The federal receiver in charge of prison medicine considers one facility the gold standard for inmate care. The Central Medical Facility looks and feels different than other state prisons. The halls are wider to ease the way for inmates in wheelchairs. Those halls are busier, too. The prison’s chief medical officer, Dr. Joseph Bick, says that’s because most of these prisoners pose little security risk. Report from Southern California Public Radio.

“Most of them move about the facility unescorted,” says Bick. “They have a little pass. They may be going to school, work or to a doctor’s appointment to get their blood drawn.”

Inmates chronically or terminally ill
Bick points into the prison’s gymnasium window. Most prisons have to use gyms as dorms. Here, the inmates use the gym to exercise. There’s no overcrowding, because to be in the Central Medical Facility, an inmate has to be chronically or terminally ill.

“The overwhelming majority of the 3000 prisoners here have some major medical problem, often multiple,” Bick says. “You see them walking around, they may be going to work or school. But they may have hepatitis, major mental illness, HIV disease, diabetes, asthma.”

Bick says most of the inmates at the Central Medical Facility can feed, dress and bathe themselves, but they need to be close to medical help.

The prison’s medical mandate inspires a professional tone between the staff and inmates. Bick says he treats inmates with respect, which earns their trust. He stops to talk to prisoners in the hallways. He calls by name to a passing inmate. They shake hands.

“Oh hey, Dr. Bick! How you doing?” the inmate says.

Not exactly ‘Cadillac care’
Prisons are typically noisy places. Bick tries to turn down the volume inside his medical clinics.

Prisons often treat inmates in converted cells, broom closets or storage rooms. Bick’s clinic is a real clinic. It’s clean, white and quiet. Bick says one of the biggest unexpected benefits of that clinic is that it changes the way his patients behave.

“They come into an environment that is clearly designated as a medical environment, their voices come down.”

Bick says his modern clinic also attracts a better staff. But he says it doesn’t administer “Cadillac care.” Ask Johntae Bailey.

He was waiting for a dental appointment when his bad tooth got so bad that it woke him up in the middle of the night. A guard told Bailey he couldn’t get an emergency appointment unless his jaw was swollen.

“And I told him how’s it not a medical emergency if my tooth is throbbing and it’s killing me and I cannot sleep?” says Bailey.

Bailey asked the guard to check his file; there they found his three-week-old request to see a dentist. Bailey says the prison’s dentists care about their inmate patients.

“It just takes a long time to get there – I want you to hear it: It takes a long time to get in there!” Bailey laughs.

But Bailey says he’s waited longer for medical care at other prisons. He should know – he’s cycled through a few for drug sales or parole violations.

“You can put in a medical slip, and three or four weeks will pass and you won’t get to see them until then,” Bailey says. “That’s why you hear the alarm go off a lot of times. Because people know they got a long wait, so they just go ‘man down’ so the medical will come to them.” When an inmate goes “man down” he collapses on the floor.

Inmates’ health a public health issue
Bick says there’s usually some truth to inmate complaints – and he investigates them. He also knows few Californians care about better inmate care. But most of these prisoners will get out one day. Bick says that makes inmates’ health a public health issue that concerns everyone.

“If we don’t do something to diagnose and treat the treatable diseases while they’re here,” Bick warns, “educate them about prevention of transmission of some of the illnesses they have, and then link them to services in the community when they get out – if prisons fail to do that, we’ve squandered a huge opportunity.”

Clark Kelso, the federal receiver in charge of prison medical care, considers Vacaville’s Central Medical Facility to be the best in the state prison system.

He wants a hub of similar places to cluster the sickest inmates together. The cost of sending sick inmates for care outside the prison has doubled since the receiver took over to $845 million in the most recent fiscal year. Kelso says treating them in prison facilities would save hundreds of millions of dollars a year.

In June, state lawmakers approved $2 billion to build Kelso’s medical hub. But it’ll take three years to complete the main building in Stockton and that medical facility will have only enough beds for half the number of inmates with chronic or serious conditions.

jchev California, Inmate Health Care

The cost of keeping illegal immigrants in prison and providing them with medical care exceeded $250 million last year in Texas, according to state health and corrections officials. The testimony before the House State Affairs Committee on Wednesday came as lawmakers faced a projected state budget shortfall of up to $18 billion. News from the Bloomberg Business Week.

“We want to focus on what the real costs are for state services,” said Rep. Burt Solomons, R-Carrollton, the committee chairman. “There’s really not a lot of wholly accurate data.”

Jerry McGinty, the Texas Department of Corrections’ chief financial officer, said state prisons held 11,766 offenders who are foreign citizens in July. He said it costs the state about $171 million per year to hold them, although the federal government reimburses about 10 percent of that total.

Rick Allgeyer, director of research for the Health and Human Services Commission, said illegal immigrant health care – mostly emergency hospital care – cost the state nearly $100 million last year.

Rep. Rene Oliveira, D-Brownsville, said an Arizona-type law allowing police to question anyone they stop about their citizenship status could fill every county jail in Texas. “It would bust all our counties,” said Oliveira.

Rep. Pete Gallego, D-Alpine, told fellow committee members that when making policy, “you always have to be aware of unintended consequences.”

Gallego said there could be significant effects if law enforcement and other public agencies were asked to reallocate already-sparse resources to check citizenship of people in Texas.

jchev Economic Issues, Illegal Aliens, Inmate Health Care, Texas

Today, California spends $1 billion more on medical care for inmates than it did in 2005 when a federal judge found that care so flawed that he seized control of the system and appointed a receiver to improve it. Prison officials say the problem’s now fixed – and it’s time to put them back in charge. But as KPCC reports, California’s prison medical system still lacks critical reforms. Story and links to resources from Southern California Public Radio.

To hear the secretary of the California Department of Corrections and Rehabilitation, Mathew Cate, tell it, California prisons now provide inmates with quality medical care.

“I invite you to go into any prison and walk into any of those medical facilities, and you tell me if it’s not just as good care as you’ll get at Blue Shield or Kaiser or anywhere else,” he said last year.

Blue Shield or Kaiser might not appreciate the comparison. Between 2003-2004, one inmate a week died as a result of poor medical care in state prisons.

U.S. District Judge Thelton Henderson seized control of California’s prison medical care and appointed a receiver to fix it. In his order establishing the receivership, Henderson wrote, an “unconscionable degree of suffering and death is sure to continue if the system is not dramatically overhauled.”

The first receiver, Robert Sillen, went to work in 2006. On his second day on the job Sillen visited medical facilities at San Quentin—California’s oldest prison. What he found there appalled him.

“This isn’t medical care in any way, shape or form that anybody would recognize it,” Sillen said.

Medical conditions ‘worse than Third World’
Back then Sillen called the conditions “worse than Third World.” Medical staff treated prisoners in converted cells with no running water. Lab results didn’t reach doctors for weeks, sometimes months. At San Quentin, Sillen’s staff found unprocessed X-rays that showed inmates with active tuberculosis.

“Transcribed results were coming back and sitting in a pile on the floor – literally hundreds and hundreds of them – because there was only one person to deal with them,” Sillen said. “She happened to be out sick.”

Sillen found similar delays in lab results, and delayed diagnosis and treatment, at all of California’s 33 adult prisons. He also found that Corrections had failed to pay outside doctors and hospitals for services going back months and in some cases years. Those facilities were refusing to treat California’s inmates because of it.

Sillen, the former medical director for Santa Clara County, found the problems in prison medical care so numerous that there was no way to tackle them all at once. So he concentrated on what he described as the best and quickest way to improve conditions: he would bring in quality doctors to lead prison medical teams and force out incompetent ones.

In his two years as receiver Sillen dismissed dozens of incompetent doctors. He also raised prison doctors’ salaries to attract better qualified staff.

Inmates missed medical appointments about half the time
Today, roughly half the doctors working in California’s prisons are board certified. About 10 percent of physician positions are still vacant. But it used to be 30 percent.

Still, even the best doctors and nurses can’t provide better care to inmates if they don’t see them. That’s why Sillen hired Joe McGrath, a former deputy secretary for the California Department of Corrections and Rehabilitation.

“My job really was to try to put together a custody support team that was part of the healthcare side of the house,” McGrath recounted.

McGrath visited all 33 of California’s prisons to identify systemic problems in the delivery of medical care. One problem emerged in every prison: inmates missed medical appointments about half the time.

McGrath said that prison administrators were already juggling staff to get inmates to meals, classes and work. Getting them to prison medical clinics required extra guards they couldn’t afford.

“They have to be escorted outside of security areas over to these medical facilities,” McGrath said.

And since many prisons lack the doctors or equipment to treat inmates, “They have to be put in cars and taken downtown to doctors or to the hospital.”

McGrath said prisons have to orchestrate the movement of inmates all day long.

“Unless you have dedicated staff to the health care piece, it just falls by the wayside,” McGrath said.

Doctor cops assigned to get inmates to medical appointments
McGrath recalled one inmate who fell by the wayside at San Quentin’s reception center. Reception centers are where CDCR processes inmates entering the prison system to determine which facility to send them to serve their terms.

McGrath said the inmate was awaiting transfer to another prison to serve a drug sentence of less than two years.

