Court Issues Final Order in Prison Class Action Requiring Treatment for All Incarcerated People with Hepatitis C

On April 18, 2019, Judge Mark Walker of the U.S. District Court for the Northern District of Florida issued a final order in the Florida Justice Institute’s (FJI) prison class action, granting the plaintiffs’ request to require the Florida Department of Corrections (FDOC) to provide treatment to all incarcerated people with Hepatitis C (HCV), including those at the earliest stages of the disease.  The Court also required the FDOC to improve its identification of people with the disease, either by employing routine opt-out testing (testing everyone unless they decline), or by using their existing testing method paired with a system of peer education.  The Court also required the FDC to close some of the loopholes in its existing policy, to ensure that patients are not improperly excluded from treatment because they have insufficient time remaining in prison, and that any exclusion is based on truly medical criteria.  This case affects roughly 20,000 to 40,000 Florida prisoners.

“This case is a victory for public health in Florida,” said Dante P. Trevisani, Executive Director of the Florida Justice Institute (FJI).  “As a result of this court’s order, thousands of people will be treated for hepatitis C and will no longer be at risk for cancer, liver disease, and premature death.”

The Court also required the FDOC to make elastography available to its medical staff, a type of imaging technology that more precisely measures the amount of scarring on the liver.  The order also requires FDOC medical staff to provide to anyone who refuses treatment with sufficient information about the disease to ensure that the refusal is informed.

“Before we filed our case, over one hundred prisoners in Florida died of a curable disease,” said FJI attorney Erica Selig.  “While our case was still pending, our client Carl Hoffer died waiting for a liver transplant.  This order will prevent further suffering and deaths, like Mr. Hoffer’s, in Florida’s prison system.”

FJI initially filed this case in May of 2017, accusing the FDOC of failing to provide incarcerated people with life-saving medications for hepatitis C, resulting in thousands being left at risk for liver failure, liver cancer, and a painful death.  The Complaint described how treatment of HCV was revolutionized in 2013 with the advent of direct-acting antiviral (DAA) drugs, which cure 90 – 95% of all hepatitis C patients, regardless of the form of the disease, with little to no side effects. In November 2017, the Court issued a preliminary injunction, requiring the FDOC to provide treatment to prisoners by certain deadlines depending on the severity of their disease, but not requiring treatment for those at the earliest stages of the disease.

Since the entry of the preliminary injunction order, FJI filed a motion for summary judgment, asking the Court for a final injunction with several more requirements.  The order largely granted that request.

Florida’s Department of Children and Families had already recognized that the standard of care, developed by medical societies and available at, was to provide direct-acting antiviral medications to everyone diagnosed with chronic HCV, regardless of the stage of the disease, by approving Medicaid coverage using that standard.  The Florida prison system will now follow suit.

The case was originally headed by Randall C. Berg, Jr., who passed away last week. The case is Hoffer v. Jones, Case No. 4:17-cv-00214-MW-CAS.

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