Hoffer v. Jones

290 F. Supp. 3d 1292
CourtDistrict Court, N.D. Florida
DecidedNovember 17, 2017
DocketCase No. 4:17cv214–MW/CAS
StatusPublished
Cited by17 cases

This text of 290 F. Supp. 3d 1292 (Hoffer v. Jones) is published on Counsel Stack Legal Research, covering District Court, N.D. Florida primary law. Counsel Stack provides free access to over 12 million legal documents including statutes, case law, regulations, and constitutions.

Bluebook
Hoffer v. Jones, 290 F. Supp. 3d 1292 (N.D. Fla. 2017).

Opinion

I. Findings of Fact1

A. Hepatitis C and the Progression of Liver Disease

HCV "is a viral infection, which is spread by exposure to blood or blood products." Pls.' Ex. 28, at 3.2 The most common way of contracting HCV is through intravenous drug use, but a person can also get infected through tattooing or blood transfusions. Id. "The principal consequence of [HCV] infection is infection of the liver, which causes inflammation that in turn may result in scarring of the liver (fibrosis)." Id.

Unlike a scar on your skin, scarring of the liver can have severe consequences. "Liver scarring can significantly impair liver function and damage its crucial role in filtering toxins from the blood, as well as making proteins involved in liver clotting and fighting infections." Id. Moreover, liver scarring places patients "at risk of liver failure or liver cancer." Id.Liver failure carries with it a host of serious symptoms, including bleeding from any site, fluid accumulation in the legs or abdomen, life-threatening infections, and failure of other organs such as the kidneys. Id. Liver cancer is essentially untreatable, and "has a very dismal prognosis." See id.

The amount of liver scarring a patient has is usually measured on the METAVIR scale. Id. at 7-8. On this scale, a person can be classified F0 (no fibrosis), F1 (mild fibrosis), F2 (moderate fibrosis), F3 (severe *1295fibrosis), or F4 (cirrhosis ). ECF No. 138, at 166.3 The rate at which patients progress along this scale differs among the population. Defendant's Exhibit 1 includes a useful flowchart demonstrating this difference in progression:

Def.'s Ex. 1.

As can be seen in the flowchart, about 20-50% of people infected with HCV spontaneously clear the virus within six months of infection. ECF No. 138, at 58. The remaining 50-80% who don't clear the virus are referred to as having chronic HCV. Id.

Among those with chronic HCV, about 30% of patients maintain a stable chronic infection, 40% suffer from slow fibrosis progression, and 30% suffer from rapid fibrosis progression. See Test. of Dr. Dewsnup.4 Patients with a stable chronic infection usually only reach F1 (mild fibrosis) as long as they maintain other healthy habits such as abstaining from alcohol. See Test. of Dr. Dewsnup. Patients with a slow fibrosis progression may take upwards of 20 years to reach F4 (cirrhosis ). Id. Finally, patients with a rapid fibrosis progression may reach cirrhosis within as short a timeframe as one year. Id.

The extent of liver scarring a patient has does not necessarily correlate with the symptoms they are suffering. For instance, "[s]omebody can be completely asymptomatic and present with cirrhosis." ECF No. 138, at 51. Nor do "symptoms have anything to do with what the risk is of liver failure." Id. at 113.

*1296Once a person reaches F4 (cirrhosis ), they are further classified based on whether they are suffering from HCV-related symptoms/complications. A patient with cirrhosis and no related complications is referred to as having compensated cirrhosis. Id. at 49. On the other hand, a patient with cirrhosis that is accompanied with complications is referred to as having decompensated cirrhosis. Id. The distinction between these two groups is important because their survival rates are markedly different. Whereas the five-year survival rate for someone with compensated cirrhosis is 91%, the five-year survival rate for someone with decompensated cirrhosis is only 50%. Pls.' Ex. 28, at 6-7. Once a person has decompensated cirrhosis "their liver has truly failed." ECF No. 138, at 99. At that point, "the only true curative treatment is a liver transplant." Pls.' Ex. 28, at 11.

B. Treatment of Hepatitis C

Historically, HCV has been "difficult to treat." Id. at 9. One old method of treatment involved the drugs Interferon and Ribavirin. ECF No. 138, at 62-63. That treatment required weekly injections and could take as long as twelve months to complete. Id. ; Pls.' Ex. 28, at 9. The side effects were "terrible." ECF No. 138, at 62. Taking the treatment was akin to "having the flu for a year." Id. "People's hair fell out, they had rashes, they had chest pain, they felt suicidal, [and] some committed suicide." Id. at 63. Despite these side effects, doctors still prescribed the treatment when patients had a high level of liver scarring because "the likelihood of getting to cure, which was still only about 30 percent, was better than those terrible side effects." Id.

But in late 2013 a new class of drugs known as direct-acting antivirals ("DAAs") were released to market. Id. These DAAs proved to be "a revolution in medicine." Id. Treatment with DAAs consists of taking a pill once or twice a day. See id. ; see also Pls.' Ex. 28, at 10. The treatment period with DAAs is only about twelve-weeks long. ECF No. 138, at 64. Moreover, DAAs have "very few" side effects. Id. Most importantly, about 95% of patients who take DAAs are cured of HCV. Id.

Unfortunately, this revolution in medicine came with a price. DAAs "are very expensive." Id. at 74. In September of 2016, a single course of treatment with DAAs cost approximately $50,000 to $75,000. ECF No. 151, at 34.5 Even though prices have been going down as new DAAs are released, a single course of treatment may still cost $37,000 today. Id. at 45.

Despite the high cost of DAAs, the present-day standard of care is to treat chronic-HCV patients with DAAs as long as there are no contraindications or exceptional circumstances. It is inappropriate to only treat those with advanced levels of fibrosis. ECF No. 138, at 66-67, 73; see also Test. of Dr. Dewsnup. The HCV Guidance-a resource developed by the American Association for the Study of Liver Diseases (AALSD) and the Infectious Diseases Society of America (IDSA)-recommends giving DAAs to any patient with chronic HCV (absent certain contraindications). See Pls.' Ex. 6.6

C. The Plaintiffs

The named Plaintiffs in this case are Carl Hoffer, Ronald McPherson, and Roland Molina. All three are inmates in FDC custody and are infected with HCV. Mr. *1297Hoffer currently suffers from decompensated cirrhosis, and Mr. McPherson and Mr. Molina have compensated cirrhosis. ECF No. 138, at 136-42.

FDC has known about the Plaintiffs' conditions for years. Mr. Hoffer likely had cirrhosis as early as 2012 and likely developed decompensated cirrhosis"around the midpoint of 2014." Id. at 136. Mr. Hoffer needs to be referred for a liver transplant evaluation. Id. at 138. Mr. Hoffer should have been treated "as early as 2012 or certainly by 2014." Id. at 137.

Mr. McPherson has HIV in addition to having chronic HCV. Id. at 139. Doctors realized that Mr. McPherson had cirrhosis during a gallbladder surgery in 2015. Id. Mr.

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Bluebook (online)
290 F. Supp. 3d 1292, Counsel Stack Legal Research, https://law.counselstack.com/opinion/hoffer-v-jones-flnd-2017.