elayn Hunt Correctional Center, according to records from the Department of Corrections.

However, data from 2017 and 2018 showed that in those years — after the prison's policy took effect for administering the new Hepatitis C treatment to some of the sickest patients —  10 inmates died at Elayn Hunt of complications that appear to be linked the virus, corrections data showed.

Corrections spokesman Ken Pastorick noted that no one dies directly of Hepatitis C, so their medical staff had to determine which cases were due to complications that may be associated with the virus. It is unclear how many inmates housed at other prisons died of Hepatitis C during this time period. 

State corrections officials declined to provide the names of the inmates who died of complications associated with Hepatitis C, and therefore The Advocate could not request their autopsies. 

“Plaintiff strongly believes that the defendant would rather let Plaintiff continue to suffer until some affordable treatment is made available which clearly means that this defendant has chosen to save the State money rather than to save plaintiff’s life," one of the lawsuits says. 

Inmates Richard Henderson, Tony Cormier and Levell Doughty, who are all housed at Elayn Hunt Correctional Center in St. Gabriel for treatment at their Liver Clinic, each claim the corrections department violated their 8th and 14th amendments, by making medical decisions based on cost and neglecting their care.

“This callous disregard for the health and safety of Henderson was not a negligent act but a deliberate indifference to his health and safety," the first lawsuit, filed in 2015 states. “This egregious failure caused Henderson to be in constant fear of organ failure.”

The state's response in the cases of both Henderson and Cormier says both received care and medical treatment up to the standards that were in place in 2014. The response does not detail any further care they got until 2017,when they became candidates for the new, expensive treatments.

In between those years, prison officials reported that they were monitoring the conditions of the two inmates and that they remained stable, according to motions filed on behalf of prison medical officials.

In a deposition, Raman Singh, the former medical director for the Department of Corrections, said that cost was only "one of the many concern" in this decision, including medical research, availability and operational policies. Singh was fired in 2017 after an investigation found he sexually harassed another employee. 

A settlement conference in Henderson and Cormier's cases is scheduled Monday, where Long said he's hopeful of reachingan agreement between his clients and the prison agency. Doughty's case remains in discovery. 

Follow Grace Toohey on Twitter, @grace_2e.