May 2, 2012

Hep C Program Comes to Life at CHAS
April 2012
By Katie Kolbet, Communications

Dr. Ethan Angell, Primary Care Provider - Community Health Association of Spokane

Dr. Ethan Angell and Michelle McCartney, Medical Assistant, are pioneers of sorts here at CHAS.  About 5 years ago while working together in family practice they started to notice a cycle of patients presenting with Hepatitis C.  Sadly, a lot of people don’t realize that they have Hep C until they are in the process of liver failure. There also are not many clinics that accept or know how to really deal with this condition. “We knew there had to be a better way to service patients with Hep C, to be able to build a relationship with them, get them clean (which is a requirement for the program) and help them deal with the side effects of the medications that clears the virus,” states Michelle.

Dr. Angell recalls the main motivation behind the push for the Hep C program. “A few years ago we had a patient who we became very close with.  He was in need of a liver transplant and was sent over to the University of Washington.  Two days before his appointment there, he passed away.” “It was the first funeral Dr. Angell and I attended together,” adds Michelle.

From there, they pushed to get a pilot program started that would help people with this curable disease. In 2009, they were allowed to take on five patients.  All five cleared the virus, meaning no trace of Hep C could be found in their systems. This was a great result and showed the impact that could be made.

The Hep C program is tough to get into and is growing by leaps and bounds. But with Dr. Angell only seeing Hep C patients on Tuesdays and Wednesdays, the demand is growing.  Below is a synopsis of 2011:

  • 192 referrals made
  • 100 patients attended the educational classes (a requirement for all participants)
  • 103 patients met with Dr. Angell
  • 20 patients are currently undergoing treatment
  • 9 patients are ready to start treatment
  • 25 patients completed treatment!

Many of the folks who are seen by Dr. Angell and Michelle are drug addicts – most contracting Hep C from sharing dirty needles or snorting cocaine.  Amazingly, the virus can live on a dollar bill for four days!  And most patients find out they have the disease by the plasma clinic where all blood is screened before a donation can be made.

When speaking about the program, Dr. Angell adds, “this is not something that people can just jump in and out of.” In order to be accepted into the program the patient must remain clean for 6 months, and must be emotionally and mentally stable. Patients must be committed to staying clean, or they are removed from the program.  Then there are others that experience side effects that are too much for them to deal with or and yet others that simply do not respond to treatment.

“There can be terrible side effects from these drugs,” says Dr. Angell.

One of the benefits of treating patients for Hep C, who are also primary care patients, is Dr. Angell and Michelle already know them, there is a trust built, and they can treat the side effects better than a Hepatologist would be able to in most cases.  They are also able to give patients their weekly injections at the clinic, because for some, injecting themselves is a trigger of their prior drug use.

For the Hep C program to successfully continue, Dr. Angell and Michelle know that case management is the key! “We are their medical home, a lot of patients are sad when treatment is over – we are part of their family,” Michelle adds.

Congratulations and appreciation to Dr. Angell and Michelle for instituting such a beneficial program at CHAS!