Dr. John Farley, right, speaks with hepatitis C patients whose requests for anti-viral drug coverage have been turned down by Pharmacare. (CBC)

A specialist who treats patients with hepatitis C is criticizing the B.C. government for denying lifesaving treatment in what he terms a full-blown epidemic.

Dr. John Farley, an epidemiologist who practises internal medicine in Vancouver and is recognized as an expert in the blood-borne infectious disease, said Pharmacare is routinely denying his patients coverage for antiviral drugs that can cure it.

"At best, I can say it is indifference to an epidemic of huge proportion," Farley said. "It is one of the most serious epidemics we are facing in our community today."

Hepatitis C is a virus that can eventually cause severe liver damage and premature death. It is spread through the transfer of bodily fluids, similar to HIV.

British Columbia has by far the highest rate of infection in Canada. An estimated 50,000 people have the disease in B.C. and the province gets approximately 300 new cases each month, according to the B.C. Centre for Disease Control (BCDC).

Although hepatitis C is often associated with drug abuse, it has spread far beyond intravenous drug users, said Farley, who has worked for the BC Centre for Disease Control, the B.C. Ministry of Health, the Canadian Society of International Health and Correctional Services Canada as an infectious disease expert.

"In my patient population about 40 per cent — maybe 50 per cent of them — who are not getting their treatment have not acquired the disease through intravenous drug use," he said. "The longer we take to treat them the more advanced it gets and the worse the outcome."

Denied drug coverage

Patients who've been denied Pharmacare coverage include Teresa Iezzi, who was stuck with a contaminated needle by a troubled former foster teenager, and Michael Loring, who got hepatitis C while working as a first-aid attendant in the early 1980s.

Michael Loring says he contracted hepatitis C while working as a first-aid attendant in the early 1980s. (CBC)

"We didn't really protect ourselves," Loring said. "We protected the patient, which meant that I was exposed to blood and body fluids."

Loring, formerly a software support technician, now is unable to work and lives on a CPP disability pension.

"I've gotten to where — on a typical day — three to four hours is my usable day. Up until recently, maybe one or two days a week I had no energy at all," he said. "Eventually I will have permanent liver damage and I will get cirrhosis."

Anti-viral drugs such as Pegetron and Rebetron have a cure rate of between 45 per cent and 80 per cent, according to the B.C. Ministry of Health. They are approved for use in B.C., but Pharmacare won't cover the cost for patients such as Loring unless their liver enzyme levels have reached a level that indicates liver damage.

Loring said his enzyme levels are never stable, despite liver damage detected by a biopsy.

Farley said the guidelines are out of date and are contrary to what experts now know about hepatitis C.

"They [Pharmacare] don't know what they are doing because the levels can fluctuate," Farley said. "I think this is entirely unacceptable for the magnitude of the epidemic we are dealing with. Somebody does not get it."

B.C. Health Minister George Abbott said experts set the criteria for Pharmacare, and he insisted the coverage is adequate.

"I know sometimes doctors would like to immediately be able to use drugs for whatever purpose they think is right but [the guidelines] are a safeguard for patients."

'Epidemic' label unfair: minister

Abbott also said he doesn't agree with Farley's assessment of the magnitude of the hepatitis C problem in B.C.

B.C. Health Minister George Abbott, right, answers questions from Go Public reporter Kathy Tomlinson about the hepatitis C situation in the province. (CBC)

"I don't think its fair to say it's an epidemic," Abbott said. "Certainly hep C is a very big challenge — that is why we are expending about $100 million annually in identifying preventing and treating hep C when it occurs."

Antiviral drugs cost approximately $30,000 per patient, according to Pharmacare, depending on how the patients react to treatment.

Farley predicted if the government doesn't start covering more people the disease will continue to spread and the cost — in lives and taxpayer dollars — will be much higher.

"The average cost of hep C in B.C. is in the billions of dollars and that is from time off work, visits to the physician and hospital care when they do become ill," Farley said.

Huge cost predicted

"We are now going to be facing a situation,10 years from now probably, where our hospital beds that we need for the breast cancer patients or the other cancer patients, are taken up by liver patients. We are beginning to see that now," he said.

He estimates the cost of a liver transplant alone — the only possible treatment for end-stage liver disease — is $100,000 or more.

"When we had the SARS [sudden acute respiratory syndrome] epidemic we spared no effort to reach and treat people. We have people who are dying [of complications from hep C] every day. Yesterday, I had two patients come in with end-stage liver disease. They came too late."

Farley said the problem is made more complicated by two of the hospitals — Vancouver General and St. Paul's — which, unlike others in B.C., refuse to accept his patients for liver biopsies because he doesn't have physician privileges at their facilities. He said it means several more months of delays for patients, who have to wait to see another specialist.

Biopsies are the only way to prove liver damage and appeal for drug coverage if the enzyme level is not at the specified level.

"That adds more cost to our health care system," he said. "And I find that abhorrent as a taxpayer. As a physician I find that it is unethical that we should not be providing the [biopsy] service."

A spokesman for Vancouver Coastal Health Authority said the policy is there to protect patients.

"There are significant complications associated with liver biopsies," Gavin Wilson wrote in an e-mail. "A process needs to be in place to ensure there is physician coverage available for these patients if and when they are admitted to hospital as a result of any complications."

Farley, who also once spearheaded a campaign to have all grade 6 students in the province vaccinated for hepatitis B, and whose groundbreaking work will be honoured by the Canadian Liver Foundation with a gala tribute in November, says he is left feeling buried under bureaucracy while his patients die.

"Where are the folks that are supposed to be responsible? What are they doing?" he asked. "Sometimes I wonder why the heck I entered medicine. I cannot give the patients what I was trained to do."