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Against
the backdrop of the bombing of Baghdad and the president's
emergency request for nearly $75 billion in new money to conduct
his war in Iraq, the last thing on most people's minds is
spending money on health care for prisoners. Yet, if the
government continues to disregard the explosive situation
developing in prisons and within communities where released
prisoners reside, there will be a health care crisis of epidemic
proportions.
Tens of
thousands of prisoners suffering from undiagnosed or untreated
communicable disease, chronic disease and mental illness are
being released into communities around the nation. And thousands
more are scheduled for release in the next few years. The human
costs to the health of our neighbors, and the financial well
being of states, counties and cities across the country is
already threatened. That's the conclusion of a report completed
nearly two years ago, but inexplicably held since then by the
National Institute of Justice.
Former
prisoners with Hepatitis C, tuberculosis, AIDS and a battery of
mental health problems are a ticking time-bomb for their
families and friends as well as other members of the communities
in which they live.
The
report, "The Health Status of Soon-To-Be-Released Inmates: A
Report to Congress," was produced by the privately-run National
Commission on Correctional Health Care and sponsored by the
National Institute of Justice (NIJ), "the Research, Development,
and Evaluation Agency of the Department of Justice." It was
finally released to the public, through the initiative of its
author, Dr. Robert Greifinger, at a January 2003 conference of
prison medical officers in San Antonio, Texas, a meeting
sponsored by the Centers for Disease Control and Prevention.
Dr.
Greifinger's study points out that "each year the Nation's
prisons and [county and city] jails release more than 11.5
million inmates... [many of whom] may be contributing to the
spread of infectious disease in their communit[ies]." Because
prisons generally provide less than adequate health care
services to its inmates, "society may have to pay substantially
more to treat them than if these conditions had been treated at
an earlier stage -- or prevented altogether -- while these
individuals were still incarcerated."
Why
aren't prisoners given adequate health care services in prison?
As the report observes, there are a number of "political,
logistical, and financial barriers" to doing so, most of which
can be overcome. "I think this is the largest untapped public
health opportunity in the country," Dr. Greifinger said in a
telephone interview. "If we are going to put public health
dollars anywhere, this would be the biggest bang for the buck,
the best opportunity to save lives and money by focusing on
prevention, early detection, and treatment according to
nationally accepted guidelines, than any other health problem we
are not yet dealing with." Although the returns would take a few
years to be realized, he added, "the potential financial savings
would be great."
When
asked if there is the political will to deal with this problem,
Dr. Greifinger said that unfortunately "public policy makers
have little insight into the rewards from this investment. The
fact that these are prisoners allows people's prejudices to
surface; they think that any services to inmates are
perquisites, but they aren't." In addition, the reality that
millions of Americans outside of prison lack adequate health
care services makes improving prisoners' health care a hard sell
politically; most politicians will avoid championing this issue
like, well, the plague.
In
2000, about nine million people were released from jail and
prison, according to Allen J. Beck, of the Bureau of Justice
Statistics, the statistical arm of the Justice Department. "This
is a public health problem that has been growing and growing,
but we are reluctant to do anything about it because these are
bad guys," said Dr. Greifinger, a former chief medical officer
for the New York State Department of Correctional Services.
An
American Civil Liberties Union (ACLU) press release declared
that "nearly 330,000 imprisoned individuals tested positive for
Hepatitis C in 1997 and approximately 1.4 million Hepatitis
C-infected individuals left prison or jail in 1996. And," the
press release continues, "Hepatitis C is not the only threat
from sub-standard prison health care; ex-inmates comprised 35
percent of the U.S. population infected with tuberculosis in
1996 and accounted for 17 percent of the AIDS infected
population."
The
federal government funds the Federal Bureau of Prisons, which
represents only a fraction of the prisons in the country. Each
state operates its own correctional system and each county
operates its own jail. Therefore, says Edward Harrison,
President of the National Commission on Correctional Health Care
(NCCHC), there is really no one place where you can find a
comprehensive picture of how much money is being spent on
prisons nationally, let alone on healthcare for prisoners. This
task is compounded by the fact that different jurisdictions
often have different items in their healthcare budgeting.
In
1999, the NCCHC surveyed the 50 state correctional systems, the
District of Columbia prison system, and the Federal Bureau of
Prisons (BOP) "to determine how much each was spending on health
services for prisoners." "Correctional Health Care: Guidelines
for the Management of an Adequate Delivery System," published in
2001, covered results garnered from 41 jurisdictions and the
BOP, and used numbers that varied between FY 1997 to FY 1999.
The report found that total DOC expenditures for this period
"ranged from a low of $18.5 million in North Dakota to a high of
nearly $3.8 billion in California, with a mean DOC expenditure
totaling nearly $595 million... .[T]he median expenditure... was
$339 million."
Spending on prisoner health care "ranged from a low of less than
$1 million in North Dakota to nearly $500 million in California,
with a mean total expenditure of about $70 million per state,
and a median of a little more than $32 million."