“While in reception, he gets an abscessed tooth,” McGrath said. “Through a series of events and mishaps, he didn’t get the antibiotics that he needed. The abscess got into his blood. He was septic and he died.”

McGrath’s team of corrections consultants decided to address inmates’ access problem with what he calls the creation of “doctor’s cops” – a squad of 2,400 correctional officers whose sole purpose is to get inmates to medical appointments. Every prison in the state has some now and inmates now make their appointments 88 percent of the time.

Recession stymies improvements
In 2009, CDCR was poised to add 350 more “doctor’s cops” when the current receiver, Clark Kelso, froze hiring.

“I don’t have a bottomless checkbook here,” Kelso later explained. “I do have to account for how those funds are being spent. They’re taxpayer dollars.”

Kelso took over as the receiver two years ago – just as California was slipping into the worst recession since World War II.

In his order replacing Sillen, Henderson said he wanted to usher in a new phase of the receivership – one in which control of prison medical care would begin to transition back to the state.

Kelso, a professor at the University of the Pacific’s McGeorge School of Law, fit the bill. Kelso had earned a reputation in Sacramento as a fixer. He did that by sweeping up after former Insurance Commissioner Chuck Quackenbush who resigned in 2000 amid allegations of corruption. Kelso most recently turned around the state’s information technology department.

Kelso’s first public action as the receiver of prison medical care was to scale back his predecessor’s improvement plan. But even so, lawmakers balked at the cost. Kelso wanted $8 billion to construct seven new prison hospitals and renovate medical facilities at all the prisons.

But the timing was bad. California lawmakers faced a multibillion-dollar deficit and still do.

After a couple of unsuccessful attempts to get funding, Kelso worked closely with the secretary of Corrections to lessen the costs. But the Schwarzenegger administration – which had backed the smaller, $2 billion plan – pulled its support at the last minute.

After a couple more years of wrangling, state lawmakers finally approved the receiver’s construction funds in June – but they simultaneously cut his budget for on-going medical care in half.

jchev California, Inmate Health Care

Curtis Ballard rides a motorized wheelchair around his prison ward, which happens to be the new assisted-living unit — a place of many windows and no visible steel bars — at Washington state’s Coyote Ridge Corrections Center. A stroke left Ballard unable to walk. He also has had a heart attack and underwent a procedure to remove skin cancer from his neck. At 77, he’s been in prison since 1993 for murder. He has 14 years left of his sentence. News from the Columbia Tribune.

Ballard is part of a national surge in elderly inmates whose medical expenses are straining cash-strapped states. They have officials looking for solutions, including early release, some possibly to nursing homes. Ballard said he is fine where he is.

“I’d be a burden on my kids,” the native Texan said. “I’d rather be a burden to these people.”

That burden is becoming greater. The American Civil Liberties Union estimates that elderly prisoners — the fastest-growing segment of the prison population, largely because of tough sentencing laws — are three times more expensive to incarcerate than younger inmates.

The ACLU estimates it costs about $72,000 to house an elderly inmate for a year, compared with $24,000 for a younger prisoner.

That’s not the case in Missouri’s correctional system, though. The per diem cost for medical and mental health care is the same for each offender in the system, said Jacqueline Lapine, spokeswoman for the Missouri Department of Corrections.

The department contracts for medical care through Correctional Medical Services, which charges $9.90 a day per offender for health care and $2.34 a day per offender for mental health care, Lapine said. The cost is included in the average daily cost to house an offender in Missouri, which is $44.68, she said.

The federal Bureau of Justice Statistics reported that the number of men and women in state and federal prisons age 55 and older grew 76 percent between 1999 and 2008, the latest year available, from 43,300 to 76,400. The entire prison population grew 18 percent in that period.

“We’re reaping the fruits of bad public policy like ‘three strikes’ laws and other mandatory minimum sentencing laws,” said David Fathi, director of the ACLU National Prison Project in Washington, D.C. “One in 11 prisoners is serving a life sentence.”

Washington has 2,495 inmates who are 50 or older, the state’s definition of elderly, according to information released after a public records request from The Associated Press. There are 270 inmates older than 65. The infirm started arriving at the new assisted-living facility at Coyote Ridge when it opened Feb. 1.

The unit has a capacity of 74 inmates. To qualify, an inmate must be disabled and be considered a minimum security risk, said Jeffrey Uttecht, prison superintendent.

The oldest inmate there is Ernest Tabor, 84, who was incarcerated for murder in 1997 and has 13 more years to serve. The average age in the assisted-living unit is 59, a figure skewed slightly by three inmates in their 30s with disabilities.

Nearly all the inmates in the assisted-living unit are in for murder or sex crimes, although a few are serving time for assault, drug or property crimes. Some were due to be released this year. Ballard is set for release in 2024.

The documents show the average age of a prison inmate in Washington has risen from 34.8 in 2000 to 37.3 in 2010. The average is rising because of longer sentences, not because older people are being sent to prison, the state said.

The assisted-living center is a unit in a much larger prison, which has two doctors for more than 2,000 total inmates. But the elderly prisoners tend to consume a big share of medical resources, including having two nurses assigned 24 hours a day, seven days a week, health care manager Mary Jo Currey said.

The assisted-living prisoners need walkers, wheelchairs and lots of medications. Some experts suggest infirm prisoners could be more cheaply cared for in conventional nursing homes, as people older than 50 rarely commit violent crime, Fathi said.

A visit to a prison ward for the elderly is an eye-opening experience, he said.

“Some were entirely bedridden,” he said. “It looked like a nursing home with razor wire.”

As of Wednesday, Missouri had more than 4,500 incarcerated offenders older than 50, Lapine said. Charles Barnes, who turns 83 next month, is the oldest serving an extended period of time. He was convicted of second-degree murder in 2008 and is serving a 10-year sentence.

Many states, including Missouri, are studying ways to reduce the number of elderly prisoners. The Aging Offender Management Team was created to identify a departmentwide solution to determine the best ways to handle needs of aging offenders and to reduce the need for long-term, prison-based care, Lapine said.

“When these offenders can no longer function in the general population, placement options are limited,” she said in an e-mail. Segregation beds are limited and not ideal, and infirmary beds are “a very limited resource,” Lapine said.

The committee made the following recommendations:

* Develop “enhanced care units” within Missouri prisons to provide appropriate health and housing services to offenders with special health needs.
* Keep better track of aging offenders’ daily activities to be used in conjunction with annual physicals.
* Develop a way to better identify the physiological age of offenders and their special needs.
* Develop an education campaign around the issue of aging prison populations.
* Train correctional staff to identify and meet the needs of a growing aging population.

New or expanded early release programs were adopted last year by 12 states and the District of Columbia.

But a study released in April by the Vera Institute of Justice in New York City found the laws have rarely been used, in part because of political considerations and complicated reviews.

Early release for infirm inmates would be fine with Uttecht, the Coyote Ridge superintendent. But those prisoners need to be able to pay for the nursing care they need, so it doesn’t happen often in Washington, he said.

“Usually it’s for a terminal-type illness,” he said.

Jane Parnell, who ran a special prison for the elderly in Yakima, Wash., that was closed last year because of high costs, said the public doesn’t want these inmates released.

“A lot of them are sex offenders and fairly violent offenders,” she said.

Parnell also questioned the necessity of the assisted-living center, saying it is “more unusual than I think it should be.” Many states just put elderly prisoners in the hospital ward, she said.

The assisted-living unit at Coyote Ridge is inside the fence of the regular prison but segregated from other units.

The building is one story and has wooden walls and wide doors to accommodate wheelchairs. There is a microwave oven, a shuffleboard table and a weight room in the common area.

Most inmates live in hospital ward style, with beds, desks and lockers. Sicker inmates have rooms with hospital beds.

Ballard lived much of his adult life in the Portland, Ore., area, where he worked on bridges, water towers and other tall structures.

His four kids bought his motorized wheelchair, an option not provided by the state. That allows him to work in the prison laundry, where he earns $52 a month. He doesn’t like the prison food and purchases many of his meals from the prison store.

Ballard declined to discuss why he was in prison, but records show he was convicted in 1993 of killing his estranged second wife and her adult daughter.

He also watches news, travel and cooking programs on a small television. He sometimes plays bluegrass music on his guitar. His room has a sink and toilet, and younger inmates are assigned to help him.

“Most will really help you,” Ballard said. “It’s not like in the movies, where there are a bunch of bullies out there.”

jchev Aging Population, Inmate Health Care, United States

Maine is not only the oldest state in the nation, the inmates in the state’s correctional facilities are also aging, and that is resulting in higher health care costs and consideration of changes in the way the state houses elderly prisoners. Reported in the Bangor Daily News.

“This is a calamity that is coming,” said Sen. Stan Gerzofsky, D-Brunswick, co-chairman of the Legislature’s Criminal Justice and Public Safety Committee. “The population in our prisons are getting much older every year, and it is something the next Legislature will have to look at because it is becoming a calamity now, where two or three sessions ago it was just a problem.”

Gerzofsky served on the panel in the House before his election to the Senate in 2008. He said stiffer sentences for some crimes mean inmates are staying behind bars longer, and the state needs to plan on how to handle aging prisoners.

