South Dakota plans major ramp-up of hepatitis C treatment in prison

WASHINGTON — The head of South Dakota prisons is pledging to dramatically overhaul how the system treats hepatitis C in the coming year.

South Dakota’s new hepatitis C policy for incarcerated people, which is not yet final or public, will treat all people with hepatitis C for the virus, regardless of the stage of their infection, Corrections Secretary Kellie Wasko told STAT in an interview Monday. The policy will also mandate that all people being booked into prison be tested for the virus, she added.

“Everybody will be treated,” Wasko said. “That is the goal.”

Wasko’s remarks come just weeks after a major STAT investigation that named the state one of the worst in the nation for hepatitis C care for incarcerated individuals. STAT found, through public record requests, that South Dakota treated just seven people last year for the virus, thanks to a policy that required people to get seriously ill before they could get treatment.

STAT’s series “actually helped me to move my agenda along — to say ‘See, this is what I’ve been talking about for two months,’” Wasko said. “We needed that.”

Wasko, who was hired in early 2022 and is a trained nurse and correctional health care specialist, called the state’s previous treatment rates and policies “not acceptable” and “not consistent with [the] community standard of care.” She said she’s been working to revise the state’s protocols since last fall, after the Department of Corrections took full responsibility for managing prison health care. It was previously managed by the state’s health department.

“We will be doing better,” she said, adding that the previous officials in charge of treating hepatitis C “had done the best with what they thought was good care.”

Wasko said that though the new formal policy isn’t quite finished, her department is already training medical staff on the new policy, and that they could begin prescribing the curative therapies to incarcerated people in the next week to ten days.

Initially, South Dakota will prioritize people for treatment based on a liver metric known as APRI. Wasko told STAT her goal is to have all patients in the first priority group, an estimated 200 individuals, into treatment within ninety days.

By 2024, everyone coming into South Dakota prisons with hepatitis C should be able to begin treatment “within two or three weeks,” Wasko pledged, when asked by STAT how people should judge her state’s progress.

Achieving Wasko’s overall goals will be easier said than done. While hepatitis C is curable with a roughly 12-week course of a once-daily pill, correctional systems larger and more well resourced than South Dakota have struggled to make such dramatic inroads in such short timelines — and there are a number of stumbling blocks South Dakota will have to contend with along the way.

First, the state does not have a true picture of how many people in its care actually are infected with the virus because it hasn’t been testing everyone. The Department of Corrections currently knows of nearly 400 people with the virus, but Wasko acknowledged that the number of people known to have the infection is likely to grow as the state begins testing more and more.

South Dakota will also have to come up with the money to pay for the treatment, which still retails for roughly $24,000 per person. Wasko largely downplayed the budget impacts of dramatically ramping up treatment. She said her plan is to start people on treatment and then worry about whether she needs more money.

“Right now I’ve just told [medical staff] to responsibly start treating patients and we will assess in about ninety days,” Wasko said.

The speed of her promised turnaround is striking but it is not altogether out of character for Wasko. She previously served as the deputy executive director for the Colorado Department of Corrections, and during her tenure, Colorado dramatically improved its own hepatitis C treatment rates. Her hepatitis C-specific pledges are also just some of many promises she’s made to transform the state’s prison system overall, including improving serious understaffing.