Why you should care about prison healthcare

It was kind of amazing how little coverage the recent report on healthcare in our prison systems got. Heck, you may be thinking, I don’t think that’s amazing – why waste airtime on that topic – why should I fret and worry about the healthcare that prisoners get when my child is burning up with fever and coughing up a lung and I can’t even afford to take her to the ER?

It’s true, that in the universe of lack-of-healthcare, there are fewer groups who elicit less sympathy than felons. But here’s the deal – when you’re 21 years old, should you really be forced to lie locked in a cell, gasping for air until you die, purely because no one will give you your asthma inhaler?

That, my friends, is a recent, true scenario. Not something that happened long, long ago in a distant galaxy, far, far away. We’re talking right here – an event paid for by your tax dollars.

See, here’s my bias. Way back, when I was in fellowship training, I read most (if not all) of the medical charts that were part of the Pelican Bay lawsuit that put the California prison system into receivership because our prisons’ medical care was so medievally appalling. That fact that our modern prison cells are pristine white with electronic doors, and aren’t, instead, made of dripping black stonework – that doesn’t change the Dickens-era horrors that I read about.

Back then, as part of the lawsuit, there was the story of another young man aged 21, in prison since he was 19. This young man’s medical experience was charted, point by point, in detail. He had a stable history of seizures, and before being incarcerated, was well controlled on non-addictive medication. But, just like our recent young man’s death from asthma, Tyler Henderson also couldn’t get even something as simple as his presecribed medicine. How’d that work out? He kept begging for help, locked in a cell, as he seized and seized and seized to death. He knew what was happening right up to the horrific end.

The prison medical chart accused him of “hoarding” his seizure pills because, since he was repeatedly denied access to his medication, he’d hide pills and try to space his doses apart, because he knew when he ran out completely he’d start seizing again. Sure, he was hoarding – at 21 years of age, he was desperately trying to just live a little bit longer.

Are these cases unusual? As the Southern California NPR reporter who covered this story states, “Between 2003-2004, one inmate a week died as a result of poor medical care in state prisons.” That’s on our dime.

Here’s my bias: if you’re being paid $49,000 each year for each prisoner – which is enough to raise two entire families of four above the poverty level (with thousands of dollars left over) – and you’re being paid over one billion dollars a year more than when the original lawsuit was decided, purely to improve prison healthcare, then you damn well ought to be able to do something as simple as giving out prescribed pills on a regular basis. At least that. Right?

Um, apparently not. The recent report on prison healthcare shows that giving out medicines regularly, despite the glut of cash from you and me, is beyond what our bloated prison system can do. In fact, one of the specific groups who are unable to get their medicines regularly is (drum roll please) tuberculosis patients. There’s no better way to breed wildly resistant Tb than to have patients taking pills erratically. Just ask any Third World country.

Here’s the exact language of the report:

Nearly all prisons were ineffective at ensuring that inmates receive their medications. Sixteen of the 17 institutions either failed to timely administer, provide or deliver medications or failed to document that they had done so. The 17 prisons’ average score of 58 percent in medication management was significantly below the minimum score for moderate adherence.”  “Numerous prisons were significantly noncompliant in the following medication management tasks: delivering sick call medications (new orders) to inmates; providing chronic care medications; providing medications to inmates within one day of arrival at the prison; delivering medications to inmates upon discharge from an outside hospital; and administering tuberculosis medications.

So what does this have to do with you and me? Other than the looming issue of widespread pan-resistant tuberculosis being spread around the state, that is? See, the danger when it comes to prison healthcare, or to prisoners in general, is that we’re all so overwhelmed with badness in the news, and with struggling to just make ends meet, that we’re already tapped-out, sympathy-wise. For many of us, the gut response to this kind of news is that we kind of just wish it would all go away. Hey, we all know people in prison have done some bad things. Probably some skin-crawlingly bad things. But so often, with so many people incarcerated for not-so-horrible crimes, lock ‘em up and throw away the key is not just a revenge-response, it’s also a symbol of our collective, profound, compassion-exhaustion.

The fact is, however, that none of those people in prison will just go away. All those people who are so often addicted, brain-damaged, developmentally delayed, many with poor impulse control – we’ve got no plan for them, nowhere we expect them to be, no way for them to live. Even among the many staggering thousands upon thousands of Californians who are very functional and are in prison purely because of drug and non-violent offenses, prison still becomes (with a recidivism rate of 70%) a truly revolving door experience. Even if we want to think of prisoners as some type of “Other” category of person, all ex-prisoners are people who will end up in our homes, our healthcare systems, our neighborhoods, and, in many, if not most cases, lying on our sidewalks. They don’t just go away. They can’t.

When we decimate the lives, and health, of a significant group of ourselves, these same people do, inevitably, come back home to us. Even if, after years of prison, we’ve rendered them homeless, we are still the place to which they return. Poorly-treated tuberculosis won’t just go away either. It stays and breeds and simmers. And spreads. Kind of like rage. Or despair.

So what can any of us do? I personally believe it’s past time to ask ourselves whether a prison culture – particularly one which has been given, for many, many years, an essentially unlimited financial windfall with minimal accountability – can ever render basic, non-lethal healthcare. Keep in mind, if a government-funded clinic or hospital was unable to deliver doses of medication in a consistent, reasonable manner, their license would be yanked so fast, heads would spin so rapidly there’d be a state-wide epidemic of vertigo.