He said one initiative approved by lawmakers to address the issue allows the department to place an inmate in a nursing home if the inmate would not jeopardize public safety. Denise Lord, Maine’s associate commissioner of corrections, said only one inmate is in a nursing home facility.

“No, we have not had much success at placing people in nursing homes,” she said.

Lord said there are 298 men and nine women in the state correctional system older than the age of 50. There are 2,056 inmates in the state system.

“We are doing an analysis of the length of sentences, but I know there are a lot in our system with some long sentences they will serve,” Lord said.

She said there are 416 men and 36 women in their 40s, and while she will not know how many of those still will be in prison in their 60s until the analysis is complete, several are serving long sentences — including life sentences.

Lord said the state’s corrections population is not only aging, it is significantly sicker than those outside the prison walls. When the costs of guarding inmates in a hospital or taking them to a doctor or dentist is added to the actual medical costs, Lord said it is about 25 percent of the department’s entire budget.

“When we send an inmate out, there is at least one guard,” she said. “For some inmates in a hospital, we may have two or three guards 24-7, and that gets expensive.”

Lord said the use of contracted services and a systemwide pharmacy contract has held down health care costs, but she expects the costs will increase over the next several years.

“This is not something you can just sweep under the rug and say let’s just wait and see what happens,” said Rep. Anne Haskell, D-Portland, co-chairwoman of the Criminal Justice Committee. “We have been talking with the department about what should be done, but it all comes down to money.”

She said some states have looked at what amounts to a correctional nursing home that provides care for aging inmates and security for the public.

“Some of these inmates, no matter how old, are still a danger to the public,” Haskell said. “We have to remember there are victims of the crimes these prisoners have committed, and we can’t let people out of prison just because they are old.”

Rep. Gary Plummer, R-Windham, served several years as a county commissioner and is a member of the committee. He said the problem of dealing with aging inmates and their health problems has been growing at all levels of corrections, and county jails also are facing some tough choices.

“We know we have to face it,” he said. “Frankly, it is cheaper to house people in a nursing home than in a jail. And as much as I don’t want to see the state in the nursing house business, I think we have to look at it very seriously and not wait for it to be a crisis.”

Haskell said the new state corrections board should work with the counties and the Department of Corrections to develop a plan to address future needs. She said finding resources always has been difficult, but when people are jailed for a crime, the state is responsible for their care — including their health care.

“We are not talking about them spending their golden years in a facility,” she said. “We are talking about doing what we need to do to protect society and what we have to do to take care of prisoners in our care.”

Gerzofsky said the issues around the aging inmate population need to move to the top of the list when lawmakers reconvene in December.

jchev Aging Population, Maine

The Illinois Department of Corrections and University of Illinois at Chicago are partnering on a new Telemedicine Pilot Program designed to bring elaborate and sophisticated healthcare to inmates with HIV and Hepatitis C. This interagency pilot program successfully rolled out at three sites: Danville, Lincoln and Robinson Correctional Centers. News from the Illinois DOC.

Three more prisons in the system will be piloting this program and the hope is to add three prisons each month until all of the facilities are using this technology to treat inmates with HIV and Hepatitis C. According to IDOC Medical Director Dr. Louis Shicker, “The program allows for specialty care of complex medical issues at remote locations. Each facility will have equipment installed and UIC will have a designated area where the physician can do their assessments.” Each location has a screen along with medical instruments that are connected to the telemedicine unit at UIC. This allows the physician to listen to the heart and lungs and visually see any skin abnormalities from the UIC location. A medical staff member from the prison is with the inmate at all times and can be directed in the exam by the specialist at UIC. Pharmaceuticals and lab work are provided by UIC. ”I hope this program will provide standardized, quality care to our population, foster closer ties between UIC and IDOC and possibly even expand into other areas where telemedicine can be utilized for our population,” said Dr. Shicker.

University of Illinois at Chicago, Department of Medicine, Section of Infectious Diseases, Immunology, & International Medicine, Assistant Professor Dr. Jeremy D. Young says, “The launch of this program was hugely successful. The equipment worked well, the clinic flow was smooth, and the patients were very receptive. With this program, we hope to provide evidence-based, up-to-date subspecialty care for offenders with HIV and Hepatitis C infections. We at UIC are very excited about the program as it will not only provide medical care, but intensive case management services for offenders as they transition from the prison setting out into the community. Our plan is to make this an academic program as it will help provide education and training to IDOC staff and UIC students, residents, and post-graduate infectious diseases fellows.”

This type of innovative program could save IDOC transportation costs and remove the risks associated with moving inmates outside of the prison. IDOC pilot sites next month include: Logan, Moline, and Western Correctional Centers.

jchev Economic Issues, Illinois, Inmate Health Care

Law enforcement agencies across the region are yet to reap the benefits of an amendment approved last session to reduce the amount of money counties have to pay for the medical treatment of state inmates and pre-trial detainees. Smith County Sheriff Charlie Crumpton said it’s “hard-hitting” when small sheriff’s departments in rural areas like Smith County have to spend thousands to care for state inmates. News from the Laurel Leader Call.

“Any time there is a county inmate, the county is solely responsible for caring for the inmate,” said Crumpton. “When we pick someone up for the state for something like violating probation or some other crime, in addition to providing medical care when needed, we have to provide food and clothing.

“The state doesn’t reimburse us until after that person is revoked,” he added. “That could take some time, and in the meantime, we have to pay everything from our budget.”

The new law, which took effect after Gov. Haley Barbour’s signature on April 7th, seeks to limit counties’ responsibility when bills exceed standard Medicaid rates or rates paid by the Mississippi Department of Corrections. Rates may vary depending on what kind of procedure or prescription an inmate needs.

Before the change, counties had to pay medical and drug costs for all state inmates. The state then reimbursed the counties at a fraction of the cost. Counties also were responsible for the full cost of care for pretrial detainees — those arrested and waiting to go to court.

“It’s tough because you are always questioned about why the jail budget is over,” said Crumpton. “It’s something you can’t help when the state houses inmates at your facility.

“The way the law is written, while they are here, they are ours to protect and make sure they are properly treated while they are in our custody.”

While Crumpton would only say Smith County spends a substantial amount of money for the care of inmates, Perry County Sheriff Jimmy Dale Smith said his agency spent close to $60,000 last year.

“We budget so much every year,” said Smith. “We have to carry inmates to the doctor if they complain about being sick.

“If we go to the emergency room or if they have to see a specialist, it all comes out of our budget. You’ve got to provide for them. I don’t know of any other way around it.”

Last year, Perry County had an in-house company providing medical care to its inmates. However, because of budget constraints, the county was forced to end the service.

“These medical costs are hitting us hard,” Smith said.

It’s different for Jones County officials. Jones County Administrator Charles Miller said the cost of the medical care of state inmates is not an issue.

“If we have medical concerns, we have a plus here,” he added. “We own the hospital (South Central Regional Medical Center) and we can work out something with them.”

Shaunita Weathersby, public information director for the Jones County Sheriffs Department, said Sheriff Alex Hodge doesn’t make it a habit of housing state inmates. “We barely have enough space for those here in the county,” she said.

jchev Economic Issues, Inmate Health Care, Mississippi

Dr. Ricki Barnett, chief medical officer for California Prison Health Care Services, has in front of her a list of two dozen of the most expensive patients under her watch. Their names and medical histories are highlighted in yellow. Complete story, additional photos and statistics in the Ventura County Star.

Patient A, she says, is a man in his 40s who suffered a head injury as a result of “institutional trauma,” likely a prison fight. He has never regained consciousness, has no cognitive function, suffered respiratory failure and survives through breathing and feeding tubes. He’s been this way for 2,600 days, or more than seven years.

Patient B, a 62-year-old man, suffers from AMS, a neurological condition similar to Lou Gehrig’s Disease. He’s paralyzed, has severe lung damage and breathes via a ventilator. “He’s a pretty sick guy, but he’s stabilized,” Barnett says. “I would anticipate he’ll be with us for a good deal longer.”

Patient C underwent surgery for a benign brain tumor. “The gray matter in his brain has been pressured out of existence. He’s vegetative.”

Barnett starts to read on, looks up and shakes her head. “They all start to sound the same.”

These are the California Department of Corrections and Rehabilitation’s $2 million-a-year-patients. All are men, most in their 40s and 50s, many with no known family members who could, if they chose, sign end-of-life directives that could hasten their deaths. They are housed in isolated wings in two long-term, acute care community hospitals, cuffed to their beds and guarded 24 hours a day, 365 days a year by two armed prison guards, one in each room and another in the hallway outside the door.

If the patients were to be placed on medical parole, their guards could go back to doing more useful work, the cuffs could be replaced with electronic monitoring devices, the cost of their medical care would be partly paid by federal tax dollars, and the state prison system would save $42 million.

These inmate-patients, Barnett said, would never know the difference. “They have no capacity to realize where they are.”

Next month, California lawmakers will decide whether to create a medical parole classification that would give the state’s Board of Parole Hearings authority to free the state prison system from direct responsibility for these patients and potentially hundreds more medically incapacitated inmates.

