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“The only thing necessary for these diseases to the triumph is for good people and governments to do nothing.”


Health Care Costs Rising As Prison Population

            Grows Health Care Costs Rising As Prison Population Grows And


Health Care Costs Rising As Prison Population Grows And Ages

By Sunny Kaplan, Staff Writer

Thursday, June 24, 1999


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 prisoner's constitutional right to health care dates back to a 1976 U.S.

Supreme Court ruling that held that deliberate indifference to a prisoner's

serious illness or injury constitutes cruel and unusual punishment.


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



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



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



"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



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.


© 1999