Penn State researchers making end-of-life care for prison inmates are the focus of a $1.27 million grant. Researchers are using the National Institute of Nursing Research grant to develop a comprehensive toolkit of tailored resources for end-of-life care in prisons, assistant professor of nursing Susan Loeb wrote in an e-mail. News reported in the Daily Collegian.

Leaders of the program plan to apply study findings at six different prisons state-wide in an attempt to improve care for inmates reaching the end of their lives, wrote Loeb, the principal investigator for the study.

“Since prisons are among the most restrictive, most complex organizations — prisons are the best context for this study,” Loeb wrote. “Our hope is that findings will benefit not only dying inmates but also others who spend their final days in a complex organization.”

Though the study is still in the early stages, researchers are quickly learning, said Christopher Hollenbeak, associate professor of surgery and health evaluation sciences and an investigator on the study.

“The real goal of it is to come up with a tool in prisons to improve the quality-of-life care,” Hollenbeak said. “We want to provide a toolkit that would be cost-effective as well.”

Current end-of-life prison programs only offer limited low-cost medications. One proposed change is the “buddy system,” where healthy inmates are paired with a terminally ill inmate to help look out for them, Hollenbeak said.

So far, researchers have visited the Philadelphia prison system for a chance to experience what it is like to be in a prison as an inmate, Hollenbeak said. Researchers are also spending time with the Pennsylvania Department of Corrections in order to understand the prison landscape at all levels, Hollenbeak said.

janchavarie Inmate Health Care, Pennsylvania

They may be the busiest medical clinics in Jacksonville, treating tens of thousands of patients with chronic diseases, mental disorders and drug addictions each year. Full report in the Jacksonville News.

They’re open 24 hours a day, seven days a week. But they’re also very closed: hidden behind bars and bolted doors in buildings few people ever willingly visit.

On any given day there are roughly 4,000 people housed at Duval County’s three correctional facilities. And their medical issues – from a risky pregnancy or prostate cancer to AIDS or schizophrenia – must be addressed.

But beyond the legal requirements, law enforcement officials say it’s sound public policy to help inmates get as healthy as possible before they’re released.

Women who weren’t getting prenatal care while on the streets have given birth to healthy babies in jail. People have been successfully weaned from drug and alcohol addictions. Some inmates are receiving consistent treatment for a chronic disease for the first time.

“We try to see incarceration as an opportunity to intervene, because the vast majority of people go back to the community,” said Max Solano, the doctor who oversees the health services division of the Jacksonville Sheriff’s Office.

Because of that philosophy, Solano and others say, patient care has improved and the number of lawsuits has dropped.

A change implemented last summer is also helping keep costs down. That’s when the Sheriff’s Office ended its partnership with the Duval County Health Department and brought those employees in-house. The change wasn’t because of a disagreement about patient care, but because the state and city couldn’t agree to contract terms when it was time for renewal.

Sheriff John Rutherford estimates the switch could save taxpayers up to $700,000 this year because the city is no longer on the hook for an administrative overhead fee paid to the state. Overcrowding at the jail caused that fee to rise in recent years.

Most of the jail health employees under the old system remain, including Solano, but now they’re Sheriff’s Office employees instead of state workers.

Though the community health model was embraced during the Health Department partnership, Solano said the transition to an in-house division of health services has provided even greater flexibility to meet his patients’ needs.

Cassandra Bush, founder of THORMINC Ministries, is often a witness to the end result: offenders transitioning back into the community.

“You know the old horror stories you used to hear?” she said of jail medical care. “You don’t hear that anymore.”

Community partnerships

The treatment rooms at Jacksonville’s jail look familiar – adjustable beds topped with sanitary paper linings. There’s a small pharmacy nearby, along with a room with a dentist’s chair where emergency procedures can be performed.

Some are shocked that the medical services at the jail are about the same as any other doctor’s office, only busier. The clinics at the three correctional facilities handle about 150,000 patient visits a year.

The city’s indigent-care contract with Shands Jacksonville allows inmates with injuries or ailments beyond the capabilities of the in-house clinics to be treated at the hospital. There are also partnerships with other service providers, so even services like chemotherapy or dialysis can be provided.

But while the new program has its fans, there are detractors. One recently released inmate told the Times-Union he was forced to wait two weeks to have his injury treated.

Lee Suitter said he spent six months in jail for a domestic dispute. Two months before his release, he was injured in a scuffle in his cell, which he reported the next day.

“I said, ‘Look, my hip’s killing me,’” Suitter, 49, recalled.

He said corrections officers chastised him for not reporting the incident immediately. Two weeks later, he was finally seen by a nurse. After three visits to the jail clinic, he was taken to Shands for an X-ray, he said.

“It took them that long to even think about getting me down there,” Suitter said.

Two days later, he said, he was released without ever receiving any real diagnosis or treatment. But he was still charged $5 for the clinic visits under a policy that allows the Sheriff’s Office to recover some of its medical costs.

Solano said the long delay shouldn’t have happened because the turnaround time is normally 24 to 48 hours, maybe a bit longer on weekends. He said his staff conducts quarterly surveys to ensure the clinic is meeting accreditation standards for response times.

‘Many, many chronic diseases’

There was a time when complaints like Suitter’s were more common.

Solano remembers working at the jail years ago when medical services were managed by a private company. That company began to put the bottom line ahead of patients’ rights, Solano said, and he felt himself losing the ability to make medical decisions.

He walked away from the job.

Duval County Jail Chief Tara Wildes, who has spent most of her 25-year career in corrections, also remembers the battles.

“Care wasn’t their primary concern,” she said. “But also the bigger thing is they didn’t seem to have a connection with the bigger community.”

In 2006, Rutherford ended that relationship and medical services were provided through the Duval County Health Department partnership. Embracing the community health model, Solano was invited back to serve as its head.

The sheriff said the years he served as corrections director opened his eyes to the myriad medical and mental health issues the department addresses.

“I was amazed when I went over there to find out that not only did I run the largest residential mental health facility, but also the medical issues,” he said. “This is a sick population. They have many, many chronic diseases.”

The focus is now on helping patients receive the best care while under lock and key so they won’t overload emergency rooms or endanger the public when they’re released.

“We need to be sending them back better than when they came, or at least identify what their problems are instead of just sending them back out there to, if they’re contagious, infect the community,” he said.

A similar philosophy is employed at the 478-bed Clay County Jail. Major Craig Aldrich, who oversees the facility, said the Sheriff’s Office considered outsourcing medical services to a private company but began to worry about quality of care.

It’s illegal and potentially costly if an inmate can prove his medical problems, no matter how small, were ignored while in lockup.

“I have to be worried about the bottom line, but I also have to worry about taking care of that inmate so I don’t get sued in federal court,” Aldrich said. “We just thought it was in the best interest of the county, so we could have a lot of control of our own medical staff.”

By contrast, the St. Johns County Sheriff’s Office has embraced the privatization model, contracting medical services out to Armor Correctional Health Services.

janchavarie Florida, Inmate Health Care

Phillip Damon Arnold drunkenly hit three Lakewood police cars during a chase that ended with two bullets in his shoulder and another in his cheek. It also ended with the taxpayers of Lakewood becoming the financial caretakers of Arnold’s medical treatment. The city’s reward for capturing him without injuring bystanders: a hospital bill of $138,000. News reported in The News Tribune.

On Sept. 26, 2008, Arnold drove his Chevy Blazer toward a police officer, who responded with gunfire, according to police reports obtained by The News Tribune.

The bullets hit the Lakewood resident but didn’t stop him. Police eventually pinned his vehicle on Gravelly Lake Drive Southwest and wrestled a bloody Arnold out of the front seat. He was arrested and taken to Tacoma General Hospital for treatment of his wounds.

Arnold was convicted 11 months later of felony harassment, attempting to elude a police vehicle and three counts of first-degree malicious mischief. He was sentenced to almost three years at McNeil Island Corrections Center. A review board deemed the shots fired by police to be justifiable.

