On reentry, healthcare, privatization, sheep and goats

While I was on vacation last week, the state of Texas' prison healthcare was a big topic of discussion. A well-done story at the Fort Worth Star-Telegram yesterday focused on continuity of care for HIV positive inmates when they leave Texas prisons. Reporter Alex Branch wrote that:

studies show that HIV-positive prison inmates still regularly experience dangerous lapses in treatment after discharge.

[According to a study from several years ago,] 20 percent of inmates enrolled in an HIV clinic within 30 days of their release, and only 28 percent did so within 90 days.

It's a problem with consequences beyond the personal health of the offenders. Interruptions in medication increase the risk of transmission, can lead to medication-resistant strains of HIV and often require more costly treatment later.

Health officials have launched initiatives to end the lapses, including using telemedicine to connect HIV-positive prisoners with local AIDS organizations that can assist them when they return to their communities.

Why do inmates fail to keep up with their meds on the outside? Though the writer at one point says the problem is a lack of "personal responsibility," which I'm sure plays a role, the larger public policy reasons are fairly predictable:

Former prisoners report several obstacles to getting medication, AIDS outreach workers say. Many are unsure where they will live after discharge, lacking homes and families to which they can return.

Some don't even complete the bus trip home, using the $50 they are given at discharge to fall into previous bad behaviors, they say.

Those who have been incarcerated for a long time have little experience making doctor's appointments, filling prescriptions and understanding bureaucracies, said Shannon Hilgart, associate executive director at the AIDS Outreach Center.

"Navigating a hospital system is daunting if you have been incarcerated since 19 and never had to deal with it," she said. "Getting to a clinic, getting through the paperwork. ... It's a whole new learning process."

It's a "learning process," though, that until recently didn't begin until release, and then the inmate was on their own. Recent changes thanks to a renewed focus on reentry services for prisoners begun in 2009 have somewhat mitigated the problem, reported Branch:

State officials held a summit to discuss the issue and agreed on several strategies to link services offenders received in prison with those provided by organizations in communities, said Janina Daves, re-entry coordinator for the Texas HIV Medication Program, which spends $90 million annually supplying HIV medication to low-income Texans.

Prison officials are using medical discharge planners to help inmates complete applications for treatment programs before they're released, she said. Inmates are told how to contact the AIDS service organizations and given phone numbers to call if they run into difficulties.

As a result, "Since the state made changes, the agency has had more success in getting ex-offenders to continue medical regimens, officials said. Case managers, mental health counselors and nutritionists help clients set up medical appointments and live healthy lifestyles." Hopefully cuts to reentry services this legislative session won't roll back this successful and important effort. If they do, it will merely shift costs to local emergency rooms who will then have to deal with much sicker, more expensive patients down the line.

In other prison health news, Mike Ward at the Austin Statesman reports that legislators this week beat back a proposal to give the Governor control over decisions whether to privatize the prison healthcare system, after "critics of privatization feared that it would have allowed Perry to push ahead with outsourcing of the nearly $1 billion-a-year system, which has been plagued for years by mushrooming costs."

Ironically, though, private prison health providers have said they couldn't operate the system if the TDCJ health budget was slashed, which of course it was by 14%. So by most accounts, privatizing prison healthcare would cost more than the state has budgeted for the next biennium. Not only do most private vendors not have UTMB's telemedicine system, enabling access to health providers outside the unit, but they must build profit into their costs while the universities providing healthcare can do so covering only the cost of services.

Texas already has among the lowest per-inmate healthcare costs in the country. And carceral institutions elsewhere that have privatized health services have sometimes generated pitiful results. Plus, privatization of Medicaid and Medicare services has resulted in widespread fraud. At a minimum privatization would require a great deal more state oversight and supervision than  the Correctional Managed  Healthcare Committee affords now.

Finally, both last and least, attorney Edward Lane at the "Wichita Falls Law Enforcement Examiner" this week complained that, even if the Lege passes a $100 per year healthcare fee to be taken from prisoners' commissary accounts, it's still an outrage for prisoners to receive medical care at all, writing:

Many Texas residents who are law abiding citizens would be very happy to pay $100.00 a year for healthcare for their children and themselves. These same people are probably asking themselves why convicted criminals are getting such a good deal and they aren't.

As it stands now, the Texas Constitution  only guarantees one group of people in the Lone Star State healthcare......prisoners.

One Wichita Falls man was appalled to discover that prisoners receive free health and dental care.

"Why do convicted murderers and other felons get better healthcare than those of us on the outside of prison walls?  A person has to make less than $434 a month in the state of Georgia where I just moved from to receive free healthcare. There's something wrong with this picture!"

Another  Wichita Falls man exclaimed in anger,  "The worst of it is we (the taxpayers) have to pay their (convicts) medical bills after they've committed some crime."

These are common, if utterly uninformed sentiments. For starters, TDCJ doesn't provide healthcare for prisoners' children. And contrary to Lane's claim, there's nothing in the Texas Constitution about prisoner healthcare, which is requirement derived from the 8th Amendment by federal courts. That's not just for inmates' benefit, but for everyone's. Prisons are breeding grounds for disease and most inmates eventually get out (more than 70,000 per year are released from Texas prisons), meaning untreated illnesses will inevitably be spread into the free world.

The $100 fee is not a particularly major change: Mostly it shifts costs from sicker inmates to healthier ones: It a) replaces a $3 per visit copay already in place and b) doesn't apply if the inmate has no money in their commissary account, which their families pay for, not them. The sickest inmates' families might pay more than $100 per year at $3 a pop, under the old system, while a younger, healthier inmate would not normally reach that threshold. But given what healthcare actually costs, these are small amounts.

If many people in Wichita Falls are "appalled" or "angry" that the state pays for inmate healthcare, the writer should have also added that those same people are "ignorant" and "foolish." Grits has mentioned before on this question that Christ taught compassion for sick prisoners is one of the criteria by which, eventually, the sheep will be separated from the goats; I'd always considered Wichita Falls a church-going town, but those quoted in this story all appear to fall in the latter category. Are Wichita Falls residents also "appalled" that inmates don't get paid for their labor? That's the only way it'd be possible for them to pay for their own healthcare.

In any event, as California is learning, the US Supreme Court has long said that if the state chooses to incarcerate someone - to restrict their liberty, in other words - they're liable for their health needs. Want to pay less for inmate healthcare? Lock up fewer people or stop holding them as long.

What a stupid column, particularly coming from an attorney. I suggest Mr. Lane contact Baylor University and demand his law school tuition back.