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Health Care in Incarcerated Persons. By: David Chamberlain, Dan Clark, and Audra Lenczowski. Objectives. What Rights do Incarcerated persons have What Costs are involved and who is responsible Medical Care Possible Solutions and Closing. Cruel and Unusual Punishment .
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Health Care in Incarcerated Persons By: David Chamberlain, Dan Clark, and Audra Lenczowski
Objectives • What Rights do Incarcerated persons have • What Costs are involved and who is responsible • Medical Care • Possible Solutions and Closing
2011-13 legislatively Adopted Budget • Health Services : Medical, Dental, Mental Health and Pharmacy ( with reserves)
$82.48 per inmate per day Cost of Incarceration in Oregon Correctional System
Medical Care • Oregon Department of Correction is responsible to provide healthcare to over 14,000 prisoners across the State. • Medical issues that are seen range from: major to minor problems, acute illnesses or injuries to ongoing care for chronic diseases, preventative healthcare to end-of-life care • Nursing engage in over 1000 patient care contacts each day in Oregon statewide • Physician/Family Nurse Practitioner/Physicians’ Assistant staff provide more than 250 on-site appointments each day
Medical Care • These inmates enter the system with a lower than average educational level, lower than average income, and a higher level of chronic disease and illnesses. • It has also been reported that they have had poor medical care • 12% have respiratory or heart disease • 18% have moderate to severe mental health problems • 70% have drug and alcohol problems
Medical Care - Prioritized • Medically Mandatory- Level 1 • Care that is essential to life and health where surgical intervention outcome makes a significant difference and has a high cost • Examples are: Repair of deep open neck wound, myocarditis, myocardial infarction, appendectomy for appendicitis, maternity care
Medical Care - Prioritized • Presently Medically Necessary- Level 2 • Care without which the inmate could not be maintained without significant risk of either further serious deterioration of the condition or significant reduction of the chance of possible repair after release or without significant pain or discomfort. • Examples are: medical management of insulin dependent Diabetes, pain management for hospice or end stage diseases - AIDS, medical management of Asthma, hypertension, immunizations, preventative care
Medical Care - Prioritized • Medically acceptable but not medically necessary- Level 3 • Care for non-fatal conditions where treatment may improve the quality of life for the patient. • Examples are: routine hernia repair, treatment of non-cancerous skin lesions, corneal transplant for cataract, and hip replacement
Mental Health • All intake all inmates are screened for mental illness, and on-going evaluations continue throughout their incarceration if severe mental health problems arise. • Mental illness inmates are assigned mental health case managers who work closely with psychiatrists and psychiatrist nurse practitioner in prescribing the appropriate medications as needed • Individual and group therapy for severe and persistent mental illness • Individual sessions are short term and only for crisis situations • Group therapy focus on learning skills to manage mental illness within the institution and in the community after prison discharge • Mental Health Infirmaries are available for short and long-term needs
Mental Health • 7 out of 10 Oregon inmates need some type of mental health care • Oregon Corrections Department has added 525 beds for mental health care since 2005 for a total of 900 which is more than the Oregon State Hospital • Mental illness is most prominent among prisoners younger than 24 • Women have a far higher rate of mental illness than men • The loss of mental health services in communities has turned prison system into one of the state’s largest mental health providers
Mental Health • No psychiatrists will work for a prison in eastern Oregon so health professionals have resorted to teleconferencing with inmates • Corrections officials elected to bring the most severely ill inmates to the Willamette Valley, but where to put them…… • SUPERMAX- a high-security setting for the most dangerous offenders. In fall of 2011 they opened with a 187 bed
Mental Health Courts • Only handle cases involving offenders with mental disorders • Special training has been given to the judge, prosecutor, court staff, and defense attorney in community health services • Defendants can have their charges or jail sentences deferred if they agree to participate in mental health services such as: medication management, substance abuse treatment, psychosocial rehab, and job training
Automated Criminal Risk Score to identify offenders most like to recidivate- In Oregon is considered a reconviction of a felony within three years of release • Age, time earned, sentence length, revocation, number of prior incarcerations, prior theft convictions and type of crime (person, property or statutory) • Oregon’s rate fell from 29.8% in 2005 releases to 27.5 % in 2008 releases which is an 8% decrease • Reducing recidivism by 1% saves $4.3 million in annual taxpayer and victims costs • RECIDIVISM
Michelle Kosilek • 27 W. New Eng. L. Rev. 219 (2005) Criminal Law - Kosilek v. Maloney: In Prison While Imprisoned in the Body of the Opposite Sex: Examining the Issue of Cruel and Unusual Punishment Presented by an Incarcerated Transsexual; Andreopoulos, Nikolas • http://www.youtube.com/watch?v=13UsUSjv1TM http://www.google.com/imgres?imgurl=http://4.bp.blogspot.com/-HHbLsruEeXE/UEjLpJq3Y2I/AAAAAAAAcdw/wfgVvIejg-I/s320/Michelle%2BKosilek.jpg&imgrefurl=http://transgriot.blogspot.com/2012/09/conflicted-about-kosilek-case.html&h=306&w=265&sz=22&tbnid=QbX8_A73op0QIM:&tbnh=90&tbnw=78&zoom=1&usg=__v7BHd5lZmU1rwKGxsT52ERlDsBY=&docid=6L5B-zuf6t55BM&hl=en&sa=X&ei=0u8RUbKzMqTBigLp44GIDA&sqi=2&ved=0CFkQ9QEwBQ&dur=2534