Even so, the city was on the hook for Arnold’s hospital stay, which included surgery and other care. Lakewood leaders say his care actually cost more than $138,000, but the hospital offered a negotiated rate.

The city paid the bill last fall, and City Manager Andrew Neiditz notified the City Council in an Oct. 6 e-mail that was obtained by The News Tribune. Similar incidents have played out across Washington since the state Attorney General’s Office issued a controversial opinion on jail costs in 2005.

The attorney general placed the burden of inmates who need medical care before they are booked into jail on the agencies that arrest them, as long as the inmates have no insurance or otherwise cannot afford medical treatment.

The U.S. Supreme Court had previously ruled that people behind bars have a right to health care. It also ruled that whoever has custody of a convicted inmate – a county government or the state – must pay for that care.

But up until 2005, it was unclear who was responsible for the medical bills of people who are wounded or injured during the arrest or before being booked into jail. Since then, cities including Lakewood have had to shell out thousands of dollars.

“It’s been a big pain and cost to the cities,” said Jim Doherty, legal consultant for Municipal Research and Services Center of Washington. “It’s the hot potato. None of the agencies want to be responsible.”

COSTLY CARE
The hot potato has landed in the hands of various jurisdictions across Washington.

• In Tacoma, the city paid about $115,000 for health care for people arrested in 2008, almost all of which involved a man who had been shot, according to deputy city attorney Michael Smith, legal advisor to the police department.
• In Orting, Police Chief Bill Drake said the department had a nearly $72,000 medical bill for someone it arrested in 2008. The city negotiated a reduced price, but for a department with an annual jail budget of about $30,000, it still took a hit, he said.
• In Sequim, a man who eventually pleaded guilty to killing his girlfriend in a motel room was diagnosed with cancer shortly after his arrest. The city had budgeted $75,000 for all inmate medical costs for the entire year. But his chemotherapy treatments had cost the city about $37,000 by 2005, according to News Tribune files. The man later died.

“It does become an issue when these bills become substantial,” said Drake, the Orting chief. “It can be substantial for smaller cities.”

WHO’S RESPONSIBLE DEPENDS ON THE CRIME
Pierce County charges a daily fee of $80 per inmate to the agencies that use its jail – a fee that includes medical, dental and mental health services for felons.

But before an arrested person is allowed into jail in the first place, a nurse determines whether he or she is “stable enough to be cared for in a stabilized environment,” said deputy prosecutor Craig Adams, legal advisor to the Sheriff’s Department.

If he’s not, then the arresting agency must pay for the care that will make the alleged criminal healthy enough for jail.

Later, if an inmate is convicted of a felony, the county continues to cover health care costs – or the state does, if the person is sent to a state prison. If the person is arrested or convicted of a misdemeanor, medical care is the city’s responsibility.

Meanwhile, the cost of medical services at the jail continues to climb – even as county leaders have lowered the overall corrections budget.

Pierce County budgeted $3.6 million for medical services related to the jail in 2003. This year, it budgeted $6.2 million.

The jail provided 73,932 sick calls to inmates in 2009, 1,000 more than the previous year. It budgeted almost $441,000 to cover drug supplies for inmates this year, more than $25,000 above 2009.

Corrections Chief Martha Karr cited a number of factors for the rising costs.

“We’re getting older, less healthy inmates,” she said. “We have to treat them.”

“We are seeing offenders with significant medical issues,” she added. “When individuals are arrested, they may not have seen a doctor or dentist in years. Unlike in our community, while they are incarcerated, they have a constitutional right to health care.”

LACK OF INSURANCE
Hospitals first try to charge the medical insurance provider of the person arrested. The problem, city officials say, is that many of these people don’t carry insurance.

There have been efforts to implement reforms to help cities. The Association of Washington Cities has discussed everything from jurisdictions pooling money to lobbying the state to help with extraordinary bills. But no law has been passed to provide assistance to local governments.

The state Department of Corrections can release low-risk inmates who have costly medical conditions under electronic monitoring if their release is expected to save the state money.

In Arnold’s case, he didn’t have insurance coverage for the wounds he sustained during the chase.

According to police reports, officers initially stopped him because of improper lane travel in the 5400 block of 100th Street Southwest. Arnold wouldn’t follow the officer’s directions and sped off.

Eventually police cornered him in a parking lot at the 9100 block of Bridgeport Way Southwest, where he rammed two of their patrol cars, sped away again and got stuck on a fence, police records state.

Three officers got out of their cars to confront him, according to the records; that’s when he put his car in reverse, got unstuck from the fence and headed toward the officers. One officer fired three shots.

Arnold’s SUV was eventually pinned again and he was pulled, wounded, from the vehicle on Gravelly Lake Drive.

He already had a criminal history of burglary, theft and possession of stolen property.

EXTENSIVE CARE
Lakewood wouldn’t disclose what treatment the $138,000 paid for, but police reports indicate Arnold was in bad shape and needed extensive medical care.

“The suspect was covered in blood and was bleeding from the jaw,” one officer wrote in his report.

“When I told Arnold to get out of the car he replied, ‘No! You guys already shot my teeth out!’” wrote another officer. “At this point I noticed Arnold’s mouth had been injured and his shirt was covered in small white chunks of material that could have been teeth.”

Officer Ronald Owens guarded him on Sept. 26, 2008, hours after the chase. (Owens was one of the four Lakewood officers fatally shot by Maurice Clemmons in a Parkland coffee shop two months ago.)

“I could smell an overwhelming odor of intoxicants emitting from the room,” Owens wrote in his report. “I observed Arnold lying on a backboard. He was covered up with blankets. Arnold’s right side of his face was extremely swollen. He had on a clear plastic mask that covered his mouth and nose. He was in a ‘C collar’ and there was blood on him.”

The officer who shot Arnold was placed on paid administrative leave, which is standard procedure in officer-involved shootings.

In November 2008, the department’s review board unanimously ruled the shooting was “lawful and within LPD policy,” and the matter was closed, according to documents.

Today, Arnold is 31 years old and is serving a 33-month sentence at McNeil Island. He is scheduled for release in 2011.

SOLUTION DIFFICULT TO SEE
The $138,000 was the most Lakewood has paid for an inmate’s care. It has paid for other inmates’ treatments, but they amounted to a few hundred dollars each.

City Manager Andrew Neiditz said the money for Arnold’s care did not come out of the police budget; it was taken from the city’s operating budget, which in 2009 was $38 million.

Lakewood City Councilman Don Anderson said it’s unfortunate that inmates’ medical bills are an extra financial burden on local governments.

But Anderson said he doesn’t foresee reform soon, because any option will require the use of public dollars. Where the cost falls legally – city, county or state – is almost accidental, he said.

“I honestly don’t know a way around it,” he said.

janchavarie Inmate Health Care, Washington

As of mid-December, the Shawnee County Department of Corrections had spent $141,856 on medications, including $63,869 in psychotropic drugs. News reported by the Topeka-Capital Journal.

The amount of money spent per month has decreased in the past few months, said Brian Cole, deputy director of the Shawnee County Department of Corrections. However, at times, the county jail has had one of the highest bills for psychotropic drugs in the Midwest.

Sixteen percent of inmates at the county jail suffer from mental illness, and 45 percent of the money spent in 2009 on medications has been to treat those individuals.

Crisis Intervention Team is a program that Shawnee County began implementing a few years ago to try to divert people with mental illness to community-based treatment facilities instead of jail.

“A jail is not a place to stabilize those with mental illness,” Cole said. “We are not a mental health facility.”

CIT was started after Greg Eilert, 45, who was schizophrenic, was shot and killed by Topeka police in August 2006 while in his car near S.W. 29th and Fairlawn. The shooting was reviewed and found to be justified. “His family became very motivated,” Cole said.

Greg Eilert’s mother and sister often share Greg’s story with officers who are receiving CIT training. About 30 percent of all law enforcement officers in Shawnee County have voluntarily received the training, including corrections officers who work at the jail. “We need to continue to build the pool of officers,” Cole said.

The training has several goals, Cole said, including to ensure officers’ safety, reduce the stigma associated with mental illness and increase collaboration among area agencies.

