Problems Traced to Cost Containment
Tragically, the cause of these conditions is not a mystery. Everybody seems to have the same answer: providing adequate medical care costs money, and as long as the general population is willing to turn a blind eye to conditions inside our own prisons, the system will provide nothing more than the bare minimum. Sometimes even less.
“It’s budgetary,” says David Singleton, executive director of the Prison Reform Advocacy Center in Cincinnati, OH. “It’s all related to cost containment, because you get crappy doctors if you can’t afford to pay for them.”
Singleton cites hepatitis C as an example. This disease runs rampant through the US prison system. By some estimates, as much as 40% of the prison population has hepatitis C. The disease is deadly because symptoms are frequently delayed for years while often irreversible damage is inflicted to the liver.1
Unfortunately, however, hepatitis C is also very expensive to treat. The standard treatment, a ribaviran-interferon cocktail, can cost as much as $25,000 a year.
Rather than pay, prison officials overlook hepatitis C and other diseases as long as possible, frequently discharging infected prisoners without treating or sometimes even telling them. According to a study sponsored by the National Institute for Justice, inmates released from prison or jail account for 35% of the US population infected with tuberculosis and 17% of those infected with AIDS. In 1996 alone, nearly 1.4 million people infected with hepatitis C were released from prison—untreated.2
“You have to have advanced liver disease to get the treatment,” Singleton says. “It’s a huge topic. There needs to be more coverage of it.”
The public needs to know. In 2004, a Human Rights Watch publication wished for Abu Ghraib-style photos to emerge from US prisons, if only to shock people into caring. The paper concluded, “Absent such graphic and unavoidable evidence, it is all too likely that abuse will continue to be a part of many prison sentences.”3
Indeed, until there is a major overhaul of the US prison system, the medical neglect is almost certain to continue. After having a chunk of abdomen the size of his fist removed, Robert Treadway had some simple questions: Why was a patient with a hernia allowed to suffer for five months before getting outside care? Why was a surgical wound allowed to fester into a gangrenous mess before proper medical care was sought?
“Even the nurses said, ‘I don’t know why they didn’t send you to the hospital sooner,’” Treadway says.
Seeking relief, Treadway filed a formal Request for Administrative Remedy with the prison warden. He accused the prison medical staff of “deliberate medical indifference” and requested $10 million and home confinement for the three years remaining of his nine-year sentence.4
In a one-page letter, the warden, M. Pettiford, flatly denied Treadway’s request: “You must let the Health Service care providers know when any medical problems arise, in order to receive the medical attention you need. There is no evidence to support your allegation of deliberate indifference to your medical needs . . . Based on our findings, your Request for Administrative Remedy is DENIED.”
Denial, however, is not an option when it comes to health care for prisoners. The courts have determined that under the Eighth Amendment of the US Consti-tution, officials are obligated to provide prisoners with adequate medical care.5 This is known as the “community standard” of health care, meaning that prisoners are constitutionally entitled to the same level of health care the community provides for itself.
In today’s prison systems—federal, state, and local—the community standard of health care has been eroded by budget pressures, a huge increase in the number of people imprisoned, and a staggering national indifference to the fate of our prisoners. The result is a national disgrace of lawlessness, disease, and abuse:
- According to a 2001 Human Rights Watch study, 21% of male prisoners in America are raped during their incarceration.3 Beatings and abuse by guards and other inmates are disturbingly common.
- According to experts, 20-40% of the prison population has hepatitis C, yet “some state prisons . . . have gone so far as to adopt a ‘don’t ask, don’t tell’ policy as a way of avoiding costs affiliated with the treatment of hepatitis C.”1 Indeed, until late 2002, the state of New Jersey refused to treat prisoners for hepatitis C. It changed its policy only because of pressure from the Philadelphia Inquirer.6
- One of the fastest-growing industries in America is incarceration. America’s war on drugs has flooded our prisons with new inmates; up to 57% of the federal prison population consists of nonviolent drug offenders.3
Privatization: Part of the Problem
Prisons everywhere are bursting to capacity, and prisoners of different security levels are regularly “mixed,” often to the detriment of minimum-security prisoners. To help ease the crunch, states and the federal government have turned to private companies. Today, we contract out to private companies the building, maintenance, and guarding of prisons, as well as the provision of health care within them.
The two largest private health care providers inside prisons are Correctional Medical Services (CMS) and Physician Health Services (PHS). Industry leader CMS operates in 27 states, providing health care for 225,000 inmates on a contract basis. In turn, it contracts with 450 health care providers, including physicians, dentists, and optometrists.
Although CMS claims that about two-thirds of its facilities are “accredited” by “independent reviewing organizations,” it remains very difficult to get an accurate picture of the health care system in prisons. The world inside those walls is closed, and it usually takes a lawsuit to be noticed. Oversight is internal, private, and, in too many cases, nonexistent.
Whether or not privatization works is almost beside the point. Privatization itself is an experiment. The fact is, in the 1990s, the US began incarcerating people at an alarming rate that could not be sustained. By 2002, one of every 146 US adults was incarcerated.3 Yazoo City, where Treadway is housed, was designed for 1,400 inmates and currently houses more than 1,900.7
By putting this many people behind bars, the government has taken responsibility for their welfare. They need to be housed, fed, and otherwise cared for. But there has been no corresponding increase in prison budgets.