| 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.
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