The training is usually 40 hours long and is offered in Shawnee County at the Topeka Police Department twice per year. The next CIT training is in April.

“Our main focus is to diffuse the situation,” Cole said. “We see the need. Topeka, Kansas, and Shawnee County have a high population of people with severe mental illness.”

Usually people with mental illness who are arrested are arrested for minor crimes, such as trespassing, public intoxication or drug-related offenses, he said. Every year, about 800,000 people with severe mental illness are incarcerated in U.S. jails.

At the Shawnee County Jail, a person is evaluated upon their arrival to find out if he or she has a mental illness. Once identified, the inmate meets with a member of the mental health team, which includes two social workers and a psychologist. David Coleman serves as the mental health team leader for Shawnee County. He has been in his field since 1973, he said.

Although the Shawnee County Department of Corrections oversees the mental health team, Prison Health Services, a company made up of more than 3,800 professionals who work in jails, prisons and juvenile facilities nationwide, oversees medication dispensing and prison health. A registered nurse is on staff 24 hours at the jail.

Medication rounds are conducted in the morning, at noon and at bedtime, said Karen Marsh, PHS health services administrator. Inmates have illnesses ranging from severe depression to schizophrenia. Those with mental illness don’t fare well in the criminal justice system, Cole said. Oftentimes they are exploited or manipulated by other inmates, have difficulty coping and can’t make bail.

A U.S. Justice Department study found that 60 percent of people with mental illness in jail don’t get treatment, Cole said. The Shawnee County Jail works hard to make sure inmates get the help they need, the deputy director said. Statistics show the CIT program is working, Cole said.

Since the third quarter of 2008 through the second quarter of 2009, only one person out of 134 calls to which CIT members responded went to jail.

“We are seeing an improvement,” Cole said. “What I want the public to understand is this is a much-needed resource.”

No money from the Shawnee County Department of Corrections goes into the program, Cole said. Volunteers do all of the training, too.

Topeka Police Chief Ron Miller said the CIT program is very valuable. He said the training is helpful because officers are the ones who have to determine if a person needs to be arrested or treated.

“The key for the police officer is assessing the needs of the person,” Miller said. “It is also key to recognize the need and know how to connect the person to the services they need.”

TOP 5 PSYCHOTROPIC DRUGS ADMINISTERED
The top five psychotropic drugs administered by Prison Health Services at the Shawnee County Jail are:

1. Abilify, a medication used as an add-on treatment for depression, as well as for the treatment of schizophrenia and manic episodes.

2. Zyprexa, a medication used for the treatment of schizophrenia, acute manic and mixed episodes of bipolar disorder and maintenance treatment.

3. Seroquel, treats the symptoms of schizophrenia and bipolar disorder.

4. Risperdal, used to treat schizophrenia and symptoms of bipolar disorder.

5. Geodon, a medicine for the treatment of acute manic or mixed episodes of bipolar disorder and for schizophrenia.

janchavarie Budgets, Inmate Health Care, KS Shawnee County

A brand new prison is taking credit for the plummeting crime rate in the Isle of Man. News from the Daily Mail.

But it is not the fear of being locked up that is making criminals think twice before stealing, fighting or trading in drugs. The prospect of being forced to give up smoking is apparently far more frightening.

The £42million jail, which opened last year, is Europe’s only non-smoking prison. Inmates and guards are not allowed to smoke either in or outside the buildings.

With just under 100 prisoners, there is plenty of room for more, with at least 40 cells empty. The Isle of Man, already one of the safest places in Britain, has seen a 14 per cent drop in crime since the jail opened, or rather closed, its doors in August 2008.

Prisoners arriving at the jail are told they have no choice but to give up smoking and are offered nicotine patches and counselling to help them cope. An Isle of Man police source said: ‘There are 200 officers on this island and anything which makes our lives easier is welcome news.

‘It has become a standing joke that when we nick someone we remind them that if they get sent down they’ll have to come off the cigarettes – their faces are a picture.’

In the last 12 months, the number of burglaries has plunged by more than 35 per cent, there has been a 25 per cent drop in the number of assaults, and the number of people caught stealing cars has fallen by seven per cent.

Domestic assaults fell 11 per cent and criminal damage offences dropped eight per cent.

The crime rate on the Isle of Man was already low, with experts saying it is down to ‘low unemployment and high community spirit’, but also that the criminal justice system takes a hard line on crimes, with even small crimes often resulting in imprisonment.

One former prisoner, who spent six months there, said the smoking ban had cons ‘crawling up the walls’ in desperation for a nicotine fix. The inmate, who didn’t want to be named, said today: ‘As soon as you get to the prison they take your fags and lighter off you.

‘It came as a big surprise to a lot of us – smoking is something that helps people doing time stay sane – it’s something to do with all that time you have on your hands.’ He added: ‘As soon as word got round that it wasn’t a joke and that all smoking was banned, even in the exercise yard, a lot of people I know started having second thoughts about committing crimes.

‘It was something they genuinely feared. Not prison itself, but the idea of being forced to give up smoking. Some of my mates have simply given up crime, whether it be stealing cars, shoplifting to order or burglary, as a direct result of the smoking ban.’

A spokeswoman for the prison said that the huge drop in recorded crime could not be ‘wholly attributed’ to the non-smoking prison, but said the non-smoking status of the prison was now a well known fact on the island.

She said: ‘The No-Smoking Premises Regulations 2007 are well known throughout the Island. All smoking prisoners are offered every assistance through our professionally qualified medical team and prescribed nicotine replacement therapy in accordance with clinical guidance.’

Home Affairs Minister Martyn Quayle, said at the opening of the prison: ‘It’s been a very difficult issue to reflect the fact that we are not going to please everybody. Certainly the prison officers have a right to enjoy a no-smoking environment as much as their counterparts in the civil service working outside the prison.

The Department considered a total ban was the right policy to adopt. Chief Inspector Simon Lowe, of the Isle of Man Constabulary, said today: ‘Anything that helps reduce crime is welcomed by the police.’

A Facebook group has even been set up to fight for the right to smoke in the prison and already has 218 members. The group called ‘Allow smokers to smoke in the Isle of Man prison’ states: ‘This group is really more of a petition against the banning of prisoners smoking in the new prison on the Isle of Man.

‘Smoking being banned in the entire prison is an absolute joke and an infringement against human rights by do-gooders.

‘At least let the people who are in (prison) smoke outside. It’s the only prison in Europe that has this rule.’

janchavarie Smoking, United Kingdom

On the sixth floor of the Nueces County Jail, an X-ray machine, lab, physical therapy room and dentist’s office are provided for inmates to reduce any need to transport them outside. It costs about $10 a day per inmate for the jail population to have instant access to routine medical care. Reported by the Caller-Times.

“Neither you or me has access to this kind of medical care,” Sheriff Jim Kaelin said.

The risk of taking inmates to a hospital is too high because some of the jail’s population includes high-risk offenders, Kaelin said.

“These guys would kill you and wouldn’t think twice about it,” he said.

County commissioners recently approved a one-year, $3.6 million contract extension with the Christus Spohn Health System to cover inmate medical care until October 2011. The contract includes $300,000 of one-time payments as part of negotiations.

That contract, along with a doctor who is paid $144,719 annually by the county to supervise a contracted physician’s assistant, adds up to the inmates’ medical costs.

Christus Spohn Hospital Memorial has provided the jail’s medical services for at least 17 years, Kaelin said.

He said he didn’t think the county has gone out for bids to compare that cost. Instead, the county always has chosen to negotiate contract extensions.

“They haven’t seen if they could get the same quality of service at a better price,” Kaelin said.

The Nueces County rate is higher than similar-sized jails such as those in Williamson, Brazoria and Galveston counties. Medical costs at those jails are less than $7 a day per inmate.

“I think Nueces County has gone above and beyond and they’ve got to be complimented for that,” said Adan Muñoz, executive director of Texas Commission on Jail Standards.

The level of medical care at the Nueces County Jail, he said, is something usually seen in much larger jails such as Harris and Dallas counties where full hospital wings or floors are devoted to medical care.

