Prison Health Care System

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Prison Health Care refers to the care that incarcerated individuals receive while serving prison sentences. By the end of 2015, there were roughly 1,526,800 incarcerated persons in the United States – roughly 0.7% of the total population (Plattner 2016). Prisoners are the only individuals in the United States that are constitutionally guaranteed health care. This is the result of a 1976 Supreme Court decision in Estelle v. Gamble that found “deliberate indifference to medical need” to be a violation of the 8th amendment, which prohibits cruel and unusual punishment (McDonald 1999, 435). As a result, prisons were forced to expand care to ensure its population’s health.

Since the 70’s, long-term incarceration has become a tool in the war on drugs, and the number of incarcerated persons in the United States has increased dramatically (Western 2010, 44). Not only has the number of inmates strained the prison system, but the types of inmates have as well. Over 50% of inmates have a mental disorder recognized by the DSM-IV, over 50% have behavior that fits the criteria of substance abuse or dependance, and inmates are several times more likely to have sexually transmitted infections (Madmadu and Rich 2015, 65). Female inmates are especially likely to have treatable STIs due to sex work. Many inmates have HIV, but rates are often uncertain, as many prisons operate on an Opt-In system, where inmates must specifically request HIV testing to know their results. Routine testing for HIV at these prisons is low, however – estimated at around 19% (Madmadu and Rich 2015, 65) Much of the health complications that prisoners face come from the communities from which they were taken. Inmates are disproportionately likely to be from low income areas, and to be African American – both communities that face elevated risk of drug use and HIV, as well as lower socioeconomic status (Western 2010, 44). Thus, prisoners have, on average, elevated medical needs compared to the general population, though prisons are often poorly equipped to handle this need. While prisons may not be able to handle existing needs, Federal Bureau of Prisons promises to provide adequate medical care. According to the Federal Bureau of Prisons’s (BOP) website, prisoners are provided medical, dental, and mental health care (BOP 2017). In addition to providing care, the BOP seeks to promote health by providing inmates counseling during examinations and education about medication, chronic conditions, infectious disease prevention, and nutrition (BOP 2017). Revealing the range of conditions prison healthcare providers are supposed The BOP also provides clinical practice guidelines on disease and health conditions ranging from schizophrenia to diabetes to managing foodborne illness outbreaks revealing the range of conditions prison healthcare providers are supposed to address (BOP 2017).

Budgeted at $50 billion annually, state correctional spending is now the second-fastest growing area (after Medicare) of government spending. (Madmadu and Rich 2015, 66) This large budget still fails to adequately serve the large prison population. As highlighted by Douglas McDonald in his analysis of prison care standards, one of the greatest challenges in providing care to inmates is the recruitment of physicians. Primary care physicians must often face low salary and disrespect from inmates. As a result, less skilled physicians are recruited, including those with “restricted licenses, limited postgraduate medical training, no area of specialization and no board certification.” Time with these physicians is limited as well, with the average time for each consultation between a prisoner and physician lasting only one minute (Mcdonald 1999, 441). McDonald also notes that the inadequacies extend beyond the physicians to the facilities as well, with little means of isolating sick inmates from the healthy, and a reluctance to build specialized facilities. (McDonald 1999, 443) This reluctance is due to the fact that prisons can’t choose their inmates and thus do not know what illnesses they will have to confront in the future. Specialized facilities are costly, and there is no guarantee that enough prisoners will require them for their construction to be justified. As a result, prisons often depend on nearby hospitals for more specialized care – a large expense when one factors in the cost of escorting and guarding the prisoner during treatment.

To try and compensate for the high cost care for prisoners, the Federal Bureau of Prisons permits correctional facilities to charge prisoners for their medical care (Andrews 2015). Currently, 35 states charge prisoners copays and fees for medical care (Eisen 2015:4).  In a study by the Brennan Center for Criminal Justice at the New York University School of Law, Lauren-Brooke Eisen, a senior counsel in the program, analyzes the effects of such fees (Andrews 2015). Eisen theorizes that the large debts incurred by these fees make it harder inmates to reenter society successfully (Eisen 2015:2). The fees for medical care can be collected directly from inmates’ bank accounts while they are in prison or are collected from their assets after they are released (Eisen 2015:2). However, since many prisoners are indigent which means they are poor enough that they cannot pay for their care, the inmates’ families absorb the cost in many cases (Eisen 2015:4). Already struggling financially struggling with the loss of income from the family member in prison, fees for medical care in prison hits families particularly hard (Eisen 2015:4).  As a result, inmates will go without treatment to avoid placing a burden on their families (Eisen 2015:4). Thus, Eisen asserts that medical care fees can cause detrimental impacts on prisoners and the community by keeping inmates from seeking medical care “to keep chronic conditions in check or treat communicable diseases that could easily spread through crowded prisons” (Andrews 2015).

In addition to charging prisoners for treatment, many government correctional facilities have outsourced healthcare for prisoners to private providers to cut costs (Kutscher 2013). While 20 states report to have outsourced healthcare, Dr. Marc Stern, the former medical director for the correctional facilities of the State of Washington, estimates that in reality half of prisons and jails, whether state or local, have contracts with private healthcare services (Kutscher 2013). By outsourcing care, state and local governments reduce the costs associated with paying the pensions and benefits of unionized public employees and place medical liability on the private vendor when inmates have “adverse medical outcomes” (Kutscher 2013).  The top private prison healthcare companies are Wexford Health Sources, Correct Care Solutions, Centurion Care, and Corizon, which it the largest in the nation (Kutscher 2013). Outsourcing has generated criticism and caused controversy. Prisoner advocacy groups fear that privatization will decrease the quality of care inmates receive (Kutscher 2013). Providing a basis for these fears, economists at the University of California found that while there was a reduction in costs to states, outsourcing care was correlated with “higher inmate mortality rates” (Kutscher 2013). However, state-prison systems are not without their flaws. In 2005, the federal government found that the State of California did not provide adequate healthcare to inmates and took over supervision (Kutscher 2013).