Those sentenced to death or to life in prison without possibility of parole would not be eligible.

If the proposal were to pass in the Legislature and be signed by Gov. Arnold Schwarzenegger, California would become at least the 18th state to adopt some form of parole or release program for old, infirm or incapacitated inmates.

The terms under consideration in California require that eligible inmates be “physically or cognitively incapacitated,” which, Barnett said, means they would be unable to perform any of the functions of daily living or, as would be the case with inmates with advanced Alzheimer’s disease, have severely limited brain functions.

The proposed conditions would be among the most restrictive in the nation, said Tina Chiu, who wrote a report in April on geriatric release programs for the New York-based VERA Institute of Justice.

Chiu identified 17 states with such programs, and said the California proposal would be among the most rigorous. “The threshold for being incapacitated seems very high,” she said.

Even at that, the California proposal, embodied in SB 1399, is politically controversial. It passed the Senate in June with the minimum votes required and received no Republican support. It will be heard by the Assembly Appropriations Committee early next month, and the bill’s author said he expects it will receive some measure of bipartisan support in the Assembly.

The measure is opposed by Crime Victims United, a victims’ rights organization closely allied with the state’s prison guards union, the California Correctional Peace Officers Association.

In a letter to lawmakers last month, Crime Victims United Chairwoman Harriet Salarno argued the definition of what conditions would qualify inmates for medical parole consideration is too vague.

“This criterion is incredibly broad and would apply to illnesses that are not life-threatening,” Salarno wrote.

Since that time, supporters have agreed to tighten the definition. It now says an individual must be “physically or cognitively debilitated or incapacitated.” Joyce Hayhoe, legislative director for California Prison Health Care Services, said supporters have agreed to delete the word “debilitated” before the bill is considered by the Assembly.

The change, Hayhoe said, would eliminate from consideration inmates who suffer from chronic, debilitating conditions such as diabetes, hypertension or kidney disease, whose medical conditions can be managed without rendering them incapacitated.

Prison Health Care Services is overseen by federal court receiver J. Clark Kelso, who was given authority to run prison healthcare operations by a federal judge after he determined the state was making insufficient progress in correcting medical services the court had found to be unconstitutionally deficient.

The Department of Corrections and Rehabilitation, which runs the entire prison system, has not taken a position on the bill. A spokeswoman for Schwarzenegger, noting the governor’s budget calls for an $811 million reduction in prison healthcare spending, said the administration “is working closely with the receiver in reviewing his proposal, with public safety being the governor’s top priority.”

Supporters believe they have addressed all legitimate public safety concerns. Medical parole would be subject to conditions, such as a requirement that parolee-patients be electronically monitored with GPS tracking devices, and could be revoked if a parolee’s medical condition improved and he or she became healthy enough to be deemed a threat to public safety.

Crime Victims United argues the revocation provision is not mandatory and its inclusion in the bill, in Salarno’s view, “raises concern about what offenders would be eligible.”

Sen. Mark Leno, D-San Francisco, the author of SB 1399, said the receiver’s office has identified about 700 inmate-patients it believes would be eligible, but the decisions would be left in the hands of a parole board that has historically been extremely selective in granting paroles.

“All this bill does is give authority to the board. It doesn’t release a soul,” Leno said. “If anything, the parole board may err on the side of caution. This is a parole board that doesn’t release very many.”

Indeed, the experience in other states has been that very few inmates have been released or paroled on medical grounds.

The VERA Institute study found a large “gap between intent and impact” of state medical and geriatric release programs. Over a seven-year period, Colorado released only three individuals, the study found. Virginia released four over six years. Only in Missouri, where 235 have been released over the last decade, does it seem the program is having a significant impact, the study found.

Because Missouri has only about one-sixth the inmates in its prisons as California, the proportional equivalent of that release rate here would be about 1,400 inmates.

The motivation for the proposal in California, as it has been elsewhere, is to reduce state costs for prison operations. “When you see these programs discussed, it usually comes at a time when there are a lot of budgetary pressures,” Chiu said.

With California struggling to close a $20 billion budget shortfall, the pressure is intense to bring prison spending, the fastest-growing segment of the state budget, under control.

The medical parole proposal deals with a small, but financially significant, slice of California’s inmate population of 166,000. The cost of providing medical care to all inmates has soared in recent years, more than doubling, to $2.5 billion from 2006 to 2009. The rising costs are partly the result of staffing improvements ordered by the receiver.

On average last year, the state spent $16,000 per inmate on prison healthcare.

As in the general population, however, healthcare costs are not evenly spread, but rather heavily concentrated in a small percentage of the sickest individuals.

A major contributing factor to the prison system’s soaring healthcare costs has been the cost of providing specialty care that is contracted out to hospitals and doctors outside of the prison system. That cost has jumped from $394 million in 2005 to $845 million last year.

An analysis done in May by the California State Auditor found that 39 percent of specialty healthcare expenses was spent on just 1,175 inmates, the sickest 2 percent of those who required specialty care.

Based on those statistics, Leno said, he believes the state could save up to $200 million annually in prison costs once a medical parole system becomes firmly established.

“We have limited resources,” he said. “They’re not coming back tomorrow or the next day, or next year. In these desperate times, and they are desperate, we have to conserve our resources. Justice is best served when we spend our limited resources on education, not incapacitated inmates.”

jchev CA Ventura County, Inmate Health Care, Mental Health Issues

The Board of Examiners on Tuesday agreed to a deal settling the ACLU’s lawsuit over prison medical treatment at the Ely prison. Reported in the Nevada Appeal.

The American Civil Liberties Union filed the class action suit in 2008 charging grossly inadequate medical care at Ely State Prison was putting the prison’s 1,000 inmates at serious risk. The suit followed a medical report commissioned by the ACLU to investigate conditions in Ely. Dr. William Noel said in that report medical treatment conditions at Ely amounted to “a pattern of gross medical abuse.”

Director of Corrections Howard Skolnik said the ACLU agreed to settle the case after an independent expert examined the medical conditions at Ely and recommended some changes.

The board consisting of the governor, attorney general and secretary of state voted Tuesday to pay $350,000 to cover a portion of the ACLU’s legal expenses in the case. Skolnik said none of the money would go to inmates in the prison.

He said the deal must still be accepted by the court and Ely Prison will have to maintain compliance with the terms of the deal for two years before the case will be finally dismissed.

In addition, the board approved a $4.5 million contract to implement the Nevada Business Portal. The Legislature approved the plan to create a one-stop-shop for businesses moving to Nevada to streamline the process of getting all of the necessary state and local licenses and approvals in one place. The portal project is being managed by Secretary of State Ross Miller’s office.

Finally, the board approved $1.58 million in funding to cover salary shortages in the Department of Corrections from the 2010 fiscal year, which ended June 30. That is money spent before the department’s correctional staff joined other state workers in taking furloughs.

jchev Inmate Health Care, Nevada

It’s become a challenge for Health Care Services staff to remember life before the new Electronic Medical Record (EMR), which was up and running in the late fall. It’s hard to imagine that when an inmate patient transferred from one building to another, all of his/ her medical paperwork had to be collected and physically transported to his/her new facility. It’s hard to remember that when an inmate patient arrived to a new facility, if a nurse or doctor had questions about upcoming appointments or wanted to know what was going on health-wise with the inmate, he/she had to look through pages and pages of the paper record. It is mind boggling to think that the typical way for providers to leave updates and notes about inmate patients was to place post-it notes on the paper chart. Now if a provider gets a question about an inmate/patient regarding followup appointments at outside facilities, for example, he or she can access that information right at his or her computer. Things like resubmitting orders for medications are now a matter of a few keystrokes, whereas in the days of old, the ordering practitioner would have to write out an order and fax it to the pharmacy. Published on Corrections.com.

“This way of working is much more efficient, and a much better use of people’s time,” notes newly appointed Director of General Nursing Services Gordon Bouchard. “We’re not paying people to run between buildings tracking down paper,” he continues. “Docs used to have to hand write orders, a nurse would then have to transcribe the orders and fax them to the pharmacy, then wait for two days to match the order against what had come in,” he shares.

Bouchard provides an example of a patient who was sent to Rhode Island Hospital at 11 p.m. and within two to three hours was returned to Intake. The staff at Intake, in the pre-EMR days, would have no idea why he had been sent out. The patient’s record would still be at Intake while he was at the hospital. Now, facility health care staff can look up the EMR and have the information they need instantly.

Another advantage to the EMR pointed out by Pauline Marcussen, Interdepartmental Project Manager, is the ability of more than one user to access a patient’s record simultaneously. Pauline also applauds the fact that physicians can have Virtual Private Network (VPN) access to the EMR from home, meaning they don’t have to physically be here in order to look up information about an inmate/patient.

The EMR’s reporting features are also a plus. We can now run reports by diagnosis, building, or chronic condition, to give just a few examples. “Now we can see within an instant how many inmates had their vitals checked, how many have had a TB test within the past year, how many tested positive for a specific illness, and who is due for vaccines,” notes Marcussen. “This is something we would have had to find by manually going through all medical records.” In the past, staff would also have to look through paper records to determine when medications would expire. Now they can run a list of medication expirations and reorder accordingly.