At the Galveston County Jail, medical services are contracted through Correctional Medical Services, a private firm. Instead of county-owned medical equipment such as X-ray machines, the contract covers the cost of contractors bringing in supplies as needed, jail superintendent Mike Henson said. Galveston County doesn’t bear the cost of fixing or upgrading equipment, unlike Nueces County.

For any immediate medical needs, such as chest pains or surgical needs, inmates are taken to one of two nearby hospitals, Henson said.

At the Brazoria County Jail, medical costs are contracted with the University of Texas Medical Branch, which covers all inmate medical costs including hospitalization, County Auditor Connie Garner said. The county used to have an in-house medical wing, much like Nueces County, but did away with it years ago, she said.

“We decided it was better for us to go with UTMB. At the time, it was a reasonable deal, and it got us out of liability situations. It also saved a lot of headaches,” she said.

At the Williamson County Jail, medical costs are even lower. The jail contracts with a full-time doctor and mental health professional and pays emergency medical technicians from its own budget. The medical technicians don’t require the same salaries as registered nurses that work at the other jails. The in-house operations lower the jail’s medical costs to $1.12 million, $2 million less than Nueces County pays.

Nueces County: Total medical budget: $3.63 million; cost per inmate per day: $9.75

Brazoria County: Total medical budget: $2.83 million; cost per inmate per day $6.62

Galveston County: Total medical budget: $3 million; cost per inmate per day $6.92

Williamson County: Total medical budget: $1.12 million; cost per inmate per day $2.71

janchavarie Economic Issues, Inmate Health Care, TX Neuces County

Prisoners and workers at the Department of Corrections are about to deal with a big change. Story from WALB News.

The Department is banning tobacco use at its 37 facilities. In 1995, they banned the use inside buildings and that led to a riot by state prisoners in Lee County. This time they hope phasing it out gradually will ease inmates into the transition.

The state prison system is following the lead of facilities like the Dougherty County Jail that has been tobacco free for 15 years and Lee County Jail that went tobacco free nine months ago. Prison leaders say it’s counter productive for inmates to give up smoking in jail only to start lighting up again in a state facility.

By the end of 2010 Georgia’s state prisons will be tobacco free. The Georgia Department of Corrections says it’s a move that will improve the health of inmates and save tax money by cutting health care costs.

“With tobacco use contributing greatly to health issues and health problems, that’s something that we are always cognizant of when it come to the budget, is making sure we contain our health costs this is one of the ways to help do that as well,” said Michael Nail, Deputy Director of the Corrections Division.

The Dougherty County Jail banned tobacco products in 1995 when the new jail opened, it’s meant a cleaner facility, but created a new problem.

“It has become the largest items of contraband in the jail,” said Col. Doug McGinley, the Dougherty County Jail Administrator.

Family and friends have gone as far to leave tobacco outside the guard line for work details. The Department of Corrections says while tobacco may be the new contraband it may cut back on other dangerous substances.

“What is increased in contraband is tobacco, ironically the possession of drugs as contraband actually goes down, so in one sense of it while you still have some contraband by way of tobacco you’re minimizing the drug contraband,” said Nail.

Dougherty Jail Officials say it’s been a while since they’ve had a complaint.

“Surprisingly it’s been 10 or 12 years since we’ve had a complaint from the inmates that this is a tobacco free facility,” said McGinley.

The state’s ban of the substance will also mean a loss in the revenue, right now they can sell cigarettes in the commissary, but that will end when the ban takes affect.

Over the next two weeks, inmates will get information from the Department of Corrections explaining how the tobacco ban will take place.

The ban will start January first when tobacco use will be banned at two diagnostic facilities where inmates are evaluated before being transferred into the state system.

The Augusta State Medical Prison will be next followed by other state facilities.

janchavarie Georgia, Smoking

The prison community faces its own battle against rising medical costs, with the elderly constituting the fastest-growing sector of inmate population. Experts say inmate medical-care costs are about $3 billion a year and several states are allowing the early release of older, ailing inmates. Report and slideshow on CNN.

White fuzz covers his bald head. His sallow skin sags. A wheelchair and cane support limp legs.This is not the typical image of a prison inmate. But 73-year-old George Sanges is among the burgeoning elderly population behind bars, a group expected to continue to grow as baby boomers age and states implement longer sentences.Sanges, who is serving a 15-year sentence at Men’s State Prison in Georgia, has cerebral palsy and takes multiple medications twice a day. His condition has worsened since he entered prison in 2005 for aggravated assault against his wife of 48 years. Twice while in prison, he was rushed to the hospital for heart problems. “They help me here,” Sanges says. “Everybody is very nice to me.”

As health care sparks debate across the nation, the prison community faces its own battle against rising medical costs. The elderly constitute the fastest-growing sector of the inmate population, experts say. It is a group that needs more frequent and costlier treatment, which states are required to provide under the cruel and unusual punishment clause of the Eighth Amendment to the U.S. Constitution.

An analysis of Bureau of Justice Statistics data found that the male prison population over age 55 ballooned by 82 percent in eight years, from 48,800 inmates in 1999 to 89,900 in 2007. The definition of “elderly” varies by state. The National Corrections Institute, a prison research organization, calls inmates over 55 elderly, and some states place inmates over 50 in that category. An inmate’s body ages faster than the body of someone not in prison.

Georgia, one of the 10 largest prison systems in the country, spends about $8,500 on medical costs for inmates over 65, compared with about an average of $950 for those who are younger, corrections officials say. Across the county, inmate medical care costs about $3 billion a year.

Men’s State Prison holds the largest number of sickly elderly inmates in Georgia. The medium-security facility, in a quaint rural town, is enclosed by barbed wire just like any other prison. But inside, inmates play card games and checkers rather than shooting hoops or lifting weights. The oldest inmate here is 89. There are veterans who served in World War II.

Gang fights here are rare, though there is still bickering and catfights from the wheelchair seat. Diapers, breathing machines and hospital beds wrapped in plastic for easy cleanup are visible in almost every corner of the hostel-style room where prisoners sleep.

Every inmate here has a medical condition; dementia, hypertension and diabetes are the most common, the warden says. “With the elderly population, we’re beginning to run something comparable to nursing homes,” says Sharon Lewis, medical director for the Georgia Department of Corrections. “This is one of the unhealthiest populations found anywhere. They really lived life hard.”

In the last few decades, a growing number of prisons have improved their quality of medical care, says Edward Harrison, president of the National Commission on Correctional Health Care, an accreditation organization based in Chicago, Illinois.

Elizabeth Alexander, director of the ACLU’s National Prison Project, says investigations revealed that inmates were often denied access to certified doctors in the 1970s. In some instances, inmates were providing medical and dental care to one another. There continues to be lawsuits filed against prisons and jails for providing poor medical care, she says, but overall, the care has vastly improved.

Some states, such as Virginia and Pennsylvania, have built geriatric prison facilities that resemble mini-hospitals, equipped with medical devices and oxygen tanks. Prisons are being licensed as acute-care settings with a crew of registered nurses, correctional health experts say.

Placing elderly prisoners into separate facilities or wings can help the state consolidate costs. Nearly 75 hospice programs exist in prisons — up from less than 10 a decade ago, says Carol McAdoo of the National Hospice and Palliative Care Organization.

“I would argue that the health care that is rendered behind bars is better than what is received in the general population,” says CEO Rich Hallworth of Prison Health Services, a private medical corrections company in Tennessee that serves 172 jails and prisons around the country.

To ease budget woes in California, one bill up for debate would allow nonviolent elderly prisoners to be released into hospice care or monitored with ankle bracelets. In the past few years, Georgia officials say, the state has released more frail and dying inmates on medical reprieve than ever before. Other states, including New York and Virginia, have also allowed early release of ailing elderly inmates.

But critics, including victims’ advocacy groups, have scrutinized this policy. Will Marling, executive director of the National Organization for Victims Assistance in Virginia, said most victims believe offenders will strike again after they are released.

