Inmate Healthcare

I have blogged previously on my practice's involvement with healthcare delivery to local inmates at our jail. We care for a population of approximately 1,000 inmates. This is a big problem for taxpayers and is only going to get worse as time passes. We have an aging, sicker population. We could speculate for hours on why more people are commiting crimes-drugs, money, etc.

Our society demands justice and it seems like our default method of rehabilitation is incarceration. In my opinion, there are certainly people that need to be behind bars. But there are many crimes that could be punished more effectively out of jail and then the burden of healthcare would not be placed on the taxpayers. A prime example of what is rampant in the correctional system regarding healthcare is here. Susan Atkins, one of the Manson murderers has a $1.4 Million tab in the past four months with a malignancy of the brain. Now, she is obviously someone who needs to be behind bars but her case illustrates what is going on throughout the country in correctional healthcare. The state of California taxpayers are having to pay this bill for her. At least for now, because inmates are unable to have a choice in their healthcare, their healthcare is a right as defined by the Supreme Court. And I do believe that inmates deserve good medical care while they are being held. It is the delivery and payment of the care they receive that needs to be changed. I realize we have many who think it should be a right for everyone but that's another discussion altogether.

Should taxpayers have to pay the medical bills for inmates? I don't think so. I know that many of the problems we face are non-violent offenders such as people who owe child support and things like that are coming into the system with chronic medical problems that only one trip to the hospital will greatly exceed any penalty they owe. Let's take an example in my practice-my partner went to the jail not long ago to suture a guy's head who got in a fight there. Took about an hour to go up there get to the medical unit and do it. He was talking to the inmate and they guy could bond out for $100 but he didn't have it. Now, had that guy needed to go to the ER for a CT, what would we have accomlished as a society? His crime was writing a bunch of bad checks. I don't dismiss his crime but for crying out loud, let's use our heads in sentencing these people. In my previous post regarding correctional healthcare, I talked about an inmate with HIV who was in jail for breaking into a Coke machine. His medications cost about $1500/month. The whole machine didn't cost that much. Find another sentence.

Another twist to this situation is that if an individual has private insurance, Medicare or Medicaid, the moment they are incarcerated, the insurance is stopped. It can be reinstated after release but many times this takes 60-90 days. So, in the case of someone with an illness which requires expensive medications, the taxpayers have to start paying for the inmate's medications immediately. Then comes the problem of release. Let's say a non-violent offender on Zyprexa for a mental illness with Medicaid gets incarcerated then released a month later. The taxpayers paid for a month of the Zyprexa and now the person has no way of affording his or her medication when he or she is released for 60-90 days. This, especially in the case of mental illness, leads to a high recidivism rate. Unfortunately, many of the mentally ill in the jail have been placed there because of something they did while they were not controlled on their medications. They then get incarcerated for a non-violent crime and lose their Medicaid. When they are released, there is no way to get their medications because they have lost their insurance and any of the free psychiatric services are booked up for months at a time. What happens? They then either commit another crime because they are off their medications or they actually intentionally commit a crime in order to get put back in so they can receive their care. I have actually had county inmates tell us that when they have dental problems, they will commit a small crime so they can get put in jail and get their teeth pulled for free.

I will briefly mention, as well, that many jails pay the "retail" fee to hospitals for services for inmates. This is another area in which the taxpayers are penalized. However, we can't completely blame the hospitals for this because what we have learned from the hospital association is that a common practice is to "release" an inmate from custody when they go to the hospital for something. The hospital is then left with a "self-pay" patient to care for since their insurance has been suspended. So they have been looking out for their interests in this as well. Fortunately, we were able to negotiate a Medicare rate with our hospital on behalf of our county and this step alone has saved almost $500,000 per year. If an inmate goes to the hospital, the county gets a fair rate, the inmate doesn't get released on the doorstep and the hospital gets a fair payment within 30 days.

This is a complex problem with very few answers. Our group has made suggestions which would greatly reduced the local taxpayer cost to our state legislators but this has really fallen on deaf ears. One would hope the case in California will open they eyes of the powers that be but I wouldn't hold my breath.