Another thing that can now be easily tracked is volume in our clinics. We can track how many patients have been seen where and by what provider. This enables us to be more efficient in our allocation and scheduling of staff.

Correctional Officer Hospital II J.R. Perez is a super user of the EMR and has trained numerous new and current staff on how to utilize the many features of the software. “There was a definite learning curve,” Perez notes. “But it’s become so much easier.” Each member of the Health Care Services staff received 16 hours of training over four weeks when the software was first implemented. One of the many improvements Perez notes is the fact that nurses’ notes are now so much easier to read because they are typed into the computer and not hand scribbled in illegible hand writing.

There are about 140 authorized users of the system, with varying levels of access depending on their position and need. Each user has an in box where important information about patients is shared. “Things used to fall through the cracks, like lab work might not get transferred with a patient,” notes Perez. “Now everything gets documented.”

Another advantage over the old paper system is patient confidentiality, according to Marcussen. “We can limit access and I can easily track what a user is doing on the system, how they are using the information – so if there were to be any misuse, I would know about it and have documentation of it.” Access is also tied to position. Some users can only view information, some can write, and some can do both.

Processing new inmates has become much more streamlined thanks to the EMR. There is just one nurse doing the intake questionnaire, and it has become much easier to translate information to physicians and to chart. In the past, one chart would have to be stored on each inmate. Now the information about each inmate is all accessible on line.

We are one of the first states with a unified system to go with an EMR, meaning our jail and prisons are all on one complex and information is accessible between the jail and prisons. Since the vendor, NextGen, has designated Rhode Island as a “premiere site,” we are getting inquiries from many states considering implementing the technology. Staff from the Alabama DOC, for instance, visited the RIDOC on April 21st and 22nd, to see the program in action and pick the brains of our staff about how it’s working. Joseph Marocco, Associate Director for Health Care Services, figures he has received about 20 calls from different states and counties wanting to ask about our experience with the EMR in the past three months alone. Also in May, Pauline Marcussen was invited to provide an overview of the new technology to sheriffs and staff from jails across the country along with the Information Technology specialist from Portland, Oregon, at the American Jail Association’s annual meeting.

It’s been about six months since the RIDOC’s Health Care Services staff began using the EMR, and most can hardly remember how they did their work without it. “It’s getting better and better all the time,” says Marcussen, “because the information is becoming more and more complete.” It’s slightly more labor intensive for physicians to have the EMR, because they have more forms to complete and can’t just leave written notes on a chart, but few would argue that the additional time doesn’t have huge payoffs. Newly hired nurses go to about four hours of training with J.R. Perez because even if they come from a place that had an EMR, they need to learn the particulars of the RIDOC’s system.

For Pauline Marcussen and Joe Marocco, having the EMR in place is like a dream come true. They’ve been advocates for this type of technology for well over a decade. Like anything else in state government, it’s been a long time in coming, but they still sometimes have to pinch themselves to realize it’s indeed a reality. Like all major changes, there was resistance and griping at first, but you’d be hard pressed now to find a Health Care Services staff member who would say they would prefer to go back to things they way they used to be.

jchev Inmate Health Care, Rhode Island, Technology

The state is ordering private prison company Correction Corporation of America to pay thousands of dollars and fix problems with drug and alcohol treatment and medical care at the Idaho Correctional Center. News from The Associated Press.

Ten of 13 drug and alcohol counselors at the prison near Boise aren’t qualified to provide treatment under CCA’s contract with the state, according to records obtained by The Associated Press.

Additionally, a medical audit by Idaho Department of Correction officials earlier this year shows the private prison has extensive problems administering medical care, including inadequate records; delays in providing medications, immunizations and mental health care; and a lack of follow-up or oversight when inmates are returned to the lockup after being hospitalized.

The state ordered CCA to provide it with a plan to fix the medical care problems by May 25, but the company has already missed that deadline.

Idaho is also imposing liquidated damages against CCA for violating its state contract by failing to have qualified drug and alcohol counselors. The damages rack up at a rate of more than $2,600 a day; so far, CCA owes the state more than $40,000 for the violations.

“We’re very concerned,” said Rona Siegert, director of Idaho Department of Correction Health Services. “That’s the whole purpose of the audit, to find these things before they get to a level where they’re critical.”

Nashville, Tenn.-based CCA responded to questions about the problems through a prepared statement.

“Regarding the findings of recent medical audits completed by the Idaho Department of Corrections at Idaho Correctional Center, we acknowledge and share the concerns of our government partner and take them seriously. While the identified issues are not at a critical stage, we are working actively and deliberately to quickly and effectively resolve them,” the company said.

CCA also said it is trying to hire qualified staffers for its drug and alcohol rehabilitation program.

“Our efforts to recruit qualified and credentialed addiction, alcohol and drug professionals from the available pool of local candidates continue. We are confident that these efforts will result in our company being in compliance in the near term with a fully credentialed Therapeutic Community staff, as local qualified professionals seek employment opportunities.”

Company officials also said several staff members are set to undergo certification testing in the coming months. But Natalie Warner, the Idaho Department of Correction’s contract administrator and quality assurance manager, said that under the schedule CCA provided for its current employees, the last of the certifications won’t be completed until June 2011. Meanwhile, CCA will have racked up more than $100,000 in liquidated damages.

In an April letter informing the private prison company of the issues, Idaho Department of Administration purchasing officer Jason Urquhart said the Correction Department feared that the drug and alcohol program violations could increase costs for the state.

Offenders often are required to complete the Therapeutic Community program to be released, so if the program’s integrity is compromised, offenders may have to stay in prison longer, increasing costs to the state, Urquhart wrote. He went on to say that the parole commission could require offenders to take part in drug and alcohol programs at other prisons — also increasing costs.

The medical audits, completed between February and April, suggest that in many cases, inmates are going without adequate care, Siegert said. Still, Siegert said the Correction Department didn’t know of any inmates who had suffered injury or harm because of the violations.

Among other problems found in the audits, inmates in the prison’s infirmary were sometimes left alone, without any working pager or call-light system to call a nurse or doctor in an emergency. They also were going too long between medical checks by nursing staff, according to the records.

“Our requirement is that a provider makes the rounds every day to see if they’re getting better or getting worse, what their vital signs are,” Siegert said.

Medical test results also languished unread for too long, raising the possibility that serious medical problems weren’t being addressed right away, Siegert said.

If the company doesn’t repair or adequately explain the audit findings, Idaho can impose liquidated damages for those violations as well.

“It’s going to stay on our radar and we’re going to continue watching it very closely,” Warner said.

jchev CCA, Idaho, Inmate Health Care

As California struggles to pay for social services for its poorest residents, it spends hundreds of millions of dollars a year on health care for a small group of sick inmates – in one case $1 million during a dying inmate’s final year, according to a state audit released Tuesday. News from the San Francisco Chronicle.

The state also spends billions of extra dollars on the longer sentences handed down under the state’s “three strikes” law in part because those inmates age in prison and need health care, the report by State Auditor Elaine Howle found.

Roughly one-quarter of the $2.1 billion spent on prison health care in 2007-08 paid for specialty health care, or services beyond primary care. Specialty care is provided by contractors, and typically involves inpatient acute medical and surgical care.

About 59,000 of the state’s 170,000 inmates received specialty care, with only 1,175 inmates accounting for a large portion of specialty health care spending: $185 million a year.

“In contrast, a large majority of the population of inmates incarcerated during 2007 and 2008 did not have any specialty health care costs,” Howle wrote.

Find Cost-savings
She said the state, and the federal receiver overseeing health care in California’s prisons, should continue to explore cost-saving measures, including an early release program for terminally ill or incapacitated inmates.

State Sen. Mark Leno, D-San Francisco, has introduced a bill with the backing of the federal receiver that would allow inmates, who do not pose a public safety threat and are incapacitated, to be “medically” paroled. The measure, SB1399, could be taken up for a vote on the
Senate floor as soon as Thursday.

Leno said the audit illustrates the need for medical parole, noting that the state now spends more than 10 percent of its general fund on state prisons – a portion that has more than doubled since 2003. He also said he was struck by Howle’s finding that the state spends about $132 million a year on overtime for prison guards who transport and guard ill inmates, many of whom are nonambulatory, because the state does not plan ahead for those costs.

“We can’t afford to squander taxpayer dollars the way we currently are,” Leno said. “There’s a better way to do business – 36 other states are doing (medical parole), Texas is leading the way. … This audit makes a strong case that our system can be run more efficiently.”

Leno has said that if California inmates are released, the cost of their care would largely be borne by the federal government through programs such as Medi-Cal and Social Security.

Audit ‘Helpful’
The state’s prison health care system is under the control of a federal receiver and has been since 2006, when a judge ruled that substandard treatment was killing about one inmate a week and violating the constitutional ban on cruel and unusual punishment. The receiver, J. Clark Kelso, said Tuesday that the audit is “helpful” and addresses many of the issues he has attempted to tackle, including containing costs.

Kelso said the report lends credence to another proposal, AB1817, that would make permanent a process for the state to evaluate the necessity of certain health procedures in prisons and treatments based on established criteria.