“If a person is sentenced to life, we know they are naturally going to get old,” Marling said. “A life sentence should mean life.”

Most of the elderly inmates at Men’s State Prison in Georgia are serving lengthy sentences for crimes committed when they were younger, officials said. A “three strikes law” passed in the 1990s contributed to much of the growth in the state’s geriatric prison population.

But there remains a group of elderly inmates who committed violent crimes during their golden years, proving the point that many victims worry about.

Research has shown that arrests of elderly offenders have risen. Their imprisonment has also contributed to the aging inmate population, but little is known about why the elderly commit crimes.

With his sight nearly gone, George Sanges peers through thick glasses at an old photograph from his locker. After several seconds, he slowly distinguishes his wife’s face.

“That’s Betty,” he says.

Sanges cannot explain why he attacked his wife. He was 69 years old then, a grandfather without a criminal history.

“I got in trouble,” he repeats several times. “I’m really sorry.”

janchavarie Aging Population, Economic Issues, Georgia, Inmate Health Care

The state Department of Corrections will ban all tobacco use at its 37 facilities by the end of next year, becoming the 11th state to implement a total withdrawal of smoking at its prisons. As reported in the Atlanta Journal-Constitution.

Corrections Commissioner Brian Owens told The Atlanta Journal-Constitution on Monday that the agency will begin a phase-out of tobacco use beginning Jan. 1.

“It’s 2010 in a few days and it’s time to do the right thing,” Owens said.

Corrections’ decision follows a similar one announced this week by the Department of Mental Health. But Mental Health has said it will implement a total smoking ban in all seven state mental hospitals on Jan. 5. The Department of Corrections is taking a staggered approach, Owens said.

Beginning Jan. 1, smoking and tobacco use will be banned at two diagnostic facilities where inmates are evaluated after being transferred from county jails. Then, on July 1, 2010, the Augusta State Medical Prison — where the system’s sickest inmates are housed — will go tobacco free, followed by a total tobacco ban in all state prisons beginning Dec. 1.

Owens said he recently surveyed county sheriffs and jailers and found that almost all are already tobacco free. Inmates, Owens said, “were getting off tobacco in the county jails and then getting back on it when they came into the state system.”

Owens believes the phase-out of tobacco use at prisons, which will also apply to prison staff, will allow inmates to prepare and the department will offer cessation programs for those who want to participate.

It will, Owens said, allow Corrections officials to “implement this policy without many ripples.”

Smoking inside prisons has been banned in Georgia since the 1990s, but as in dozens of other states it is allowed in outdoor areas. When the state first implemented the smoking ban in prisons in 1995, about 150 inmates at the Lee Correctional Institution in Leesburg refused to work during a 90-minute protest against the policy. All but seven of the protesting inmates went to their job assignments at the prison after the warden called in the prison’s riot squad.

But if the experience in other states is any indication, the transition could go smoothly.

Jeff Eiser, a national expert on prison operations, ran a prison in Cincinnati when tobacco was banned there.

“Honestly? It was more difficult for the staff than for the inmates,” Eiser said. “Generally, the inmates adopted so much better than we thought.”

But the ban did bring another problem: Cigarettes, which once were treated as currency in prisons, suddenly became contraband.

“Cigarettes were going initally for more money than marijuana was” inside the prisons, Eiser said. “There was more of a demand for it. It was an interesting dynamic.”

And instead of cigarettes being used as currency to pay debts or level bribes among prisoners, Eiser said the inmates turned to whatever they could. As in Georgia, cigarettes at Eiser’s prison were sold at the prison commissary. With those gone, whatever was on the commissary shelves became used as currency.

“It was a transition to cookies, candies, anything they can buy,” he said. “We had a thing where you could get somebody ‘hit’ for a couple of big cookies. Chips, potato chips, candy, whatever it is becomes the currency. You could get beat up or badly hurt for not paying up in chips.”

Owens said he’s making the move for two reasons: It will save taxpayers money in health care costs for inmates and it will protect non-smoking prisoners from second-hand smoke.

The state spends more than $226 million a year on inmate health care — or about 17 percent of its total budget. While Owens said he cannot estimate how much money the state will save in decreased health care costs from the smoking ban, state officials have said tobacco-related disorders among inmates costs the state millions year.

The ban will “definitely have a positive impact on the prison population,” said Kymberle Sterling, an assistant professor at the Institute for Public Health at Georgia State University. “A smoking ban is a great idea.”

Bill Todd, president of the Georgia Cancer Coalition, said smoking bans, along with higher tobacco taxes and tougher laws enforcing minimum age requirements to purchase tobacco are effective methods of lowering smoking rates.

“They save lives,” Todd said. “We’re enthusiastic and excited about it.”

janchavarie Georgia, Inmate Health Care

From a feature article in the New York Times:

Allen Jacobs lived hard for his 50 years, and when his liver finally shut down he faced the kind of death he did not want. On a recent afternoon Mr. Jacobs lay in a hospital bed staring blankly at the ceiling, his eyes sunk in his skull, his skin lusterless. A volunteer hospice worker, Wensley Roberts, ran a wet sponge over Mr. Jacobs’s dry lips, encouraging him to drink.   “Come on, Mr. Jacobs,” he said.

Mr. Roberts is one of a dozen inmates at the Coxsackie Correctional Facility who volunteer to sit with fellow prisoners in the last six months of their lives. More than 3,000 prisoners a year die of natural causes in correctional facilities.  Mr. Roberts recalled a day when Mr. Jacobs, then more coherent, had started crying. Mr. Roberts held his patient and tried to console him. Then their experience took a turn unique to their setting, the medical ward of a maximum security prison. Mr. Roberts said he told Mr. Jacobs to “man up.” Mr. Jacobs, serving two to four years for passing forged checks, cursed at him, telling him, “‘I don’t want to die in jail. Do you want to die in jail?’  “I said no,” said Mr. Roberts, who is serving eight years for robbery. “He said, ‘Then stop telling me to man up,’ and he started crying. And then he said that I’m his family.”

American prisons are home to a growing geriatric population, with one-third of all inmates expected to be over 50 by next year. As courts have handed down longer sentences and tightened parole, about 75 prisons have started hospice programs, half of them using inmate volunteers, according to the National Hospice and Palliative Care Organization. Susan Atkins, a follower of Charles Manson, died last month in hospice at the Central California Women’s Facility at Chowchilla after being denied compassionate release.

Joan Smith, deputy superintendent of health services at the Coxsackie prison, said the hospice program here initially met with resistance from prison guards. “They were very resentful about people in prison for horrendous crimes getting better medical care than their families,” including round-the-clock companionship in their final days, Ms. Smith said.  The guards have come to accept the program, she said. But still there are challenges unique to the prison setting. Some dying patients, for example, divert their pain medication to their volunteer aides or other patients, who use it or sell it, said Kathleen Allan, the director of nursing. She added that patients can be made victims easily, “and this is a predatory system.”   But she said the inmate volunteers bond with the patients in a way that staff members cannot, taking on “the touchy-feely thing” that may be inappropriate between inmates and prison workers.

At Coxsackie, 130 miles north of New York City, administrators started the hospice program in 1996 in response to the AIDS epidemic using an outside hospice agency, then changed to inmate volunteers in 2001. The change saved money and was well-received by the patients.   Perhaps more significant, said William Lape, the superintendent, was the effect the program had on the volunteers. “I think it’s turned their life around,” Mr. Lape said.

John Henson, 30, was one of the first volunteers. When he was 18, Mr. Henson broke into the home of a former employer and, in the course of a robbery, beat the man to death with a baseball bat. When he entered prison, with a sentence of 25 years to life, he said, “I thought my life was over.” At Coxsackie he met the Rev. J. Edward Lewis, who persuaded him to volunteer in 2001. “You go in thinking that you’re going to help somebody,” Mr. Lewis said, “and every time they end up helping you.”

