ABCs of hepatitis: What’s the difference between A, B, and C?
Hepatitis C eroded Mike Jones’ liver for years, even as he made repeated trips to the Kansas City VA Medical Center to be treated for a variety of other ailments.
VA staff members knew that Jones had hepatitis C. They’d known since at least 2006. But according to a lawsuit, from 2012 to 2015, Jones didn’t get any of the regular scans or ultrasounds that patients with the condition should get. He also didn’t get drugs approved in 2014 that are highly effective at curing it.
By the time the VA staff realized Jones had fallen out of the regular treatment protocol, his condition had deteriorated into fatal liver cancer, according to the suit filed on behalf of Jones’ daughter.
“There was a failure of protocol, both within the hospital (standards) and national standards for monitoring these patients,” said her attorney, Edward Stump. “They’re supposed to deal with these guys with their conditions, usually it’s twice a year — CT scans and ultrasounds of the abdomen, full physicals, full bloodwork, and those weren’t being done.”
Stump said Jones isn’t the only Kansas City VA patient to die due to complications from hepatitis C.
In March Stump settled a similar case for a Navy veteran, Jerry McGinnis, who has since passed away. And he thinks there are more out there.
“I don’t expect this to the be the last one we see,” Stump said.
Seth LaBean, a spokesman for the Kansas City VA Medical Center, said via email that it doesn’t typically comment on pending litigation, but said the center “offers a robust hepatitis C treatment program” and follows national VA guidelines that call for all hep C patients to be evaluated for treatment with the life-saving medications, to have regular blood tests reviewed by physicians and for those with certain symptoms to be seen by hep C specialists.
With a pharmaceutical cure now available, the national VA system has set a goal of eliminating hepatitis C within its patient population in the near future.
But the Jones and McGinnis lawsuits suggest that the hurdles that effort faces could be more bureaucratic than biological.
Hepatitis C is common in military veterans, especially those of the Vietnam War era like Jones, because it’s blood-borne and can be spread through battlefield transfusions, tattoos or potentially the air-gun injectors the military used to use to dispense vaccines to lines of new recruits, one after another.
Almost 150,000 veterans were affected with hep C when the first drugs to cure it, Sovaldi and Harvoni, hit the market in 2014.
At first, the VA reserved the drug only for its sickest patients, because at $84,000-$94,500 for an entire course of treatment, it would have crippled the agency’s budget to make them widely available.
In March 2016, then-VA Secretary David Shulkin announced that by negotiating a much lower price and getting more funding from Congress, the VA would be able to make the drugs available to every patient with hepatitis C, regardless of its stage.
The VA has made significant progress toward eliminating the illness since then.
But getting the meds to everyone who needed them comes with logistical challenges. One is just identifying those in need.
The VA has been screening at-risk veterans since 1998, but by 2012 only about half of the 5.5 million veterans in the system had been tested, according to HCV Advocate, a nonprofit that supports hepatitis C patients.
The group estimated that if all of the veterans from the baby boomer generation were tested, an additional 51,000 cases would be found.
Stump said Jones was screened and properly diagnosed. But over the years the VA’s gastroenterelogy clinic in charge of his hep C treatment seemed to just lose track of him, even though he was at the medical center regularly for other things.
By the time they recognized the problem, Stump said, Jones had Stage IV cancer and there was nothing that drugs could do for him.
“For three years they did nothing and he was going back in constantly for shoulder stuff, for back stuff,” Stump said. “They just weren’t doing it. They weren’t surveilling. Their surveillance of guys with these liver problems is awful. That’s why we’re doing these lawsuits.”
Stump said it’s incumbent upon patients to take charge of their own medical care, ask if they’re getting all the necessary followup tests and treatments and demand to get them if they’re not.
He said seeing military veterans slowly and painfully waste away because of preventable liver cancer has been one of the toughest things he’s ever witnessed in his professional life.
“We’ve seen two guys dying,” Stump said. “We hope these suits are making them aware of what certainly was a problem.”