Three Strikes’ Impact
Howle’s report also found significant costs associated with the state’s three strikes law, a voter initiative approved in 1994 that requires a minimum sentence of 25 years to life for three-time repeat offenders with multiple prior serious or violent felony convictions.

As of April 2009, Howle wrote, 25 percent of prisoners were incarcerated under three strikes, and their sentences are on average nine years longer because of the law. She estimated that the additional years imposed by the law are costing California $19.2 billion over the duration of those inmates’ incarceration.

Howle noted that the two issues – the costs of three strikes and medical care – coincide because the older the inmate, the more the state is likely to spend on medical care. Specialty health care for inmates over 60, for example, averaged $42,000 a year. Howle determined that specialty health care provided to inmates incarcerated under the three strikes law costs 13 percent more than for inmates who were not sentenced under that law.

jchev California, Economic Issues, Inmate Health Care

A federal appellate court on Friday rejected the Schwarzenegger administration’s attempt to rid itself of the court-appointed receiver charged with bringing prison medical care up to a constitutional standard. Reported in the Sacramento Bee.

The record of the protracted class action lawsuit supports the trial judge’s ruling that, contrary to the administration’s argument, appointment of a receiver goes “no further than necessary to correct the constitutional violations, and was the least intrusive means,” a three-judge panel of the 9th U.S. Circuit Court of Appeals declared.

“The state to this day has not pointed to any evidence that it could remedy its constitutional violations in the absence of the receivership,” the judges said.

The panel also shot down the argument by the governor and his corrections boss that the federal Prison Litigation Reform Act allows for a court-appointed special master and thus, by implication, prohibits a receiver.

The act’s special master provisions “neither apply to nor prohibit the district court’s appointment of a receiver,” the judges said in a 20-page opinion.

After concluding that “if the system is not dramatically overhauled, (an) unconscionable degree of suffering and death is sure to continue,” San Francisco U. S. District Judge Thelton E. Henderson appointed a receiver in February 2006. He said prison health care was so bad it violated the Constitution’s ban on cruel and unusual punishment.

The judge conferred on the receiver all the powers of the secretary of the California Department of Corrections and Rehabilitation with respect to the delivery of inmate medical care, and suspended the secretary’s powers in that area.

Despite the unprecedented scope and dimension of the receivership, the state neither objected to nor appealed the order at the time.

But Gov. Arnold Schwarzenegger and Corrections Secretary Matthew Cate wearied of butting heads with the receiver – law professor J. Clark Kelso – over money, and last year asked Henderson to replace Kelso with a special master, but the judge refused and the administration appealed.

Legally, a special master would be limited to assisting in the development of remedial plans.

“The problem has not been with a lack of plans, but with the state’s inability to execute them,” the appellate panel said. “The district court did not err in ruling that a special master could not remedy the constitutional violations. …

“(W)e are compelled to point out that … the state is in a poor position to assert this objection to the receivership. (It) was imposed only after the state admitted its inability to comply with … orders intended to remedy the constitutional violations.”

The opinion was written by Judge William C. Canby Jr., with concurrence from Judges Mary M. Schroeder and Michael Daly Hawkins.

jchev California, Inmate Health Care

A new contract to treat state prisoners at Kino hospital includes a plan to separate inmates from the public. But hospital officials said they won’t know whether they’ll make money from treating prisoners until the contract has been in place for at least six months. They expect that, at best, they’ll break even. Rep0rted by the Arizona Daily Star.

Had the hospital declined to enter into a contract, the state would have continued sending inmates to its emergency room, hospital CEO Diane Rafferty said. With the contract in place, the Department of Corrections will pay for necessary security upgrades.

The contract signed this month calls for segregating inmates from other patients via a security upgrade and renovation of one floor of the hospital, formally known as University Physicians Healthcare Hospital at Kino.

The one-year contract covers emergency care; inpatient care, including surgery; and outpatient care, including pharmacy, radiology and laboratory services.

UPH Hospital leases the medical buildings and land on East Ajo Way near Tucson Electric Park from Pima County. The county has subsidized the hospital’s deficit for several years, but says it won’t cover any shortfalls for inmate health care.

Treatment of prisoners became an issue five months ago, after the Department of Corrections lost its contracts with Carondelet St. Mary’s Hospital in Tucson and Maricopa Medical Center in Phoenix. The hospitals terminated their contracts after the state decided to pay less for inmate care, matching reimbursement rates for the Arizona Health Care Cost Containment System, the state’s indigent health plan.

Officials at St. Mary’s and Maricopa Medical Center said accepting the low rates meant operating at a loss.

While searching for new hospital partners, the Corrections Department sent hundreds of inmates to emergency rooms. UPH Hospital saw the majority of ER admissions in Southern Arizona due to its proximity to the state prison on Wilmot Road south of Interstate 10, where most inmates with chronic and serious health conditions are housed.

Six to eight inmates are at UPH Hospital on any given day, and the length of their stays varies from hours to days, said Charles Flanagan, deputy director of the state Corrections Department. County documents list a larger number of inmates being treated each month, but Flanagan says officials are incorrectly counting each day as a new visit.

Elsewhere in the state, the Corrections Department signed a contract earlier this year with Abrazo Health Care, which has five hospitals in Central and Northern Arizona.

It also entered into three contracts to replace services formerly provided by the hospitals: DaVita will provide dialysis treatment in Tucson and 21st Century Oncology will provide cancer treatment in Queen Creek. And it has ongoing contracts with four hospitals in relatively rural areas and sometimes sends inmates to non-contracted specialists.

Securing UPH Hospital
Formerly a psychiatric inpatient facility and office space, the fifth floor of UPH Hospital is being converted into a 12-bed unit for inmates.

The Corrections Department has agreed to pay for the work and estimates it will cost a few hundred dollars to add new doors with security glass and bar the windows, using inmate labor to do the work, Flanagan said.

But UPH Hospital officials suggested it could be hundreds of thousands. In addition, the hospital may have to make the ceiling more secure, Rafferty said.

The inmates going to UPH Hospital for emergency care use a separate parking lot and entrance from other emergency patients, Rafferty said. Inside, they are treated in individual rooms within the shared emergency unit. Corrections officials call ahead to let the hospital know an inmate is coming.

To get inmates beyond the emergency room, hospital staff uses an internal elevator that other patients and visitors can’t access, Rafferty said. At least one corrections officer is with each inmate during admission, and all inmates in the hospital are supervised by officers.

Until renovations are complete, corrections officers are stationed in a makeshift inmate unit 24 hours a day, and medical staffers never enter an inmate’s room without a corrections officer, Flanagan said.

Those security measures will be transferred to the locked fifth-floor inmate unit after the renovations.

Concerns remain
The hospital has struggled for three decades as the main purveyor of health care to the county’s indigent population – and county officials worry that financial woes will continue with the new contract.

While Pima County has tentatively agreed to give the hospital a $25 million subsidy this year – $15 million more than planned – county taxpayers shouldn’t have to foot the bill if the prisoners become too expensive, Pima County Administrator Chuck Huckelberry said.

Despite the contract, the question remains as to how many prisoners have gone without critically needed health care in the last six months.

One inmate, 29-year-old David Wiser, was diagnosed with malignant melanoma in September 2009 after he found a tumor in his leg in March 2008.

Wiser, who is serving a life sentence for first-degree murder, was moved to the Wilmot facility in October after a doctor at St. Mary’s recommended “a rapid and aggressive workup for this tumor” and indicated that his “continuing weight loss is an ominous symptom and may very well show symptomatic spread,” medical records indicate.

Wiser said he didn’t receive treatment until earlier this month. He still doesn’t know the stage of his cancer and hasn’t received some of the care recommended more than six months ago, he said.

“I have just been wondering, ‘Am I going to die?’ ” he said. “The worst part is not knowing how severe this is, and I still don’t know.”

jchev Arizona, Inmate Health Care

Inside prison walls, Gary Rubenstein is facing a death sentence, but one not imposed by a judge or jury. He has terminal lung cancer and has stopped treatment, saving the state expensive end-of-life medical care in a futile attempt to keep him alive. “I said, ‘For what? I’m in prison,’” said Rubenstein. “There’s really no light at the end of my tunnel.” Story reported by KTVU.

Rubenstein has spent almost half his 53 years in prison and 16 years served so far this time for his third strike, a conviction for attempted strong arm robbery.

The talented pen-and-ink/tattoo artist is spending his last days in prison at the end of Vacaville’s X-corridor in a hospice, the nation’s first.

“It sounded like a good place to be,” said Rubenstein.

With an aging prison population and more than 350 inmates dying in California’s prisons each year, there’s always an inmate wanting one of the 17 beds. Here, other prisoners volunteer to care for them and promise they will not die alone and will die with dignity, with as little pain as possible.

But one question hospice officials are often asked: Why should criminals get compassion when they didn’t give it to their victims?

“We have an inmate who’s a ward of the state,” said Rev. Keith Knauf. “We can’t be like the murderer. We can’t be like the rapist or the child molester. We have to treat each one like a human being and these people who have done these things are broken.”

