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Veteran can't get treatment for hepatitis C

By JIM HOOK | Public Opinion, Chambersburg, Pa. | Published: July 21, 2015

GREENCASTLE, Pa. (Tribune News Service) — Adam Shaffer, a disabled veteran with two tours in Iraq, discovered that the Department of Veterans Affairs has a cure for one of the things that ails him.

Only thing is: He can't get it.

"With Hepatitis C, the government doesn't have enough money to give veterans the pills," said the 30-year-old Shaffer. "They put you on a waiting list, and it's long. You can't get any treatment. It will kill you."

Hepatitis C, or HCV, is just one affliction haunting Shaffer since the private first class was injured in 2010. An improvised explosive device destroyed his Humvee. He's 70 percent disabled from post traumatic stress disorder. He suffers from depression and bipolar disorder.

Shaffer sometimes looks at the ceiling when he talks as if he is trying to pull his words out of the air. He's proud of his tattoos — a purple heart and his dog tags.

"It was great. I loved the service," he said. "I wanted to make a career of it, and I didn't. They didn't want me after the explosion. Now I suffer from not being able to communicate."

For Shaffer HCV is for sometime in the future. It is a time bomb. After decades of infection a victim's liver is scarred, sometimes to the point of cirrhosis. The viral infection is a leading cause of liver cancer and transplants in the U.S.

When sofosbuvir, approved in late 2013, is combined with other drugs, it cures about 90 percent of HCV cases. A pill costs about $1,000 retail, or $600 at the discount to the VA. A typical regimen of 12 to 24 weeks costs $50,000 to $100,000, so the price tag to serve the more than 170,000 HCV veterans would cost the VA more than $10 billion.

Shaffer said he visited the VA Center in Martinsburg, West Virginia, two months ago and asked about the new treatment for Hepatitis C. The official told him that there was a waiting list.

"He took out a big piece of paper" with names on it, Shaffer said. "There is a cure, but they're not giving it to you. They don't have the money. How does it not have the money? He just like pushed me away. So the VA isn't taking care of veterans?"

The Martinsburg VA Center did not answer a reporter's specific question whether there is a waiting list for HCV treatment. Sarah M. Tolstyka, spokeswoman for the VA center, said that after veterans with Hepatitis C are evaluated for appropriate medications, they "are selected for treatment based upon their disease progression, their high likelihood of complying with therapy, and completing the entire treatment. The treatment regimen lasts eight to 24 weeks, depending upon the viral genotype and the veteran patient's response to treatment."

More than 6,000 veterans in 2013 were being treated for HCV in the Baltimore-Washington region covered by Martinsburg and four other VA medical centers, according to a 2014 VA report on the State of Care for Veterans with Hepatitis C. The number has been growing as health screenings identify more veterans with HCV.

USA Today reported on June 21 that the VA has run out of money for HCV treatment just as patient loads are surging. The VA is preparing to shift treatment to private providers. The move would allow the VA to use money from the Veterans Access, Choice and Accountability Act, a $16.3 billion funding and reform measure passed last year with the intention of easing the backlog of veteran appointments for health care.

The plan includes instructions generally to give the sickest veterans top priority for treatment, according to USA Today. Veterans' advocates have criticized a specific provision that patients who have less than a year to live or who suffer "severe irreversible cognitive impairment" will not be eligible for treatment.

Vietnam veterans are service members most at risk for HCV. One in 10 has the infection with 60 percent testing positive. Veterans were exposed to immediate transfusions and blood contact in combat or training. Screening blood for HCV did not improve until 1992.

But the most common way to get the virus is by sharing needles.

Shaffer said he got Hepatitis C through drug use. The VA stopped prescribing pain pills for his back problem and he switched to heroin.

"It was easy. It was there," Shaffer said. "They have the (pain) pills, but they're not giving them the pills."

He cleaned up in VA rehab.

How does he deal with the pain now?

"I drink alcohol," he said.

The drinking has led to a host of other problems, including a run-in with the law and a jump start toward cirrhosis.

"He doesn't realize what he does sometimes," said his wife, Megan, "and he tries to self-medicate."

Shaffer joined the Army shortly after graduating in 2003 from Greencastle Antrim High School. By 2004 he was a combat engineer in Iraq.

He succinctly describes the tragedy the came in the middle of his second tour.

"We were in a convoy," he said. "We hit an IED and it blew up. There was blood everywhere. It was horrible."

He was flown out of combat and out of the country.

"Because of the accident in Iraq I wasn't able to feel," Shaffer said. "I was numb. You see stuff you don't want to talk about. It just changed me completely."

He said his buddy also survived and is on a feeding tube for the rest of his life.

After he left the service he was diagnosed with PTSD and was an inpatient at Martinsburg VA for three months.

"I'm disabled. It's annoying," Shaffer said. "I do feel abandoned. They can't help me."

©2015 the Public Opinion (Chambersburg, Pa.)
Visit the Public Opinion (Chambersburg, Pa.) at www.publicopiniononline.com
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Sovaldi (sofosbuvir) costs $1,000 per pill, or $84,000 for a 12-week treatment course.
BOB ECKER/TNS

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