Medicine with a Mission

In the state’s prison population, “we knew we had an issue, and we knew we had to deal with it.”

The “issue,” said Kathleen Bachmeier (MSN ’90), director of medical services at the North Dakota Penitentiary in Bismarck, is the explosion in the number of inmates who have contracted active hepatitis C due to drug use (mostly methamphetamine) or infection from tatooing with dirty needles. 

Research conducted by a team of four physicians and two nurses has demonstrated that an alternative, less costly drug regimen is effective for treating prisoners with hepatitis C. The  team includes Kent Martin, M.D., clinical associate professor of family medicine; Jeff Hostetter, M.D. (Bismarck Family Medicine Residency ’03), assistant professor of family medicine and assistant program director at the UND Center for Family Medicine-Bismarck; Olimpia Rauta, M.D. (Bismarck Family Medicine Residency ’06); John Hagan, M.D., clinical assistant professor of internal medicine, with the North Dakota State Prisons Division; Bachmeier, and Beth Taghon, a nurse at the state penitentiary, all of Bismarck

At the Center for Disease Control’s National Hepatitis C Conference last year, they presented a poster on their preliminary findings about the efficacy of a hepatitis C treatment that is given to prisoners in the state’s correctional facilities.  They explained their initial success in treating hepatitis C with consensus interferon rather than peginterferon alpha-2b, the more common regimen.

Spike in meth use reflected in prison population

The epidemic rise in methamphetamine use in North Dakota has fueled a huge increase in the number of prisoners who have active hepatitis C in North Dakota prisons.  The increasing prevalence of the disease is “striking,” said Hagan, who teaches UND medical students and residents in Bismarck. “It’s been explosive as the rate of IV meth use has grown.” 

In order to address this public health emergency, the medical staff at the state’s Department of Corrections and Rehabilitation (DOCR) enlisted the help of Martin, infectious disease specialist with the Quain & Ramstad Clinic in Bismarck.  Martin and Hostetter, who have been working in this area for several years, agreed to track and write up the results.   

Initial treatment with peginterferon alpha-2b proved to be too costly to maintain for the large number of prisoners who require treatment, Martin said.  In addition, the side effect rate in the prison population was unacceptably high, and treating these side effects is costly.  His research uncovered little-known data that showed consensus interferon could be equally efficacious and has a much lower side effect rate. 

The DOCR implemented this treatment regimen and Hostetter, Hagan and Rauta have tracked the results. 

Alternative treatment reduces cost

Initial data is very promising and patients are tolerating the therapy much better, according to Martin.  Added advantages are: the cost of medications is 35 percent less and the need for subspecialty referral has declined to near zero. 

Using the standard regimen, the cost of treating a prisoner was $22,000 per year; with the alternative treatment, that cost has been lowered to $14,000. The result has been an effective treatment regimen that is sustainable within the current medical budget of the DOCR.

“We were able to show excellent treatment results,” he said.  “Our results of success and treatment are as good or better (than the traditional regimen). We are able to treat many more people and bring more effective treatment to more people.”

“Even if we haven’t changed behaviors, the inmates we’ve treated -- when they’re released -- won’t be able to infect anyone else,” he emphasized.                                             

The group is pleased that initial findings have been well-received. Data collection is ongoing and there are plans to submit final results for publication.

‘Really a team effort’   

“It’s a wonderful partnership,” said Bachmeier, who championed the project and requested the state legislature to fund it. “The prison couldn’t have done it alone.  This is really a team effort... We’ve done all this with no extra money.  It started from very, very humble, modest beginnings.”

“We work with people who really want to change their lives,” she said.  “We want to be good stewards of the state’s money; we select prisoners who are compliant with the drug and alcohol treatment and are stable emotionally,” based on psychiatric assessment.  Prisoners must go through six months of close monitoring before ever entering into treatment.

In what might be described as a snowball effect, Martin and Hostetter were invited to present their findings at a meeting of the American Corrections Association in August at Charlotte, NC.  And the CDC has approached the researchers about “putting our program on their Web site as an outstanding prisons hepatitis C model,” Hostetter said. 

A resouce for the state

“One of the roles of physicians, residents and faculty in state-supported academic medical institutions is to be a resource for the state,” Hostetter said.  “This is the perfect setting where the UND Department of Family and Community Medicine can assist another state agency by utilizing our resources to enrich their programs.

“It is important for resident-physicians to be involved in research in order to teach them how progress in medicine is truly made,” he emphasized.  “Most significant medical advances can be traced to community clinicians who have made astute observations that researchers have only further elucidated.

It is important for faculty to give residents the skills to function in this arena of family medicine as well as day-to-day clinical practice.”

-Pamela D. Knudson

return to top