Do inmates of US prisons receive “emergency only” healthcare like many of the uninsured, or would an inmate who, say, found a suspicious lump be provided with consultations, scans and, if necessary, expensive drugs and other treatment?
Might there be circumstances in which an unemployed, uninsured homeowner who had been diagnosed with cancer might even weigh up the horrors of going to prison against the horrors of losing their house to pay for treatment? (Please keep this GQ-friendly - I am fully expecting a big fat No here.)
They get more than just ER treatment, they do get treated for cancer as 1 example. Obviously the big difference is they cannot choose their hospital or doctors. John Gotti died in prison of cancer but he did get treatment for it.
I just read about a former major league baseball player who later became a dentist but then went to prison. He now works as a prison dentist and he said he can relate to their situation as former inmate himself. Can’t recall his name now.
I oversee correctional heath care, and deliver it.
US inmates have the right to the same standard of care that unincarcerated folks get.
That means we manage and monitor their diabetes, asthma, heart disease, and other chronic illnesses. We treat acute conditions and injuries as they arise, according to community standards. We treat a lot of cancer.
The courts have ruled that an inmate may not be denied a spot on an organ transplant list because of his/her inmate status. So we send our inmates for kidney and liver and occasionally heart transplants, if they meet the criteria otherwise.
We operate two dialysis units in our system, one large skilled nursing facility, and arrange for physical and occupational therapy as needed. We do x-rays onsite at our larger facilities, and so forth.
And it’s all paid for by the taxpayers. Private insurers and Medicare have exclusionary language which exempts them from coverage if the individual is convicted of a crime and incarcerated.
One thing that has a very strong emphasis in Corrections Medicine: We provide necessary medical care. If it is deemed medically necessary, we do it. If it’s not, we don’t.
I spent 20 years practicing in the private sector, and came to realize that at least 40% of what was being done was unnecessary care. Or care that had not been shown to be effective for the condition. We try to avoid that since we’re chewing up the public’s dime to care for felons.
So if a new inmate immediately asked for an appointment and said “I have been diagnosed with cancer which requires surgery as soon as possible”, they would receive their necessary care as promptly as feasibly possible and at no expense to themselves?
Yes, thanks, Qadgop. In what percentage of cases do prisoners have to be taken off-site for treatment, would you say, and how often do they try to escape while away?
Well, that standard varies based on so many conditions (employment, ability to pay, etc.). So whose standard are you talking about?
And what about mental health? I know it’s pretty easy for incarcerated folks to get psychiatric meds, but I hear about a seemingly awful lot of suicides in jails.
Accepted medical standards. Which state that, for example, if a person has type II diabetes they need to be seen at least twice a year, have their diabetes control monitored at least that often, with a goal of achieving an appropriate level of control. Annual eye exams by an optometrist are expected, along with referral to an opthalmologist if they have progressive diabetic retinopathy, for possible surgery or other intervention. Routine diabetic foot care needs to be done, along with referral to podiatry if significant progressive foot disease is noted. Education about their diabetes needs to be documented, and at each evaluation a notation about whether their disease condition is improve, unchanged, or worsened should be recorded. Interventions to improve their situation need to be documented too. That’s the standard of care for diabetes in a nutshell. We need to be able to do that for diabetic inmates.
I work in a prison, which is very different for a jail. I can only speak for prisons in general.
All our inmates get a mental health assessment on arrival, and if they come in on psychiatric meds, they get an automatic psychiatry referral. Otherwise they may be referred to a psychiatrist by the mental health screener. Said screener may also put them on a certain level of mental health monitoring, if suicide or other risky behavior is a concern.
All corrections staff get training updated in suicide prevention annually, to work to minimize the successful suicides.
Our inmates are definitely at higher risk for suicide than folks not in that situation, so it’s no surprise that the rate is a bit higher than the average population. The surprise to me is that it’s not even higher. Even so, we work very hard to bring down the suicide rate in our population, and in our system (Wisconsin) we’ve has some success these last few years in nearly halving the rate.
Perhaps 30-40% of our inmates need to be taken to an outside appointment/ER visit at some time during their incarceration (WAG by me). This is known to be a popular time for ‘escape attempts’ so security is appropriately heavy, and our system has had very few incidents during these visits.
Since prisoners get free healthcare, I’ve always wondered if anyone uninsured has committed a crime specifically to get incarcerated and get treatment. Ever encounter that, Qadqop?
I have had HIV positive patients express relief to be back in our system where they know they’ll get their HIV meds and followups with their HIV specialists.
(HIV meds ae now quite effective, but also expensive as hell, and many of our HIV patients do honestly try to continue therapy on the street, but are unable to.)
I’ve also had a few patients express something like both wonder and gratitude when they realize that if they hadn’t been sent to prison, their cancer would not have been diagnosed and successfully treated.
Delivering health care to incarcerated people is tough, and things can and do fall through the cracks.
Our patients often have unreasonable expectations about what constitutes a medical need. Many tell me they need oxycontin to treat their chronic musculo-skeletal back pain. And when my evaluation of them indicates what they need is to lose weight, do their back exercises, and use tylenol, they tend to be very, very, very unhappy with me. They often complain, and they often sue.
US prison healthcare systems are also often underfunded and understaffed, for a variety of reasons (one is the fact that budget increases to spend more money on prisoners is never popular with the voters).
As a result, timely access to a doctor or nurse practitioner can be difficult to get.
State legislatures should not be in the business of deciding what appropriate medical treatments are for their inmates. That’s what physicians are for. The Supreme Court has ruled that inmates must be provided with standard of care medicine.
