Getting hepatitis C treatment opens new doors for the incarcerated

WARREN, Maine — For the prisoners who receive it, hepatitis C treatment is more than a cure. It offers a second chance, an opportunity to live long enough to get out of prison and become a productive member of the community.

Take Mathiew Loisel, 37, who was cured of the hepatitis C virus at the Maine State Prison in the spring of 2021. Just a few years ago, Loisel was cycling in and out of solitary confinement, much in the way he cycled in and out of foster homes and then psychiatric facilities. Then, jail and prison, on and off, for trespassing, criminal mischief, parole violations. Now he is serving 30 years for murder, after he shot a man during a robbery.

But he earned a college degree in prison and is eyeing online business and law degrees he could put to use when he’s out, in 2034. He already has some legal experience — he’s actually the reason why Maine is treating hundreds of incarcerated people for the virus. He successfully sued the state in 2019 to challenge its policy of treating only the sickest individuals in its care.

“I have taken a life,” Loisel told STAT in the summer of 2021, sitting in the visiting room at the Maine State Prison. “At some point, you want to give life.”

Treating people with hepatitis C while they’re in prison makes sense from a public health perspective. It is perhaps the most opportune time to reach an often transient and uninsured population and ensure they take every dose of the daily medication. But it also presents a chance to help people re-enter the outside community healthier than when they entered prison.

“These are all human beings who deserve the best we can find to help them stay healthy and resume — hopefully — a normal and productive life once they’re released,” said Francis Collins, the White House science advisor. “That’s what public health is all about.”

In 2018, Loisel was one of just a handful of men incarcerated in Maine to earn his Associate’s degree. Soon after came his Bachelor’s degree, which he finished with a 4.0 grade point average.

He’s a self-proclaimed autodidact, and an eclectic reader. When he spoke with STAT, he brought along books by Karl Marx and Princeton psychologist Daniel Kahneman. He’s an avid writer, of treatises on the prison system and the values of dog training, of love poems, and of essays on his struggles with ADHD.

“What I once was is not the same as the person I now am today,” Loisel wrote in one poem.

“​​I now am a resilient, determined and unstoppable force to be reckoned with.”

At 6-foot-4, with a voice that can match the pitch and power of a boat horn, Loisel is an unmistakably positive presence in the 900-person maximum security prison, the largest in the state.

“He’s actively engaged in good work inside the facility,” said Ryan Thornell, deputy commissioner for the Maine Department of Corrections.

Loisel says it was the grace he felt at Riverview Psychiatric Center that helped him turn his life around. Maine State Prison officials sent him there soon after he was charged with murder.

Riverview was more focused on rehabilitation than punishment, unlike the jails and prisons Loisel had come to know. There, a bad day was just a bad day. It didn’t mean another trip to the segregation wing, where cells were the size of a walk-in closet. Where protests and self harm often led to blood, urine, and toilet water seeping into the hallway from the cells around him.

“I know now how important it is to have that help, and that nurturing, and that care,” Loisel said. “I want to be a person who can use that experience … to use that to create some sort of reform or change to help others.”

When he returned to the Maine State Prison, Loisel began taking college courses, training therapy dogs, and teaching English and math to other incarcerated people.

He’d work in the Maine State infirmary, a quiet sanctuary tucked into a corner of the prisons’ medical wing. There, the prison bunks are replaced with hospital beds and the walls are painted to resemble the log cabins in the woods of Acadia National Park, 85 miles north. The experience, he insists, strengthened his resolve to fight for better health care services in prison.

“When you watch men die because of a lack of services … it strengthens your convictions,” Loisel said.

Loisel came across a copy of Prison Legal News, a monthly publication by the criminal justice reform nonprofit Human Rights Defense Center that is circulated in many prisons. One article described how incarcerated people in Florida and Tennessee had successfully sued to challenge their state’s rationing of hepatitis C care.

He decided to follow their lead.

Like many in prison, he filed his first lawsuit without the help of an attorney. He finally found one, Miriam Johnson, by literally going through the phone book. Johnson had never represented an incarcerated person in a civil rights case, but Loisel’s encyclopedic knowledge of the law convinced her to help him.

“I got off the phone with Mathiew, and I think I said to my colleague, ‘I just talked to someone at the Maine State Prison and he knows more about this particular issue than when I typically deal with a forwarding attorney, and I’m looking at this and I think he might be right,’” Johnson told STAT.

The Maine Department of Corrections ignored Loisel’s lawsuit for three months. Once lawyers were involved, the case settled relatively quickly.

The quick resolution was influenced by the political climate in the state: Maine had just elected Democratic Gov. Janet Mills, replacing Republican Gov. Paul LePage, who just a year earlier had pledged to go to prison himself before expanding health care to the state’s poor.

“Gov. Mills came in with a very aggressive and forward-thinking public health approach,” said Thornell, the DOC official, who was appointed during the LePage administration. “That’s what made it possible here — in her administration — where it may not have been as possible in other administrations.”

After the settlement in February 2021, the prison system began testing every person booked into custody for the virus, unless they refuse, and nearly everyone with hepatitis C is eligible for treatment.

Maine treated 205 men for hepatitis C drugs in 2021 — including Loisel.

For him, the treatment was simple: he took a daily walk from his cell to the pill line in the main building. He’d get a cup of water from the fountain, retrieve a yellow tablet from the pill officer behind the plexiglass window, and swallow it. He’d open his mouth to prove he’d taken it, and then go back to his daily routine. Within six weeks, he was cured.

Even now, Loisel isn’t quiet about his frustrations with prison life.

Sitting in a multipurpose room one afternoon, not more than a few yards away from the warden, he sounded off to STAT about the injustices of the criminal justice system and his negative experience with a prison clinician who’s related to Maine’s corrections chief.

He only paused when his attorney arrived; he couldn’t wait to speak to her about a document he was being asked to sign that would have released the prison’s health care provider of any liability as part of his settlement.

“I’m not quite satisfied,” Loisel said. “It’s hard for me to enter into any agreements or settlements that may further restrict people from pursuing justice.”

That zeal explains how Loisel has become a vocal and engaged member of his own legal team, even without a law degree. His lawyers regularly send him legal filings to review before they file them with the court. In 2019, a judge even agreed to bus him to the federal courthouse in Bangor, 70 miles to the northeast, to take part in the formal settlement negotiations for his case.

It explains, too, his plans to go to law school. He’s now applying to MBA programs, but after that, he’s eyeing a legal career.

Maine allows certain convicted felons to practice law — and he already won his first case.