Though prison health care seems isolated, there may still be incentive to prioritize prisoner health care for the betterment of outside communities. In Madmadu and Rich’s essay on prison care reformation, they argue that “Although incarceration is often counter-productive to the health and well-being of the affected population [through exasperating mental conditions by the stress of incarceration and physical conditions by poor health care], it does create a public health opportunity: providing screening, diagnosis, treatment, and post-release linkage to care for members of a vulnerable population who may not seek or have access to services otherwise.” (Madmadu and Rich 2015, 65) Prisoners are likely to come from low-income areas with poor healthcare, and upon release they will return to those same areas. If prison does not adequately treat conditions and illnesses that inmates may have, they will continue to burden their already-stressed local healthcare systems. Prison may offer a chance for government-regulated healthcare for underprivileged people. If the purpose of prison is to better society, then strong prison healthcare can be seen as a means to improve the general health of the United States.

Prison health care relates to politics of health because it highlights a conflict of human rights and medical ethics for a population that some Americans do not think should have full rights of citizenship. Many scholars agree that prisoner health care should be improved for the sake of outside communities, but there are still many ethical violations that constantly occur within prison. As previously mentioned, prisoners are the only citizens that have a guaranteed right to health care, and some find this unfair when millions of American citizens lack the resources to cover their own medical expenses and do not receive government aid. There is sentiment that prisoners as unworthy of improved health care, and as a result when medical ethics are breached in prisons, the public is slow to react and often there is little accountability. In support of expanded health care, scholars like Nick de Viaggini argue that many prisoners are soon to return to public life, and should be as healthy as possible (physically and mentally) upon reentry: “Given that most imprisoned offenders are released after relatively short periods of confinement, custody would best serve the public by becoming supportive and empowering, thereby embracing public health principles and practices” (de Viaggini et al. 2005, 918). However, other scholars note the perceived “duality of interests” that many physicians face when treating inmates, as they struggle to fulfill their duty as physicians while also complying with a prison’s (often unethical) practices. Physicians may “forsake loyalty to their patients, often unwittingly or by failing to scrutinize routine procedures, decrees, or laws against the standards of medical ethics and human rights” in an attempt to increase productivity (Pont 2012, 476). So long as physicians continue to prioritize the interests of prisons over the prisoners, and so long as the public does not stand up for prisoners rights, prison health care is likely to remain poor.

Bibliography

Andrews, Michelle. “Even In Prison, Health Care Often Comes With A Copay.” NPR.

September 30, 2015. http://www.npr.org/sections/health-shots/2015/09/30/444451967/even-in-prison-health-care-often-comes-with-a-copay.

de Viggiani, Nick, Judy Orme, Jane Powell, and Debra Salmon. “New Arrangements for Prison

Health Care: Provide an Opportunity and A Challenge for Primary Care Trusts.” BMJ: British Medical Journal 330, no. 7497 (January 23, 2005): 918. Accessed February 28, 2017. doi:10.2307/25459470

Eisen, Lauren-Brooke. Charging Inmates Perpetuates Mass Incarceration. Report. Brennan

Center for Justice, New York University School of Law. May 21, 2015.

file:///C:/Users/Carina/Desktop/Politics%20of%20Health/Charging_Inmates_Mass_Incarceration.pdf.

“Federal Bureau of Prisons.” BOP: Inmate Medical Care. Accessed April 02, 2017.

https://www.bop.gov/inmates/custody_and_care/medical_care.jsp.

Macmadu, Alexandria, and Josiah D. Rich. “Correctional Health Is Community

Health.” Issues in Science and Technology 32, no. 1 (2015): 64–70. Accessed February 27, 2017. doi:10.2307/24727007

McDonald, Douglas C. “Medical Care in Prisons.” Crime and Justice 26 (1999): 427–78.

Accessed February 27, 2017. doi:10.2307/1147690.

Plattner, Mark. “Bureau of Justice Statistics (BJS) – Prisoners in 2015.” December 29, 2016.

Accessed February 27, 2017. http://www.bjs.gov/index.cfm?ty=pbdetail&iid=5869.

Pont, Jörg, Heino Stöver, and Hans Wolff. “Dual Loyalty in Prison Health Care.” American

Journal of Public Health 102, no. 3 (March 2012): 475–80. doi:10.2105/ajph.2011.300374.

Kutscher, Beth. “Rumble over jailhouse healthcare; As states broaden outsourcing to private

vendors, critics question quality of care and cost savings.” Modern Healthcare, September 2, 2013, 0006. Academic OneFile (accessed April 2, 2017). http://go.galegroup.com.proxy.library.vanderbilt.edu/ps/i.do?p=AONE&sw=w&u=tel_a_vanderbilt&v=2.1&it=r&id=GALE%7CA341911254&asid=e1b4564a2e3d1f9ded125fe86dfccb1f.

Western, Bruce. “The Challenge of Mass Incarceration in America.” Bulletin of the American

Academy of Arts and Sciences 63, no. 2 (2010): 44–45. Accessed February 27, 2017. doi:10.2307/41149553.

 

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