Inmates With HIV Lose Medication Access Spat

BOSTON (CN) - Cost-cutting measures that force HIV-positive prisoners in Massachusetts to wait on line for their meds aren't cruel or unusual, the 1st Circuit ruled.

Though the Massachusetts Department of Corrections used to let HIV-positive prisoners get monthly or semimonthly medication supplies and store them in their cells, the commonwealth switched to a dispensing window in early 2009 as a cost-saving measure. In addition to preventing waste, officials believed that abandoning the previous "Keep on Person" program would increase the success of the medications to keep viral counts low among the HIV-positive inmate population.

Richard Nunes and four other unnamed inmates sued in November 2012, seeking an injunction but not damages.

A three-judge panel of the 1st Circuit affirmed Thursday, however, that Massachusetts did not violate any constitutional rights with the policy change.

The ruling notes that the dispensing windows came into practice after officials studied potential effects to address complaints. They did not find any issues.

"Medication for HIV is expensive, occupying more than 40 percent of the [prison] department's pharmacy budget, although fewer than 3 percent of prisoners have HIV," Judge William Kayatta wrote for the three-judge panel.

The Corrections Department also learned that the new system helped reduce the viral load percentage among prisoners. While 83 percent of inmates had undectable viral loads before the policy change, that figure is down to 95 percent today.

Nunes, the named plaintiff, maintained that back pain and chronic diarrhea prevents him from getting on the dispensary line and thus reduces his medication access.

Rather than let Nunes get his meds all at once and keep them in his cell, however, the prison system countered with alternative accommodations: that he be given a rolling walker, and that he be allowed to sit on a bench while waiting for his meds without losing his place on line.

Alternatively, the prison system offered to admit Nunes to the medical unit.

Nunes declined all offers, the court found.

The other four plaintiffs have used the daily med line, but say their HIV status is now disclosed to other inmates because they're forced to wait on line for them.

None of the plaintiffs offered any evidence, however, that the new system has affected their viral loads or that their health has worsened because of it, according to the ruling.

"Even viewed in light most favorable to the plaintiffs, none of this testimony establishes that any plaintiff has actually received medical care falling below professional standards," Kayatta wrote.

Furthermore, inmates do not have the same privacy rights as someone not incarcerated.

"For those in prison, however, any right to privacy is inevitably diminished," the ruling states.

Requiring HIV-positive prisoners to stand on a medication line is not a "burdensome access," the court said, adding that it found "no evidence of any intent by the department to impose that burden on plaintiffs because they have HIV."

"In sum," Kayatta concluded, "even viewed favorably to the plaintiffs, the record shows that the department provides meaningful access to HIV medications through the daily med line; and its decision to provide access in that manner is driven by cost savings backed up by data suggesting a positive, or at worst neutral, impact on the health of the HIV-positive prison population."

"On such a record," the court found "no jury would find for plaintiffs on their disparate treatment claim."

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