In August, 250 inmates in Vermont prisons had hepatitis C, but just eight of them received treatment for the infectious, potentially deadly virus that can damage the liver. The number of those treated is actually an increase over 2017, when the Vermont Department of Corrections appears to have provided hepatitis C medication to just one inmate, according to its own data.

The state’s chief health care advocate, Michael Fisher called the statistics “very, very concerning.”

Fisher was part of a coalition of organizations that successfully pushed the state’s Medicaid health insurance program to start paying this year for hepatitis C medication for patients who don’t yet have liver damage.

Now advocates are turning their attention to Vermont’s prisons, where alarmingly few inmates are receiving the antiviral drugs that can cure hepatitis C, according to Fisher.

Prisons are required to provide medical services on par with what’s offered in the community. “Denial of medical care is not supposed to be part of the punishment, and the courts have been really clear about that,” Fisher said.

At least nine states have been sued for denying hepatitis C treatment to inmates. The American Civil Liberties Union of Vermont hasn't sued but is part of the coalition pushing for expanded treatment for prisoners in the Green Mountain State.

“By and large, courts are siding with inmates and saying … ‘Yes, it is a violation of their Eighth Amendment rights not to provide the cure, and no, you cannot deny them this treatment because it’s expensive,’” said Jay Diaz, an ACLU of Vermont attorney.

The cure is costly, but competition among pharmaceutical companies has driven down the price from $84,000 several years ago to less than $30,000 today.

Vermont DOC spent $47,250 on treatment in 2017 and, as of August, $144,964 in 2018, according to data it provided to Seven Days.

Ben Watts, health services director for the DOC, said the department is providing treatment that meets the community standard.

Newly diagnosed patients are monitored for six months “to see if they spontaneously ‘clear’ the virus,” Watts wrote in an email. If the disease doesn’t go away, medical staff may use a scoring system called Fibrosis-4 that quantifies liver damage to help determine whether treatment is necessary. However, Watts wrote that “patients are considered for treatment regardless” of that score.

He also noted that the University of Vermont Medical Center has provided guidance on the department’s treatment practices.

To Fisher, the fact that so few inmates get the treatment “really raised a number of red flags for us.” According to data his office requested from the state, the only inmates the department had treated as of June 2018 had already developed liver damage. The health care advocate, who plans to bring his concerns to lawmakers Thursday at the Statehouse, made the case that more than the individual patient’s health is at stake.

“This really is a public health concern,” Fisher said. “Hepatitis C is a treatable infectious disease, and the best way to deal with an infectious disease is [to] decrease the number of people who have it through treatment.”

Advocates suggest prisons are a key place to combat the disease. Studies have shown that the blood-borne virus, transmitted through unsafe transfusions or contaminated needles, is more prevalent among inmates than the general population.

“To not cure a disease when we have an opportunity is a real failing,” Diaz said.