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Alternative Approaches to Hepatitis C Screening Stall in Legislature

Both bills have same goal — to diagnose baby boomers with hep-c — but differ on which providers would be involved

hep c virus
Hepatitis C virus

Democratic lawmakers are again seeking to significantly expand testing for hepatitis C, a potentially deadly liver infection that can be successfully treated — assuming it is properly identified.

Two proposals requiring hep-C screening to be offered to certain patients advanced in legislative committees Monday, one in the Assembly and one in the Senate, and both are now set for votes before each full body. More than 8,000 New Jerseyans were diagnosed with the disease in 2015, but an estimated 150,000 are carrying the virus without knowledge.

Both bills focus on baby boomers, or those born between 1945 and 1965, who are five times more likely to be infected than other adults, according to the federal Centers for Disease Control and Prevention, which has called for widespread testing of this generation. But the Senate version calls for hospitals and doctors to offer the screening, while the Assembly version is focused on hospitals and medical labs.

Different perspectives

The two approaches reflect the different perspective of the two primary sponsors. Sen. Joseph Vitale (D-Middlesex), who leads the Senate version, has said his goal is to reach as many patients as possible. Assemblyman Herb Conaway (D-Gloucester), a doctor who is backing the version in his house, has repeatedly stressed his opposition to legislating the practice of medicine.

In fact, Conaway’s bill explicitly states it will not interfere with a physician’s duties: “Nothing in the bill will affect the scope of practice of any healthcare professional or diminish any authority or legal or professional obligation of any healthcare professional to offer a hepatitis C screening or diagnostic test, or to provide services or healthcare for an individual who is subject to a hepatitis C test.”

These bills have been introduced in past legislative sessions, and each version cleared its own house. But the Senate version stalled in the Assembly health committee, which Conaway chairs, and the Assembly proposal never got a hearing in the Senate health committee, led by Vitale.

On the attack

Hepatitis C is a virus that attacks the liver and is spread through contact with infected blood; those most at risk are individuals who were intravenous drug users, have had multiple sex partners and didn’t use condoms, received a blood transfusion or organ transplant before 1992 (when screening was enacted), or are healthcare workers. There is no vaccine, but drugs can be used to treat the infection; without medical care, patients can develop liver damage, cirrhosis, and cancer, among other things.

Nationwide, some 3.2 million Americans have been diagnosed with the disease, and three out of four are baby boomers. This higher rate is not entirely understood, according to the CDC, but is believed to relate to the generation’s lifestyle decisions during a time when less was known about hep-C transmission.

Experts have also seen an increase in hepatitis C among young, suburban residents who have developed heroin addictions, according to data collected by Princeton House Behavioral Health, a healthcare network in central New Jersey. Roughly half of these individuals did not know they were infected.

Treatment depends on diagnosis, which is why expanding screening is so important, experts agree. A national study released last March by a committee of the National Academies of Sciences, chaired by a Rutgers University chancellor, said better screening and healthcare services could save tens of thousands of lives a year, and as many as 90,000 by 2023.

Testing, testing …

Vitale’s bill (S-483) would require hospitals and physicians who don’t work for nursing homes and other long-term care facilities to offer a hep-C test to anyone born between 1945 and 1965, or arrange for the patient to be tested elsewhere. It exempts emergency situations, patients who have already been screened, and facilities that don’t have the capacity to offer the test. Patients can decline to take the test.

If the test comes back positive, the provider would be required to arrange for appropriate follow-up care. The bill, which would take effect the following January, also calls on the state Department of Health to analyze the results and report to the Legislature and governor.

The measure is also sponsored by Sen. Fred Madden (D-Gloucester); an assembly version is pending introduction.

On the Assembly side, Conaway’s bill (A-3909) calls for hospitals and labs to provide baby boomer patients with information from the CDC that outlines the risk of hep-C and the organization’s policy on testing members of that generation.

“The CDC has suggested that one-time testing of persons born between 1945 and 1965 for hepatitis C will help identify additional cases of hepatitis C infection that may otherwise go undetected, potentially improving healthcare outcomes and reducing the impact of liver disease among this population,” the proposal states.

If the patient consents, under Conaway’s bill the facility would need to provide screening and have a policy in place to inform the individual of the results. If a patient is diagnosed with hep-C, officials would be required to counsel them on follow-up options. Patients who had previously been tested would be exempt. The measure also calls for the DOH to review the findings.

This proposal is also backed by Assemblywoman Angela McKnight (D-Hudson) and Assemblyman Benjie Wimberly (D-Passaic); a Senate version, sponsored by Sen. Nilsa Cruz-Perez (D-Camden), awaits a hearing in the Senate health committee, once again.

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