Before hospice, Mr. Henson said he had given little thought to the consequences of his crime. Then he found himself locked in a hospital room with another inmate, holding the man’s hand as his breathing slowed toward a stop. Like many men in prison, the dying man had alienated his family members, who rejected his efforts to renew contact. In the end, he had only Mr. Henson for companionship. When the prison nurse declared the man dead, Mr. Henson broke down in tears. “They just came out,” he said. “I don’t even know why I was crying. Partly because of him, partly because of things that died within me at the same time.”   Mr. Henson, dressed in prison greens and with his blond hair buzzed short, spoke directly and without hesitation. “I was just thinking about why I’m in here and the person’s life that I took,” he said. “And sitting with this person for the first time and actually seeing death firsthand, being right there, my hand in his hand, watching him take his last breath, just caused me to say, ‘Wow, who the hell are you? Who were you to do this to somebody else?’ ”

Ms. Allan, the nursing director at Coxsackie, said that with a number of inmate volunteers, “You can identify in each of these guys something inside them driving them to do this. It’s a desire to redeem themselves, so even when it gets hard they’re able to plow through it. “  She added, “I think Mr. Henson made me a better mother.”

Benny Lee, 38, has spent half his life in prison for manslaughter, and for most of that time, he said, “the only thing I regretted was getting caught.” Four months ago he began as a hospice volunteer, feeling he needed a change. “I’m trying to offer some payback,” he said.   On a recent afternoon, Mr. Lee was scheduled to sit with Eddie Jones, 89, who was dying from multiple causes. Mr. Jones, who was convicted of murder at age 70, said, “I can talk with them better than staff members, because staff members have their minds made up about how things should be.”    Mr. Lee said he does not know how Mr. Jones’s death will affect him. “I’m hoping it will have an effect, period,” he said. “Growing up and in prison, I put up walls. But I have to be more emotionally receptive to these guys. This is going against everything I’ve tried to do. But I realize it’s a change I have to make.”

Mr. Lee said hospice was forcing him to learn to trust people. “It’s helping me mature,” he said. “My views of life and death are changing. I was unsympathetic when it comes to death. I’ve had friends die, and I was callous about it. Now I can’t do that. I’ve come to identify with these guys, not because we’re inmates, but because we’re human beings. What they’re going through, I’ll go through.”

jakking Aging Population, Inmate Health Care, New York

Prison health care costs are soaring in Kansas as once experimental drugs and procedures are becoming standard treatments.  From Fox 4Kc.

The Kansas Department of Corrections spent $46.5 million in the most recent fiscal year on inmate health care, up 116 from 2000.   Health care now totals 17 percent of the department’s total operating costs.

Secretary of Corrections Roger Werholtz said HIV and hepatitis C were once considered terminal illnesses. But now, he says people are being managed with those illnesses for extended periods of time.  And he says the department is obligated to extend that care when medically indicated.

There is no reason to think the prison health care costs are liking to decrease as the prison population ages and their health needs increase.

jakking Aging Population, Inmate Health Care, Kansas

The Pinellas County FL Jail will no longer charge an $8 co-payment to inmates seeking medical care, forfeiting an estimated $50,000 in annual revenue from a policy that jail officials said created more problems than profit.  Reported by the St Petersburg Times.

The jail used co-pays to help offset millions of dollars in medical bills and discourage requests for unnecessary treatments or bogus ailments. Most medical insurance does the same thing. In 1995, when the co-pays began, jail officials told the Times that the charges had cut demand for care in half, an early sign that they were clearing waiting rooms of all but those with real medical need. But in the years since, said Pinellas County Sheriff Jim Coats, the co-pays have bred hostility among inmates and bogged down staff with paperwork, making the tens of thousands in lost cash “not even worth it.” “The administrative reviewing and tracking of all that cost us more than we make,” said Sheriff’s Office Chief Deputy Bob Gualtieri. “The bang wasn’t worth the buck.”

Where Pinellas jail officials see a barrier to streamlining, other correctional institutions have found an opportunity for profit. From county jails near Tampa Bay to federal penitentiaries across the country, every facility charges a co-pay, returning tens of thousands of dollars annually to general funds. Jails in Hillsborough, Hernando, Pasco and Polk charge between $5 to $15 for medical visits, higher than the Federal Bureau of Prisons’ rate of $2. In 2005, when the co-pay system was instituted at all federal facilities, the bureau wrote it would encourage inmates “to be more responsible for their own health care.” A spokeswoman for the Florida Department of Corrections says the state feels the same way. Florida prisons earned $640,000 last year off a $4 co-pay, and in July state legislators increased the rate by a dollar. “The money obviously is a big part … but the other side of it is there are some inmates who would go to the doctor every day,” said department spokeswoman Gretl Plessinger. “And if they have a medical need, they need to go, we want them to go. But this minimizes inmates who might be trying to game the system.”

None of the county, jail or federal officials interviewed said they knew of plans to change their co-pay system, adding that the benefits of the charges made the collection process worth the trouble. Not so in Pinellas, Gualtieri said. Jail employees, including more than 100 floor nurses and doctors working in the jail’s $35 million health care building, said they felt weighed down by the often futile search for co-pays. The inmates didn’t like it either, filing more than 1,100 grievances complaining of medical care access, quality and cost last year. Inmate Eugene Betts, convicted of attempted murder, filed three lawsuits against the jail and two employees, claiming they charged him for treatment he didn’t request after he was beaten by other inmates. In each case, he asks for his $8 co-pay, $2 in interest and hundreds of dollars in court fees.

For a jail population that saw more than 350,000 medical visits last year, the invoices and complaints added up. With the co-pay policy gone, officials said, medical staff will be freed to deal with more hands-on care. “The nurses should be seeing inmates and treating them,” said Lt. Sean McGillen, “not filling out paperwork for co-pays.” Still, the decision to abolish the co-pays comes at a tough financial time for the Sheriff’s Office, which runs one of the state’s most populated jails. In the past 18 months, the office’s budget has been reduced by a quarter, meaning a loss of more than $67 million and 363 positions.

Coats said the Pinellas jail will continue to accrue revenue from other sources, like a recently increased $20 booking fee, to help pay for what amounted to $19 million in medical operation costs last year. The money inmates once spent on co-pays, taken out of commissary funds filled by donations from friends and family, will stay in the accounts allowing them to buy items like cookies and deodorant. Inmates at booking will no longer be informed of the co-pay, which was levied on inmates who requested treatment unrelated to mental health, pregnancy, infectious diseases or emergency care. During the co-pay period, inmates without money in their accounts were not denied medical attention, officials said.

Dr. Allen Beck, a Kansas City criminal justice planner who studied the Pinellas jail, said co-pays have grown popular because of the expensive costs of health care. Considering that the ratio of health problems like drug and alcohol abuse is higher among inmates, prison medical costs “chew up a budget in a hurry.” He added that there are valid arguments against collecting co-pays, including the amount of additional effort they demand. “It just doesn’t make good business sense,” Coats said. “You can only squeeze so much juice from an onion. Sometimes it gets to the point where it’s counterproductive.”

jakking Booking Fees, Co-Pay, FL Pinellas County, Inmate Health Care

Gov. Arnold Schwarzenegger has filed a court-mandated plan today to ease prison overcrowding that appears to defy demands by a panel of three federal judges, the latest salvo in a long-running feud between state and federal officials over California’s corrections system.  Reported by the Sacramento Bee.

The federal judges last month ordered the state to reduce its prison population by 40,000 inmates over the next two years in response to lawsuits alleging that overcrowding has led to unconstitutional and inadequate levels of medical and mental health care … The plan will incorporate the package approved last week by the Legislature to cut the population by 16,000 inmates, as well as proposals to send 2,500 inmates out of state and 1,000 inmates to private prisons. It also will propose constructing new buildings on existing prison sites to house an additional 7,600 inmates. California houses 150,655 inmates in its 33 adult prisons, according to corrections spokesman Oscar Hidalgo.