NIJ
holds the study
Dr.
Greifinger said that after three years of work, the study --
which had been requested by Congress -- was completed in March,
2001, and turned over to the National Institute of Justice (NIJ).
He was told that it would be released within a short period of
time; months passed and the report wasn't released to the
public. Finally, in July 2002, the report was made available
electronically by the Centers for Disease Control. As of this
writing (early February) Kara Gotsch, the Public Policy
Coordinator for the National Prison Project, says that the
complete work has not yet been delivered to Congress.
Why did
it take so long for the study to be brought to the attention of
the public? Some observers have speculated that the NIJ thought
that the report was flawed methodologically and there wasn't the
political interest in implementing its recommendations. While
acknowledging that "there are certainly some weaknesses in
methodology," Dr. Greifinger pointed out that "we used the best
available data and the best available science and came up with
projections that we were comfortable with."
Dr.
Greifinger has not heard from the NIJ since he helped engineer
its release at the late-January conference in San Antonio. There
are currently "no copies of the report in the library," Brian
(he would not divulge his last name) who works at the National
Criminal Justice Reference Service, a program of the NIJ, told
me.
In
early February, I spoke with Ann Voight, the Public Affairs
Specialist for the Office of Justice Programs, and I asked her
about the report. She claimed that the report had been released
and was available online at the web site of the National
Commission on Correctional Health Care. "We gave a grant for the
publication, but we don't have the funding to publish everything
produced by our grantees," Voight said. "Our responsibility is
to make sure it is available and as far as I know, we have
fulfilled our responsibility." Other than the report's standard
disclaimer, Voight said that as far as she knows, the NIJ did
not have any problems with the report's conclusions. As for
holding the report for nearly two years: "The sequence of events
was not unusual; we don't have a huge publication budget. We
paid for the report."
ACLU
files class action lawsuit
In a
related development, the ACLU filed a class action lawsuit
against the state of Michigan in late January that "charg[ed]
state prison officials with allowing an infectious disease to
reach epidemic proportions by failing to adequately test and
treat inmates with Hepatitis C, a blood-borne virus that is in
many cases fatal."
According to the lawsuit, over four million Americans (1.8% of
the US population), the majority of whom are asymptomatic, are
infected with Hepatitis C (HCV). Some eighty-five percent of
those infected "develop chronic hepatitis, and at least twenty
percent of these develop irreversible cirrhosis within two
decades of the onset of infection." Nearly ten thousand people
in the US "die from complications due to HCV each year."
"This
is a very serious problem for everyone in Michigan," said Kary
Moss, Executive Director of the ACLU of Michigan. "Unless the
prisons begin to follow appropriate protocols for testing and
treating Hepatitis C among inmates, HCV will continue to spread
well beyond the prison walls. And unless the disease is treated
in the early stages, the cost of treatment will undoubtedly rise
dramatically."
"The
Michigan class action suit demonstrates how poor prisoner health
care -- in this case involving the rampant spread of Hepatitis C
-- can impact the general public as a whole," said Elizabeth
Alexander, Director of the ACLU's National Prison Project.
"Reforms need to be implemented, not just to ensure a baseline
level of medical treatment for prisoners, but to protect us all
from real health risks stemming from inadequate care in
prisons."
In
response to the suit, Russ Marlin, a spokesman for the Michigan
Department of Corrections, told the New York Times' Fox
Butterfield that "We are treating hepatitis C in accordance with
federal guidelines."
According to Marlin, Michigan did not do blood tests of all
incoming inmates or all those who engage in risky behavior. "Our
position is that indiscriminate testing is not useful" and it
would cost $200 million to test and treat all suspected cases of
hepatitis C among Michigan inmates. Marlin also pointed out that
the drugs used in treatment -- a combination of interferon and
ribarvin given over a 6 to 12 month period -- is very toxic.
On
January 27, The Coalition for Better Treatment, a coalition of
more than two dozen Civil Rights organizations, medical
practitioners, and corrections officials, pointed to the
recently released report and called on Congress to hold hearings
to investigate the health care crisis in the nation's prison
system. According to the Coalition's press release, "Corrections
departments are overwhelmed by the high cost of providing
medical care and face serious challenges to providing treatment
to patients. Untreated patients jeopardize the health and safety
of prison and jail staff, institution visitors, prisoners and
the communities to which they return."
The
National Prison Project's Gotsch said that "We don't know the
full extent of this health care crisis. Many states are not
doing across the board testing, so no one knows what the real
numbers are." The cost of treating hundreds of thousands of
people after they've been released from prison far outweighs
treating them in prison and will further cripple already
overextended state budgets. "We are talking about a potential
health care crisis with financial costs that will be incredible.
We need to be paying for their care in prison when it's less
expensive to treat them."
Bill
Berkowitz is a longtime observer of the conservative movement.
His WorkingForChange column Conservative Watch documents the
strategies, players, institutions, victories and defeats of the
American Right. |
