Homeless drug users are being left to die, doctors warn

HSE is failing to give lifesaving treatment to homeless people with hepatitis C, expert says

The HSE is failing those most in need of treatment that can cure hepatitis C, according to an infectious diseases consultant at the Mater hospital. Photograph: David Cheskin/PA Wire

The HSE is failing those most in need of treatment that can cure hepatitis C, according to an infectious diseases consultant at the Mater hospital. Photograph: David Cheskin/PA Wire

 

Homeless people with drug problems are being left to die of hepatitis C because of a failure to provide lifesaving new treatments on the street, doctors have warned.

The Health Service Executive is failing those most in need of treatment that can cure the illness because its services are focused on hospital-based patients, according to Dr Jack Lambert, an infectious diseases consultant at the Mater hospital.

Dr Lambert said the HSE had “turned a blind eye” to sufferers in the community, many of them homeless drug users who tend to lead chaotic lifestyles and find it difficult to interact with hospitals.

Instead, he said, it is concentrating services on hospital patients who, though they may be carriers of the disease, are not seriously ill.

The development of antivirals has revolutionised the treatment of the disease in recent years and most cases of serious liver disease have been treated.

The cost of treatment has also fallen as competing products enter the market, allowing greater numbers of patients to be treated.

As a result, up to 1,600 patients can be treated this year from the €30 million budget, compared to between 300-600 a year in 2015 and last year.

Dr Lambert said only “higher-functioning” patients who attend hospital appointments are getting the treatment while many others could die of liver failure as a result of the HSE’s “misguided” policies.

“They devoted €30 million to ‘treatment’, but zero to community resources to identify and treat patients in greatest need,” he said.

‘Let them die’

Ireland has “no chance” of fulfilling its aim of eliminating hepatitis C by 2025 because the HSE has adopted a “let them die” strategy in relation to undiagnosed cases in the community, he added.

Services should focus on those whose disease is most advanced and who are least likely to be able to access treatment, according to Dr Austin O’Carroll, a GP who works with homeless people in Dublin’s inner city.

Safetynet, an organisation he founded to provide medical services for the homeless community, has begun offering blood tests and scans to people on the street, in the absence of HSE-provided services.

Up to 40 methadone users have tested positive for hepatitis C in the first six weeks of the service.

Dr O’Carroll says a number of his homeless patients have died from the disease and more deaths will occur without treatment being provided.

As many as one in three homeless people have the disease, he believes.

The HSE said patients were being chosen by clinicians for hepatitis C treatment “based on clinical need with those most in need prioritised”.

Although no treatment has been provided in community settings up to now, a number of pilot sites based in addiction services are due to begin shortly, according to a spokesman.

The pilot projects have been delayed but the HSE said they would begin by June.