Spending cutbacks see prisoners denied new hepatitis C treatment

Interior Ministry instructs head doctors to establish quota system

Trinidad Barrera holds up a photo of her son, who is waiting to receive the new triple hepatitis C treatment.
Trinidad Barrera holds up a photo of her son, who is waiting to receive the new triple hepatitis C treatment.JULIÁN ROJAS (EL PAÍS)

The government is restricting prisoners from accessing new medication that greatly increases their chances of recovery from hepatitis C, a disease that affects nearly 25 percent of the prison population, according to figures from the Spanish Society for Penitentiary Health.

Alleging budget cuts, the Interior Ministry - through the General Office of Penitentiary Institutions - has sent head doctors at Spain's prisons letters explaining that there is no money to treat all the inmates who might benefit from the new therapy, and that a quota system will be established with waiting lists for sick prisoners.

In late 2011, the Spanish Medicines Agency approved a new treatment that increases the chances of recovery for hepatitis C patients, especially those infected with genotype 1, the most common form of the virus, representing 75 percent of all cases. The treatment is based on a triple therapy that combines a new drug (either boceprevir or telaprevir) with the usual pegylated interferon and ribavirin. According to several studies, success rates shot up to 75 percent as a result of the new triple therapy, compared with around 50 percent using just the two latter drugs.

In February 2012, the drug agency issued recommendations regarding the types of patient who should try triple therapy, and regional public health services have been following these criteria and administering the new treatment for a year (even though the Spanish Association for Liver Studies has complained that the regions of Asturias, the Balearic Islands, Aragón and the Canary Islands are restricting access to the new treatment, which costs more money). Experts said the price of the classic double therapy is around 6,000 euros a year (therapy typically lasts one year), while the triple treatment raises the cost to between 44,534 and 59,629 euros, according to a report by the General Pharmacy Office in the Valencia region.

Hepatitis C affects nearly 25 percent of the prison population

But the incidence of hepatitis C inside prisons is significantly higher than on the outside. Figures gathered by the Spanish Medicines Agency estimate that the infection rate in the Western world is between 1.5 percent and 3 percent of the total population, yet among the prisoner population it rises to 25 percent.

One of the eligibility conditions imposed by penitentiary authorities is that patients should be convicted, rather than preventive prisoners, to try to ensure they will be in prison for the entire duration of the treatment.

According to Antonio López Burgos, president of the Spanish Society of Penitentiary Health, there have been at least 15 requests for the triple treatment at Spanish jails for hepatitis C patients who meet the requirements and have been prescribed the treatment by a specialist, yet only one has ultimately been authorized. López Burgos claims that the Interior Ministry even released one prisoner ahead of time in order to avoid the cost of treating him.

Catalonia, the only Spanish region with power of self-rule over the prison system, has authorized five triple therapy treatments for a population of 10,000 inmates, compared with more than 65,000 in the rest of Spanish prisons.

The hepatitis therapy restrictions are not the only effects of the budget cuts

"They are very delicate patients. We have to act now or we could lose them," warns López Burgos, noting that untreated hepatitis C typically develops into cirrhosis and liver cancer, in which case the only chance of survival lies in a liver transplant, which is a lot more expensive.

Restrictions to hepatitis C triple therapy are not the only effects of the budget cuts reported by prison doctors. Until now, larger penitentiaries had 24-hour medical service, but since January 1 many have no afternoon visits. Among the prisons in question are Murcia I, Jaén, Valladolid and Madrid I.

"What we are seeing is a gradual elimination of doctor's shifts as a result of budget cut criteria, but no studies have been provided to explain what savings this change would allegedly entail," says López Burgos. "We cannot forget how isolated prisons are, almost always quite a few kilometers away from a hospital. This will delay emergency medical assistance, sometimes dramatically."

The son of Trinidad Barrera, a 72-year-old woman from Seville, is one of the inmates waiting to receive the triple treatment. A doctor at Virgen del Rocío hospital prescribed it, but the therapy has yet to begin. "I was talking to the doctor last Friday and he told me that my son needs these medicines, that they need to administer them now," she says in tears. Her son, Manuel Jesús, 40, has been in jail for five years for petty theft and minor drug dealing.

Trinidad Barrera turned for help to the Andalusian Ombudsman, which filed a complaint with penitentiary authorities. The answer, dated January 22, confirms the existence of budgetary restrictions. "A register of these types of patient has been created [...] and measures will be taken to facilitate respective treatment to all the patients, with the regularity allowed by available resources and considering the budgetary impossibility of treating all cases immediately and concurrently."

Manuel Jesús' mother, who has not seen her son for two months, says she is now thinking of selling her house to raise money for the therapy. "All I ask is for him not to die in jail."

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