Health Care Costs Rising As Prison Population Grows And Ages


WASHINGTON - Prison inmates are the only Americans with a constitutional right to health care, and the cost to deliver it is on the rise. States spend 10 percent of their corrections budgets on average to cover the cost of inmate health care -- a total of over $3 billion annually.

As the prison population increases, ages and increasingly suffers from chronic illnesses such as AIDS and hepatitis, state policy makers must either foot the bill, change the way health care is delivered or rethink the sentencing laws that led to the problem in the first place.

Because of "get-tough-on-crime laws" such as California's three-strikes law, more people are going to prison and staying behind bars longer, making the United States the number one incarcerator in the world.

Non-violent criminals make up a large percentage of the nation's prison population. State and federal drug laws have put 277,000 offenders in jail, which accounts for 20 percent of state prisoners and over 60 percent of federal prisoners, according to the Justice Department.

A demographic look at state prisoners shows:

  • In the last decade, state prison populations doubled from 577,672 in 1988 to 1,158,958 in 1998, according to the Justice Department's Bureau of Justice Statistics. Women accounted for 6.4% of all prisoners nationwide in 1998, up from 4.1% in 1980 and 5.7% in 1990.
  • The number of inmates 55 and older more than doubled from 1981 to 1990, according to the Bureau of Justice Statistics. The Federal Bureau of Prisons predicts that by 2005, the number of federal inmates 50 and older will increase from 11.7 percent of the of the prison population to 16 percent. Most existing prisons are not designed structurally or programmatically for older inmates, and caring for them can be costly.
  • More and more inmates have chronic and terminal illnesses, such as HIV and AIDS, tuberculosis and Hepatitis B and C. Texas state officials announced in May that one-third of the state's inmates may be infected with Hepatitis C, and a similar study in California found that 41 percent of incoming inmates were infected with the virus. Hepatitis C infects the liver, and is spread through contaminated blood or needles. Also, one inmate in 10 is mentally ill, some having ended up in prison when budget cuts closed state mental hospitals in the 1980s.

A prisoner's constitutional right to health care dates back to a 1976 U.S. Supreme Court decision in the Texas case, Estelle v. Gamble. The judges ruled that deliberate indifference to a prisoner's serious illness or injury constitutes cruel and unusual punishment under the Eighth Amendment.

Although the attitude of most Americans may be that prisoners are not deserving of top-notch medical care because they have broken the law, sick prisoners that are released into the community take their illnesses with them, which can then be transmitted to others.

"It is short-sighted to say these people don't really affect me. You could be on a bus with an ex-inmate who has tuberculosis. We should focus more on what kind of care these people are getting," said Georgia State Criminal Justice Professor Michael Vaughn.

To quell burgeoning health care costs while hoping to provide quality health care, many states have turned to private managed care organizations to run prison medical facilities. Also, more than half the states are trying to recoup money by collecting a co-payment from prisoners, and at least eight states -- Connecticut, Louisiana, Michigan, Montana, New York, South Carolina, Tennessee and Texas -- have established medical parole laws to get the aged and seriously ill out of prison when they no longer pose a risk to society.

Texas, with the highest rate of incarceration in the country, has particular reason to worry about increasing health costs. The state pays nearly $270 million for inmate health care per year -- about $2,150 per inmate.

"Our state has set about [made] public policy that has yielded 720 people out of every 100,000 going to prison. As long as our state pursues that policy they will have to pursue that budget," said Glen Castlebury, the spokesperson for the Texas Department of Criminal Justice.

Managed Care in Prisons on the Rise

The nation's largest correctional health-care firm, St. Louis-based Correctional Medical Services, Inc., insures one out of every seven inmates nationally.

The company provides health services to more than 273,000 inmates at 334 correctional facilities in 29 states. For nearly 20 years, CMS and a few other managed care companies have been taking over prison and jail health care from government agencies coast to coast.

"There is a lot of anecdotal evidence of problems with privatized health care. In some cases medical care has improved, but in many cases the profits are taking precedence over health care," said Georgia State's Michael Vaughn.

Vaughn also questions the quality of prison health staffers. This summer he is conducting a study to find out why medical personnel choose to work in prisons. His thesis is that some of the people in correctional health care are there because they have difficulty finding employment elsewhere due to medical disciplinary problems.

"What drives a person to the practice of correctional health care? Is it that someone graduates and says I really want to work in a prison,' or is it because they have had problems?" he says.

A St. Louis Post-Dispatch investigation of the prison managed care system published last fall showed that nine prison doctors in Missouri working for Correctional Medical Services had been disciplined by licensing boards. With 35 physicians in the state that accounted to nearly one in four of the state's prison doctors disciplined for misconduct. In contrast, about one in 40 of the nation's 689,000 doctors has been disciplined, the Post-Dispatch said.

"Rehabilitating prisoners so that they can go back in society and perform is not something that profit-making companies are concerned with. Their responsibility is to their stockholders," said Kara Gotsch, a spokesperson for ACLU's National Prison Project.

The National Commission on Correctional Health Care is responsible for accrediting prison health facilities, but they do not serve as a watchdog organization monitoring health-care abuses in prisons and jails. Some state's corrections departments have ombudsmen or patient liaison departments, but medical malpractice suits against physicians are not uncommon.

"It is not unusual to see suits. Nationwide there are a half dozen or a dozen a year -- probably one or more suits at any given time," said NCCHC President Edward Harrison.

Prison Medical Co-Payments

In an effort to recoup some of the increasing costs of treating prisoners, at least 30 states require prisoners to pay a co-payment for their medical care ranging from about $2 to $10. The co-payment is waived for indigent prisoners.

Congress is trying to pass a bill this year that would mandate a medical co-payment for federal prisoners.

Michael Vaughn said that in most states when a co-pay is instituted sick call visits go down initially.

"The question is whey are the sick-call visits going down? Have the co-pays cut out the frivolousness or is it that they are using their money to buy something else like cigarettes or a candy bar at the commissary?" he says.


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