Senate Republicans objected to Schwarzenegger’s proposed prison cuts this summer, but they applauded the governor’s approach to stop short of the three-judge panel’s demands in his plan. They saw it as a potential legal strategy to challenge the federal judges, eventually forcing the U.S. Supreme Court to settle whether the federal government can mandate a release of prisoners. “I assume the court is going to find this totally inadequate,” said state Sen. George Runner, R-Lancaster. “I hope they find it inadequate, reject it and then we appeal to the Supreme Court.” Sen. Tom Harman, R-Huntington Beach, said his caucus believes the federal three-judge panel has overstepped its bounds. “The fundamental question is, do they have the jurisdiction and right to make these orders?”

The judges could respond by rejecting Schwarzenegger’s plan and asking him to resubmit it. They could put the plan under a review process that ultimately results in a final order demanding greater inmate reductions. Or the judges could hold Schwarzenegger and Corrections Secretary Matthew Cate in contempt. Even if they are cited for contempt, it is unlikely the governor and prison boss would wind up in jail. Inmates’ attorneys have said in the past they would not seek such an extreme penalty. But they questioned Schwarzenegger’s approach Thursday.

“It is inexplicable to me why the governor would not submit to the court a modified version of the plan he submitted to the Legislature,” said Donald Specter of the Prison Law Office, co-chief counsel for the inmates. “The governor said that that plan would not be a risk to public safety and, if enlarged slightly, would comply with the court’s requirements.” He referred to a deal Schwarzenegger sought in July that called for a population reduction of 37,000 over two years. That plan would allow sick and elderly inmates or those in the final year of their sentences to finish serving time on home detention or in community hospitals wearing Global Positioning System tracking devices.

Although the state Senate agreed with the alternative-custody plan, members of the Assembly, citing public safety concerns, refused to go along. Instead, both houses approved changes in parole and an expansion of good-time credits that would reduce sentences for certain inmates who participate in rehabilitative programs. The slimmed-down Assembly version will reduce the population by an estimated 16,000 in the next year. The plan Schwarzenegger intends to file today will not include the controversial alternative custody provisions, according to Runner.

If the plan proves unsatisfactory to the federal judges, “the state’s officials are correct that they may be facing contempt proceedings,” Specter said. “We will decide whether to pursue contempt after reviewing the state’s final plan.” The other chief counsel for the inmates, Michael Bien, sounded a similar note. He said he believes state officials are running the risk of contempt “if the state’s ’strategy’ is to set up a confrontation with the three-judge court by defying the court’s lawful order.”

The state’s adult prisons are operating at nearly 200 percent of design capacity. A non-jury trial was conducted late last year before the three judges to determine whether California prisons are overcrowded and, if so, whether that is the primary cause of inmate health care that violates the U.S. Constitution’s ban on cruel and unusual punishment. The constitutional violation had been found by the judges in earlier rulings.

The judges are 9th U.S. Circuit Court of Appeals Judge Stephen R. Reinhardt of Los Angeles and U.S. District Judges Lawrence K. Karlton of Sacramento and Thelton E. Henderson of San Francisco.

In an Aug. 4 order, they found that the prisons are dangerously overcrowded and that is the main reason for the unconstitutional health care. The panel said inmate population had to be slashed to 137.5 percent of the institutions’ design capacity and gave the administration until today to come up with a plan on how to meet that mandate. Under the Prison Litigation Reform Act of 1996, a three-judge court appointed by the chief judge of a federal appellate court may order a state to take steps, including release of prisoners, to alleviate an unconstitutional condition. The law requires the judges to employ the least intrusive remedy. Any appeal goes directly to the U.S. Supreme Court. State officials attempted to get a stay of the Aug. 4 order while they appealed it to the Supreme Court. Both the three-judge court and the high court refused to grant a stay. In a brief order last week, the Supreme Court strongly suggested it will take up the case after the three judges have issued their final ruling on actions to be taken to achieve the required cut.

jakking California, Inmate Health Care, Overcrowding

Harris County TX officials Tuesday challenged U.S. Department of Justice claims that conditions in the county jail system violate prisoners’ constitutional rights, producing a 300-page report contending the federal findings were based on incomplete data and anecdotal accounts from inmates. Reported by the Houston Chronicle.

The voluminous document, which was delivered to Commissioners Court by County Attorney Vince Ryan, accuses the Justice Department of conducting an inadequate investigation and questions its statistical and research methods. It is the county’s official response to a June 4 finding by the Justice Department’s civil rights division of an “alarming” number of deaths in the jail after an investigation last summer. Justice Department attorneys are considering a civil suit over violations of prisoners’ constitutional rights, claiming the county’s “systemic deficiencies” resulted in adequate medical and mental health services, and a failure to protect prisoners from serious physical harm and life safety hazards.

“Our jail has not only improved tremendously since the first of the year with our new Sheriff Adrian Garcia, but even before then, improvements were being made. But at no time … has the jail not met constitutional standards,” Ryan insisted at a news conference Tuesday morning. “Our criminal justice facilities are doing a great job in taking care of the problems of people in jail.” Ryan noted that since the investigators’ visit, the Commissioners Court has given the jail millions in federal stimulus funds to computerize inmate medical records. He also cited the recent creation of a county Criminal Justice Coordinating Council to explore methods to reduce jail overcrowding and streamline the operation of county criminal courts.

Ryan was optimistic the county’s lengthy rebuttal will satisfy the Justice Department, and predicted a civil lawsuit would not be brought against the county. “We are … confident that the Justice Department will receive this report and be very confident that Harris County is fully meeting it requirements in housing inmates in our jail,” he said … Garcia, who took office in January, acknowledged the jail system in the past was meeting only minimum standards, a performance that would have earned it a D- grade. Asked how he would rate the jail operations since he took office, he said, “If I could grade myself, we’re hitting a good A.”

Ryan’s report notes during the 2008-09 fiscal year, the county provided the sheriff’s office with a budget of $407 million, of which $234 million was spent on the jail system, including $39 million in overtime to properly staff the jails. The jail system is composed of four small substations lockups and four main facilities, which have a combined capacity of 9,800 inmates. Total capacity is 11,412 because of state jail commission variances that allow the use of 1,612 portable beds. The county also has about 1,100 inmates housed at a Louisiana jail. Two weeks ago, commissioners approved a $16 million plan to house up to 2,100 inmates at four other Texas county jails in lieu of shipping them to Louisiana.

Ryan’s report states that the 111 inmates who died in the county jails between 2000 and 2006 were fewer than the deaths in four of the five jails of comparable size. Commissioner Sylvia Garcia said the jail’s medical and mental health practices have been given a “best practices” rating by the National Commission on Corrective Health Care. In addition, she said, two other branches of the Justice Department — the U.S. Marshals Service and the National Institute of Corrections — did not find county jail conditions violated prisoners’ rights. “So, when you have two of the three federal agencies saying you’re doing a great job, I think any court is going to look at the whole thing” and would be “hard-pressed” to find a pattern and practice of violating prisoner’s, said Garcia, a former municipal judge. “You can talk about isolated cases and anecdotal history, but when you look at the facts the jail is as well run as it can be under the circumstances.”

jakking Inmate Health Care, Overcrowding, TX Harris County, Texas

Forsyth County NC officials think they’ve found a way to cut medical costs at the jail without sacrificing the quality of inmate care, according to the Winston-Salem Journal.

The county board of commissioners will vote on whether to grant a three-year contract to Correct Care Solutions LLC of Nashville, Tenn., for providing inmate health-care services.

The rising cost of those services has been a continuing concern for the county. Coming in at around $4.5 million in the 2008-09 fiscal year, costs were more than $500,000 over the amount budgeted.  “The biggest problem in inmate medical care is offsite costs,” said Joe Bartel, the county’s director of budget and management. “The inmate costs were a concern to all of us.”

NaphCare Inc. of Birmingham, Ala., now contracts with the county to provide medical services to detainees. The county put the service out for bid this spring and received six bids, including two from NaphCare that proposed different staffing options.   While Wexford Health Sources of Pittsburgh submitted the lowest bid, the company scored badly when local officials looked at references.  “None of their references responded to us,” said Marshall Mathers, the purchasing director for the city and county. “They were the only ones where that was true. We did not take that as a good sign.”