Kenneth Pike • http://www.youtube.com/watch?v=eZZT1dkSF14 https://www.google.com/search?hl=en&q=kenneth+pike&bav=on.2,or.r_gc.r_pw.r_cp.r_qf.&biw=1619&bih=737&wrapid=tlif136013085550910&um=1&ie=UTF-8&tbm=isch&source=og&sa=N&tab=wi&ei=JPMRUc6-Osa0ygHh94HIDw#imgrc=BFSOq4k4q0upjM%3A%3B2_hJbwUQzMdaQM%3Bhttp%253A%252F%252Fa.abcnews.com%252Fimages%252FUS%252Fht_kenneth_pike_nt_110425_wg.jpg%3Bhttp%253A%252F%252Fabcnews.go.com%252FHealth%252FHeartHealth%252Fconvicted-rapist-kenneth-pike-turns-organ-transplant%252Fstory%253Fid%253D13458512%3B640%3B360
(Special Cases) Kidney Organ Transplant Horacio Alberto Reyes-Camarena
Relevant Problems and Issues • Moral and Ethical issue • Future Liability Issues • Rising Cost of Inmate Healthcare
How Do We Fix? • Start • SMALL
DETOX WHILE INCARCERATED • Approximately 15% of inmates are incarcerated while addicted to heroin • The majority of US jails do not provide any medication for opioid detoxification • Muscle relaxers, sedatives, anti-nausea medications
WHY IS IT A MORAL/ETHICAL ISSUE? • Needle sharing and HIV • Vomiting and diarrhea spreads disease • Fictitious symptoms and dangerous medications. • Untreated inmates do not look for treatment outside of incarceration. • Untreated inmates are at an extremely high risk of receding back to criminal behavior after release.
CRUEL AND UNUSUAL PUNISHMENT? • “…the first time I kicked I had a heart attack. Well you start (the withdrawal) the hot and cold sweats. And with the diarrhea, stomach cramps and you throw up and you do that for like three days straight or four days straight. And then you be has weak as I don’t know what. And when I had my heart attack I was sleeping and it woke me up out of my sleep… Luckily the officer recognized what was going on and they rushed me to the hospital. And if they didn’t I probably would had died.”
IS IT A DEATH SENTENCE/LIABILITY • The loss of tolerance after detoxification contributes to the risk of fatal overdose after release. • Washington State Prison Survey (based on 30,000+ inmates) found that inmates have a death rate 12.7 X the normal citizen in the first 2 weeks of release. That rate significantly drops to 3.5 X the rate of a normal citizen after 5 weeks of being released. • Drug overdose was the leading cause of death by far.
POSSIBLE SOLUTIONS • Naloxone • Inmates who request could be trained on how to use the antidote Naloxone and be given a prescription prior to release. • This has been used in several trials across the country since 1999 with great success. • Really?! We are going to spend more money and time training prisoners on how to stay alive, therefore increasing the chances of spending more money to arrest them again?
BEST SOLUTION FINANCIAL AND MORAL • LAW ENFORCEMENT ASSISTED DIVERSION • LEAD
Lead • New program in Seattle that has captured nation wide attention • Gives offenders (low level drug dealers and addicts) the choice between rehab or jail time. • “Green light night” • Front line cops decide who gets in
Lead Facts • Is aimed at frequent flyers • Offers a hot meal, a warm coat, a safe place to sleep – as well as long term services for drug treatment, stable housing and job training • Violent offenders or larger dealers do not qualify
LEAD BEGINNINGS • Early 90’s petty drug crimes represented 1/3 of felony cases and tough sentences • Early 2000 a Seattle public defense firm began filing lawsuits on the police department involving racial disparity which led to many cases being dismissed • The result of lawsuits led to the creation of LEAD
LEAD GOALS • Reduce number of low level drug offenders entering the system • Redirect public safety resources to more pressing priorities, such as serious crime and violent crime • Improve individual and community quality of life through research based, public health-orientated interventions • Sustain funding for alternative interventions by capturing and reinvesting criminal justice system savings
LEAD SAVINGS DOLLARS AND LIVES • First time felony arrests cost the taxpayer between $3,000 to $7,500 • On average a 2nd or 3rd felony guilty plea will spend a year in jail or prison time costing between $33,000 - $72,000 per inmate • Lives are being turned around and would be frequent flyers are now becoming productive citizens • Lives are being saved r/t proper rehab and coping techniques taught by counselors resulting in fewer overdoses.
Conclusion • The cost of healthcare for an incarcerated individual can be effectively controlled by examining the processes of the system. If the funds are redirected to a preventative system that reduces incarcerations it would result in a cheaper and more favorable/moral outcome. The system must start small examining the cause and cure for each disorder that appears often in incarcerated healthcare.
CONCLUSION CONTINUED • As a result of LEAD, Seattle has also been addressing the mental health concern with the Crisis Treatment Center. This center provides a 24/7 drop off location for officers to drop of those in lieu of booking. It does assessments, and referrals to services rather than jail time.
TEXAS FOLLOWS EXAMPLE • Also following the example of the LEAD program, Tarrant County in Texas, has developed the Felony Alcohol Intervention Program. This gives the opportunity to those found guilty of multiple DUI’s to receive treatment rather than jail time. It cost’s the county $3 a day rather than the $50 per day price tag of a prison bed.