The California Medical Facility in Vacaville, where Rubenstein lives and Knauf works, was the first licensed hospice in any prison anywhere in the world and that was back in 1996.

But the caring for those in their last days started much earlier, with hospice pioneer and psychiatrist Elisabeth Kubler-Ross, and a Berkeley couple Robert and Nancy Alexander during the aids epidemic in the mid-80’s.

So many inmates volunteer to be caregivers here, the rejection rate for applicants is higher than for elite colleges about 40 to 1.

“We have a lot of applicants that want to be in the program, some with good motives, some with bad motives,” said Knauf.

The chaplain says he looks for prisoners with compassion in their hearts, even if they don’t know it yet. Inmates like Sean Reece, who’s been behind bars 13 years.

“One guy told me, ‘You know when they pass away we help put them in the bag, the body bag’ and I said, ‘Time out, hold on, wait a minute, put ‘em in the what?’” said Reece. “That’s up close and personal with something I myself had a problem with, death.”

But Reece persevered. He and others picked for the program start training by viewing 50 videos, then moved to one-on-one care-giving, cleaning bed pans, washing patients, holding their hands and those hardened hearts begin to soften.

“Oh, I don’t trust anybody but these guys are different because they’re sick,” said Reece.

He figures it was divine guidance that brought him here.

“I was put here for a reason, I don’t know why, I’m going to stay and find out,” said Reece. “Because I think the more you deal with death the more you understand life.”

Roman Galafate has spent 21 years here for killing a man. The former army medic said he regrets it every time he helps someone die.

“I hurts, it hurts, it’s like I relive a crime, I relive it each time I watch them take their last breath,” said Galafate.

With six years as a caregiver, he’s relived it many times, having seen an estimated 100 deaths. But he and the other inmates say helping other people die changes the way they live.

“In that sense, a prison hospice is not a place of death but a place of healing and closure,” said Knauf.

The final closure comes when the caregiver washes the dead inmate’s body, including the ink from the required postmortem fingerprinting, and zips the body bag.

“We have a form we fill out when somebody passes,” said Reece. “On everybody’s form I write may the creator see this man’s heart was good and judge him accordingly. That’s what it’s all about.”

jchev California, Inmate Health Care

An “agreement in principle” has been struck between local officials on one side and the federal prison receiver and state corrections officials on the other over construction of a massive prison hospital immediately southeast of Stockton. News from the Stockton Record.

The deal is not done. The final wording of the tentative pact has yet to be worked out. It has to be approved by all concerned – Stockton, San Joaquin County, the Greater Stockton Chamber of Commerce, federal receiver J. Clark Kelso, and the Department of Corrections and Rehabilitation.

A hiccup could delay things. Still, it looks like months of public rancor and hand-wringing will end with a deal. Not one that everyone likes. Not one that addresses every concern. Certainly not one that moves San Joaquin County contractors, businesses and workers to the front of the line for the construction, business and jobs that are coming.

But a deal that demonstrates that when enough pressure is brought on the state, it can be forced not just to listen to local concerns but to address them.

The main focus, of course, was on state plans for a 1,722-bed prison hospital on the site of the closed Karl Holton Youth Correctional Facility. This $895 million hospital will be the first of three prison facilities in the area of Highway 99 and Arch Road. Also planned are a mental health facility and a prisoner re-entry facility.

State officials, facing a federal court deadline of Dec. 31, 2013, to open the hospital, are trying to upgrade inmate health care after a federal court in San Francisco determined prisoner medical care is constitutionally inadequate. At first, Kelso proposed a series of hospitals, but eventually that was pared down to one massive facility, to be called the California Medical Facility, Stockton.

The state owns land on which prisons have operated in the past, and it only makes sense that property be used.

But local officials, feeling they were being steamrolled by state officials and the receiver, went to court not to block the project but to ensure at least some mitigations were in place before construction began.

It’s the tentative settlement of that suit that came Friday, a deadline imposed by Kelso and state officials on the implicit, if hollow, threat that the project would go elsewhere and with it thousands of construction jobs, hundreds of permanent jobs and millions of dollars of potential annual business for San Joaquin County vendors.

That suit – sparked by concerns from the chamber of commerce and led throughout by chamber officials – forced state officials to listen to and act on local concerns. To bring that much pressure to bear on a huge bureaucracy such as the Corrections Department and the federal receiver and to win concessions is no small feat. The result is in marked contrast, for example, to the railroad job under way to build a peripheral canal around the Sacramento-San Joaquin River Delta to convey more water south. In that case, Sacramento, working with south Valley farming interests and south state water districts, is simply ignoring concerns of Delta region residents.

We wish the prison hospital agreement were perfect. It’s not, not for either side. A negotiated settlement never is. What is important is that negotiators never let perfection become the enemy of good, in this case a settlement that appears good for all concerned.

jchev CA San Joaquin County, Inmate Health Care

Settlement negotiations in a battle over construction of a massive inmate medical center near Stockton appear to have deadlocked, with state prison officials hinting they’re about to take their $700 million project elsewhere. News from the Stockton Record.

Stockton Mayor Ann Johnston aired her frustration in a meeting Thursday with The Record’s editorial board, saying she and county leaders have received no written guarantees that the project will draw on local labor, among other demands.

Yet prison health care receiver J. Clark Kelso and Christopher Meyer, the California Department of Corrections and Rehabilitation construction chief, said the deal they’ve offered Stockton and San Joaquin County is as good as it gets.

“From where I sit, the offer on the table is sweeter than anything we’ve done before or if it were done through the court,” Meyer said in a phone interview. “I think there’s more than a fair offer.”

Johnston isn’t impressed, calling what she has seen so far a lot of “smoke and mirrors.”

“Vague promises don’t cut it,” she said.

At issue is the 1,734-bed California Health Care Facility, Stockton, which Kelso proposed late last year for the site of the shuttered Karl Holton Youth Correctional Drug and Alcohol Treatment Facility, southeast of Stockton.

Once built, it would be the state’s flagship prison medical center. Plans for it come in answer to U.S. District Judge Thelton Henderson of San Francisco, who appointed the receivership to bring the state’s inmate medical care up to constitutional levels.

Kelso’s project is the largest of three prisons proposed for state property east of Highway 99 off Arch Road. The state also plans to build a second, 1,133-bed inmate medical center and a 500-bed prison re-entry facility.

After Kelso unveiled his project, the Greater Stockton Chamber of Commerce, the city and San Joaquin County took him and the state to court, with chamber CEO Douglass Wilhoit leading the charge against the receiver’s plan.

“At no time have we said we don’t want it here,” Wilhoit said in the editorial board meeting. “We want assurances that it’s handled correctly.”

The city and county say their aim is to force state officials into living up to their promises that the prison will help the community rather than harm it.

They demanded guarantees that local labor would get priority. They also want to know in detail how San Joaquin Delta College will provide trained medical staff and what San Joaquin General Hospital’s role will be in treating prisoners.

For his part, Kelso said he’s done much of that. Federal law forbids him from promising that a certain percentage of the bids will be awarded locally, but his staff has done adequate outreach to local labor groups, he said.

The basic framework of his settlement agreement has been written and presented, he said.

“I think we’ve done just about all we can do,” Kelso said. “I’m frustrated that we are still litigating.”

Meyer said he is working under deadline. The federal judge has demanded that he open the medical center by Dec. 31, 2013. He wants to work with Stockton and San Joaquin County, but his efforts here so far have been stalled for 17 critical weeks.

Meyer and Kelso said they’ve asked local leaders to give them a response to their offer by the end of the month. Meyer all but said he will jettison Stockton as the site for the medical center.

“I am prepared to consider all options to deliver the project by Dec. 31, 2013,” he said. “All options have to be on the table.”

jchev CA San Joaquin County, Inmate Health Care

A month before Virginia banned smoking in its prisons, Warden Daniel Braxton decided to kick his own 50-year smoking habit.”I figured I’d be a good role model,” said Braxton of Augusta Correctional Center in Craigsville, Va. Reported in the USA Today.

A growing number of states are cracking down on tobacco use on prison grounds to prevent illness and help bring down health care costs. Virginia, which instituted its ban in February, is the most recent state to do so, said Larry Traylor, spokesman for the Virginia Department of Corrections.

A USA TODAY review of the 50 states found that 25 states ban tobacco for staff and inmates on prison grounds.

Georgia plans to enact a smoking ban Dec. 1, according to Bronson Frick, associate director of the Americans for Nonsmokers’ Rights Foundation.

Many other states have bans that primarily outlaw tobacco use but have some type of exception such as staff smoking areas, the review found.

The trend is growing, Frick said, because the bans help save the states money on health care and prevent guards and inmates from being exposed to secondhand smoke on the job.

“These policies work once they are in effect,” he said.

A gradual approach
Instead of a “cold turkey” approach, some prisons allowed their bans to phase in gradually, hoping that would create less of a stir among the prison populations.

In Virginia, inmates were notified in January 2009, more than a year before the ban launched, Traylor said.

“We already had eight facilities in our system that were either tobacco-free or had designated smoking areas for staff away from inmate areas,” Traylor said. “These eight facilities have proven that a gradual process is possible.”