Local officials scored all the companies for experience, references, quality of response and corporate capability. When the tallying was done, Correct Care Solutions had narrowly edged out NaphCare. The county then negotiated with Correct Care Solutions and wound up with a proposal to pay the company $3,967,991 for the first year.

That cost doesn’t count any spending of more than $700,000 for medical services rendered outside the jail, but county officials like an incentive built into the contract that they say should help hold down expenses.  Currently, the county’s contract with NaphCare includes the first $500,000 of off-site medical services, but after that the county picks up 100 percent of the cost.  Under the new contract with Correct Care Solutions, the contract would cover the first $700,000 of off-site medical expenses. After that the county and the company would split costs 50-50. “There is a real incentive for them to try not to get to $700,000,” Bartel said. “We feel like there is a good chance to spend $400,000 less per year.”

Bartel said that Maj. Wayne James, the director of detention services, has been happy with the quality of inmate medical care under NaphCare, and that that is something James did not want to lose. Although Correct Care Solutions will operate with a leaner staff, Bartel said, county officials do not believe that the quality of care will suffer.

jakking CorrectCare, Inmate Health Care, NC Forsyth County, NaphCare, North Carolina

About two dozen seriously ill prisoners in Washington state could soon be released from prison — as long as their freedom is expected to save the cash-strapped state money, according to a story in the Los Angeles Times.

A new state law, which takes effect Saturday, expands a current program to release chronically or terminally ill prisoners. Death row inmates, or those serving life sentences without the possibility of parole, are not eligible for early release.  Washington is among more than 30 states that have some form of early release program for seriously ill prisoners, according to the National Conference of State Legislatures.

The move will save the Washington state Department of Corrections an estimated $800,000 over the next two years, mainly on things like prescription costs and transporting prisoners to off-prison medical treatment.   But the state Department of Social and Health Services estimates it could see significant increases in its budget if it has to place all of those released in state-paid nursing homes or provide additional mental health services — offsetting any savings and possibly adding more costs to the already hampered state budget …

The number of prisoners who would actually be released is unknown. Also unclear is how many of those released would end up relying on social safety net programs.   Even the state corrections chief admits the program expansion is a work in progress.  “We continue to think this will save the state money, but we won’t know that for sure until we’re down the road,” said Corrections Secretary Eldon Vail. “Will it in every case? That’s the goal. You can’t know until they leave the system.”

Under the law signed by Democratic Gov. Chris Gregoire in May, the head of corrections can authorize early medical release only if certain conditions are met. The offender must have a serious medical condition that is expected “to require costly care or treatment.” They must pose a low risk to the community because they are physically incapacitated or expected to be at the time of release. And the release must be expected to save the state money.  The department works to see if prisoners qualify for private or veteran’s health coverage. Barring other options, they arrange for Medicaid, which is paid for partially by the state and partly with federal money …

The main change to the current early release program, which has been in place since 1999, is that it no longer requires the prisoner be incapacitated before being approved for release. Fifty-five offenders have been released since 1999 under the earlier program, and two more have been approved and are currently awaiting placement in the community … Vail said every request will be determined on a case-by-case basis.  “It’s a balancing act between trying to make sure a person receives proper care in a way that is cost effective,” he said. “It’s not a black-and-white decision. It all depends on the individual.”

jakking Early Release, Inmate Health Care, Washington

From the news page of the Community Corrections Website:

With growing concern and risks associated with the outbreak of the H1N1 influenza, the National Institute of Corrections has launched a webpage to track information and resources of particular interest to corrections practitioners and administrators.  The information is available at Corrections and Swine Flu. NIC will monitor developments and resources daily and add links on this page to information to assist the field.

janchavarie Community Corrections, Inmate Health Care

The costs of a new regional jail project are creeping toward $3 million — with the promise of growing larger as Kansas City MO police delay joining the project, officials said.  Reported by the Kansas City Star.

Kansas City and Jackson County officials said the Police Department’s recent decision not to send detainees — at least for now — threatened to boost the cost to taxpayers by hundreds of thousands of dollars.   “It’s just a waste of taxpayer dollars,” said Chuck Eddy, chief of staff to City Manager Wayne Cauthen.    Members of the Kansas City Board of Police Commissioners and police command have made clear they would like to close the eighth-floor detention unit at police headquarters. Sending prisoners to the regional jail “is not dead,” they added.  “It probably needs to be done, if we can do it the right way,” police board member Karl Zobrist said Thursday …

Eddy said the jail renovation work began in anticipation of the police joining in the regional jail. Police have been meeting for months with county and city officials about the project, according to city records.    Now a wall is being erected to separate the jail from areas that might be used for police later, officials said.   [But for now] the continued liability of operating the eighth-floor detention unit will remain for taxpayers, as well as the cost of transporting prisoners from police headquarters to Truman Medical Center.   In the new jail, the county will provide medical treatment, decreasing city taxpayer costs of ambulance transports and indigent medical care, officials said.

jakking County-City Issues, Economic Issues, Inmate Health Care, Jail and Prison Construction, Kansas City, MO Jackson County, Missouri

Sick Alachua County FL jail inmates who need hospitalization or expensive treatment are driving up costs and carving out a bigger chunk of the county’s budget when finances are already tight.  Story from the Gainesville Sun.

Pre-existing conditions such as cancer and heart disease that require expensive treatment are now more common and have prompted the county commission and Sheriff Sadie Darnell to begin reviewing medical care contracts to determine if costs can be lowered.

“In the last couple of years, we’ve had a number of inmates coming in that have highly acute illnesses and in some cases terminal illnesses. You have people coming in with cancer, HIV. You have people needing blood transfusions and dialysis,” said Ron Akins, county administrative support manager. “There are times I will receive a $700,000 or $800,000 bill for a quarter, and 14 or 15 inmates will make up 80 percent of that.”

Under state law, medical expenses for jail inmates first must be paid by insurance, the patient or a settlement.   The county is required to pay if those options are exhausted.  Also party to the agreement for inmates’ medical care is Prison Health Services, which oversees the jail’s acute-care infirmary, outside treatment, billing and other financial aspects, the Shands and University of Florida Health Care Network and North Florida Regional Medical Center. The total cost is about $6.5 million a year, said Philip Hoelscher, president of Alliance Medical Management, a consulting firm working with the county on inmate care …

“In most cases, the profile of folks in the jail is that they are not real healthy people. I can’t quantify this in exact numbers, but we all are noticing … that a large number of people are coming in now who are very conscious to their goal of receiving medical care,” Hoelscher said. “A very small percentage of (sick inmates) have insurance. The insurance companies have all gotten smarter to put that fine print in that if you are incarcerated, the policy no longer applies” …

Akins and Hoelscher said costs for inmates with existing conditions are now more apparent to county officials in part because they were hit with large unpaid bills from hospitals several years ago that the county was legally obligated to pay.   More money now is being budgeted for inmate health care.  And the additional money being set aside for inmates’ medical care is being cited by county budget officials as putting the county in a hole for its upcoming 2009-10 budget.

jakking FL Alachua County, Inmate Health Care, PHS

Prisoners who are seriously ill – but not necessarily dying – might be eligible for release on medical parole in future in South Africa, reports IOL.co.za.

The chairman of the parole review board, Judge Siraj Desai, has confirmed to Independent Newspapers that the provisions for medical parole will be looked at afresh to include considering the release of seriously ill – as opposed to terminally ill – prisoners on compassionate grounds.  This echoes what the chief deputy commissioner for corrections in the Correctional Services Department, Teboho Motseki, this week told MPs in the portfolio committee on correctional services.  “We need to review whether our policy of only considering terminally ill people is adequate.  It could also include critically ill people, and not be limited only to the terminally ill,” he said …

Desai said the overhaul of the medical parole system was due to start soon, adding that he would be meeting the portfolio committee on correctional services chairman Vincent Smith on the matter.  Smith earlier indicated to Independent Newspapers that the medical parole and general parole provisions would be revisited, among other things, with an eye on reducing the chronic prison overcrowding.

jakking Africa, Early Release, INTERNATIONAL, Inmate Health Care, Overcrowding, Parole, South Africa