And don’t even start on the topic of psych medication dosing and diagnosis. Right now our prison system is the state’s largest provider of mental health care services – and funds are being tidal-waved into building more and more expanding prison mental health (is that an oxymoron?) facilities. This expansion is occurring even as line-item budgets are X-ing out those same services to the non-incarcerated general population. And the expansion is continuing to occur even as the track record of prison healthcare just gets more and more littered with bodies. Back in the 1960′s, when we closed our locked psych wards, did we really, as a society, deliberately choose to replace Nurse Ratchet with Guard Nick-with-a-nightstick?

There is something deeply, deeply wrong with this picture. It’s time for someone to point out that, when it comes to healthcare, our Prison Emperor has no clothes.

One simple, important thing we can all do is spread the word. Talk about, email, share or tweet this topic. It’s time we all began discussing what we’re paying for, medically – behind locked cell doors.

Jan Gurley is an internal medicine physician who blogs at Doc Gurley.

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  • http://thedocsquawk.com thedocsquawk

    There was an old Canadian commercial about how jailors used to beat prisoners, sometimes to death. I think I’d take beating over repeated anoxic brain injury though.

  • http://Www.twitter.com/alicearobertson Alice

    What do you propose emailers and Twitters suggest? Privatization of the prisons? How about better food? Accountability for prisoners? There was a terrible uproar when there was a proposal to stop prisoners from smoking. The schools are cleaning up nutritional wise…and some prisoners are claiming the Twinkie Defense…so why are we feeding them garbage food?

    I guess I agree with all you laid out, but I also think entitlement that comes from no accountability from the receiver is just another injustice.

    How about some hard labor? Doesn’t exercise prevent disease? Just thinking aloud….exercise and nutrition would be a good grassroots project. The prisoners could work and grow their own food the way people used to…but now that is considered drudgery. Nutrition may even help with behavioral problems.

  • http://fertilityfile.com IVF-MD

    How free is the USA? Here is some food for thought I found interesting.

    - The United States has the highest documented incarceration rate in the world, 7x higher than France, 12x higher than Japan, 23x higher than India!!
    - In 2008, over 7.3 million people were on probation, in jail or prison, or on parole at year-end — 3.2% of all U.S. adult residents or 1 in every 31 adults.
    - It is estimated that 1 in 9 state government employees works in corrections.

    If you care at all, you might want to research how much of this boom in locking people up is related to violent crime (crimes against other people) and how much is related to non-violent crime (the breaking of arbitrary rules).

    There is a lot of profit being made in the business of incarceration on the backs of us taxpayers, but that certainly doesn’t make it right.

    When your freedom is taken away, you have no control over your own healthcare. Doc Gurley, thank you for sharing this article. It helped enlighten me. I hope I’m not the only one.

    http://en.wikipedia.org/wiki/Incarceration_in_the_United_States

  • http://jflahiff.wordpress.com Janice Flahiff

    Thank you for this. Yes, I agree with the above posting that exercise and nutrition are important. However, all the exercise and nutrition in the world will not cure one of asthma, heart disease, AIDS, and a myriad of other diseases and conditions.
    Sure, many/most prisoners broke the law, but they still deserve decent health care….if for no other reason they are human beings…Decent health care is not a reward for good behavior, it is a responsibility…a shared responsibility we have for each other…no matter what a person thinks or does…anything less is inhumane….

    One question for Dr. Gurley…
    What can we as citizens do to right this wrong??
    I am somewhat of a social activist (mostly letter writing at this point, but have been known to join a peace demonstration or two)….and base a lot (most) of my activism on my Christian Catholic beliefs of working for the common good, including justice for all….
    I think I need to do something about this, please share your thoughts Doctor…it would be much appreciated. I could bring this up at our next Pax Christi meeting

  • horseshrink

    It’s tempting to draw broad conclusions about systems from heart wrenching anecdotes. The media making a living from sob-sister tactics.

    I worked for several years in the correctional sector (psychiatry.)

    VERY rewarding clinical experience. Genuine, raw needs collected under one roof by law enforcement … a persistent fallout from failed community services. Very intense, stimulating, meaningful work.

    Unfortunately, and simultaneously, law enforcement (contrary to media depictions) are quite adept at finding very sociopathic persons and concentrating them also under the same roof.

    Thus emerges a tension. In my experience, on one end of a spectrum, those who demanded services most vociferously tended least to need them, taking time away from the other end of the spectrum, the anosognosically ill who wanted none of me.

    There have truly been abuses of inmates over the years … and realistic measures to curb such abuses are a necessary expression of our society’s evolving sense of decency. At a common sense level, we cannot expect to impart prosocial behavior with cruelty.

    Also, a broken correctional health system is harmful to society at large – from a public health perspective. Most inmates are released to become part of “society at large” again, and carry with them whatever disease may have been acquired while locked up.

    Let us not forget, though, that the correctional world is clearly on the short list of “most challenging” practice settings by virtue of the morbidity, predatory sociopathy, prevarication, malignant entitlement and lethal violence with which the patient population is imbued. Most inmates did not find themselves in the correctional sector by mere accident. Humble, honest, patient, service oriented, responsible people don’t tend to get arrested.

    How many people actually want to practice in such a setting? Would you?

    I took my turn … until the litigation became too onerous.