The phase-in process for Virginia gave Braxton time to quit smoking. As for the prisoners, Braxton said he’s pretty sure some of them stashed tobacco at the facility, but none has been caught smoking.

“I’m not having any issues with them at all,” he said. “They hid some in the yard, but we have cameras, and I haven’t seen anyone dig up any tobacco.”

Ohio went tobacco-free March 1, 2009. The Ohio Department of Rehabilitation and Corrections has had to discipline a few staff members over tobacco use, said Julie Walburn, chief of communication.

“In the past year, we’ve disciplined 33 staff for violations in some form of the tobacco ban, but when we employ over 13,000 staff, that really isn’t a demonstrative number,” Walburn said. Tobacco products have become a popular item on the inmate contraband market, she said.

“We are used to dealing with contraband. This is just another type,” Walburn said.

When Wyoming banned smoking in its prisons in 2006, it was more of an issue for staff than prisoners, said Melinda Brazzale, a spokeswoman for the Wyoming Department of Corrections.

“They did not break the rule, however,” she said. “They were used to just walking out the door and smoking, and now they actually had to go across a road or out of the facility and be away from it.”

Some opposition
Not all plans to ban prison smoking have been successful. Arizona attempted to ban smoking in its state prisons last year, but the legislation failed.

The bill’s sponsor, Republican state Rep. Bill Konopnicki, said there are plans to reintroduce the bill.

Michael McFadden, a spokesman for the Citizens Freedom Alliance, which mostly focuses on government interference with private-property owners, said the group is concerned with what prison smoking bans mean.

“Bans on smoking in prisons are not really separate from such things as bans on beaches, bans in bars or bans in private apartments: They are all facets of a larger and very well-funded movement to ban smoking from all aspects of life,” he said.

The American Civil Liberties Union National Prison Project supports some bans, Director David Fathi said, because in some cases, smoking in prisons can be a violation of the Eighth Amendment, which prohibits “cruel and unusual punishments.”

“Just like prisoners have the right to drink clean water and eat edible food, prisoners have the right to breathe non-contaminated air,” he said.

Braxton said he’s glad he got the opportunity to see the benefits of not smoking, which have surfaced in the months since he quit.

“I can tell there’s a big, big improvement in my health just in that short period,” he said.

jchev Smoking, United States

Cigarettes are prohibited in South Carolina prisons but treated as a privilege in the Spartanburg County jail. Reported in the Spartanburg Herald-Journal.

Powers tried banning cigarettes years ago after issuance of a county ordinance, but two officers began selling cigarettes for $1 apiece, paper matches for 10 cents and a “striker” for 50 cents. The officers were fired.

The Department of Corrections prohibited cigarettes to all inmates and employees in January 2008. Officers are patted down daily to prevent contraband cigarettes being brought into the facilities.

Spokesman Josh Gelinas said the department conducted smoking cessation seminars and distributed nicotine gum to prison inmates before the ban. Gelinas said corrections officials have observed a higher demand for tobacco than other illicit substances and continue to monitor attempts to smuggle cigarettes into facilities.

Jail Director Larry Powers said, based on studies and personal experience, he believes allowing inmates controlled access to cigarettes prevents a black market from developing to sell cigarettes and reduces the personnel hours required to enforce such a ban.

Powers said the legality of cigarette purchases “on the outside” as opposed to narcotics leads to an ample supply for those who might be tempted to smuggle banned cigarettes. Based on that, as well as employees’ desire to smoke, Powers chose to reinstate cigarettes that are sold in packs through the jail’s canteen as a privilege and designate an outside exercise area as the place where inmates can smoke. Powers also designated areas where staff can smoke. He said a survey conducted a few years ago revealed that about 70 percent of Spartanburg County jail employees smoke.

Generic cigarettes are sold for $4.90 per pack, and name brand cigarettes are sold for $5.52 per pack, Powers said. Those prices will go up if a proposed increase in state taxes is passed. The money from the cigarette and other canteen purchases is used to buy basketballs, checkers and chess sets and televisions for inmate use, Powers said.

Last week’s temporary move of female inmates from the main facility on California Avenue to the former jail next to the Spartanburg County Courthouse — now called Annex I — required creation of a separate smoking policy. Some women complained this week about stale air, warm temperatures and problems using the phone.

Powers said the complaints were unfounded. He said Annex I, which is usually used to hold inmates before their court appearances, was inspected and approved by the state as a temporary housing facility. He said ventilation is “somewhat restricted” in Annex I, which was built in 1956 and first occupied in 1958, because officials place plastic over windows to keep in the heat during the winter.

Plans to replace the current windows were put on hold about two years ago because of funding. Powers said the phone service provider worked on correcting issues with the phones this week. Many inmates fumed about not being able to smoke as many cigarettes as they could before the move.

Powers said because Annex I does not have a sprinkler system, the inmates housed there are not allowed to possess smoking materials. Female inmates who request a cigarette are given one at no charge during their outdoor time in a fenced-in area, and the cigarette butts are collected before the inmates return to the building. Powers reminded the female inmates they are in jail.

“The female inmates are right in that they cannot purchase and possess cigarettes, but they can smoke if they retain that privilege, albeit limited,” Powers said. “Again, smoking is not a right. Rather, it is a privilege.”

jchev SC Spartanburg County, Smoking

A proposal by the Schwarzenegger administration to overhaul the troubled medical care system for inmates could save $12 billion over a decade, officials say. But it would also cost jobs. News from the LA Times.

The Schwarzenegger administration wants to put the University of California in charge of state prison inmates’ medical needs in an overhaul of the troubled corrections healthcare system that could save $12 billion over a decade, officials say.

The arrangement, similar to a centralized system of managed care, would dramatically expand the use of telemedicine, a technique by which patients are seen by doctors in remote locations over a screen with an Internet connection. It would institute electronic record-keeping so providers could access medical information from anywhere.

And the plan, still being refined, could include the purchase or construction of a central hospital near several prison infirmaries for housing and treatment of the chronically sick. That would reduce the state’s current — and expensive — practice of paying correctional officers overtime to transport and guard inmates at community hospitals around the state.

Eventually, the program would mean a sharp reduction in the number of employees providing care.

The proposal would require approval from lawmakers and from federal judges presiding over inmate lawsuits on inadequate healthcare. It could meet with opposition from unions for state workers whose jobs might change or be eliminated.

The program, recommended by a Texas company that the state hired as a consultant, would be an effort to reduce, and ultimately end, oversight of California’s prison medical care by federal courts.

After a receiver took control of the system in 2006, medical costs skyrocketed. They reached $2.5 billion a year, including mental health care, which the receiver does not control, and have since declined to $2.2 billion. But they remain far higher than in other states, according a report by NuPhysicia, the state’s consultant.

“This is definitely a wholesale reform of the prison healthcare system,” said Susan Kennedy, Gov. Arnold Schwarzenegger’s chief of staff. “The system is a mess right now. California needs to . . . rein in its costs, provide quality care and get out from oversight of multiple federal courts.”

John Stobo, UC senior vice president for health sciences and services, said the university, which has not yet agreed to the plan, would be paid for the care it provided. But he noted, as in its decision to help reopen Martin Luther King Jr. Hospital in Willowbrook, the university is a public trust that exists to work with medically underserved populations such as prisoners.

“This is part of our mission and our responsibility,” Stobo said.

The project would start at 11 Northern California prisons before being expanded to all 33.

Some of the recommended approaches, including telemedicine, records modernization and cheaper bulk purchasing of drugs, are already being undertaken by the court-appointed receiver, J. Clark Kelso, who is working with Schwarzenegger to cut the receiver’s budget by $800 million in the coming year.

In proposing to pair state prisons with UC’s academic medical system, the state is suggesting faster, broader changes similar to those in place in Texas and New Jersey, which also had federal court oversight of inmate care, and in Georgia.

California pays more than $40 a day for inmate care, according to NuPhysicia; it has added resources inefficiently under court scrutiny, state officials say. Texas pays $9.67 a day, New Jersey $15.84 and Georgia $10.25. With about 12,000 medical staff members serving inmates, California has about twice as many per prisoner as those states.

Savings from the plan in California are estimated to be at least $300 million in 2010 and would reach $1.2 billion a year by 2014, according to NuPhysicia.

The company grew out of the University of Texas Medical Branch’s entrance into prisoner healthcare in the mid-1990s. Stobo headed the Texas medical center at that time.

He briefed Schwarzenegger on the plan Wednesday. The governor’s aides said they planned to work with lawmakers, Kelso and the federal judges overseeing lawsuits on inmate medical care, dental care, mental health and disabilities.

The state also would need cooperation from unions for state prison employees, some of whom would be transferred to the university system.

Kelso’s spokesman, Luis Patino, said the receiver had just received the report and had not yet reviewed it but would be pleased to discuss “any plan that will improve prison healthcare cost-effectively.” He noted that the medical spending was already decreasing.

Under the new system, lawmakers would create a state agency that included corrections administrators, federal court representatives and appointees of the governor. It would give a contract to UC and monitor spending and quality of care.

The UC system would establish another agency to absorb state prison doctors, dentists and psychiatrists and to centralize purchasing of drugs and equipment.

jchev California, Inmate Health Care