A new post by Minette, a well know blogger who focuses on the problems of incarceration.
Sometimes jail is worse than prison. In my interview with Benny who was living in a sober living house in Florida in 2016, he told me when he was transferred to state prison in Illinois after spending 8 months in Cook County Jail 11 years ago, he just laughed when he got to prison because the jail was so terrible and prison was a cakewalk in comparison. While he was in jail, he believes there were 6 stabbing deaths. He was in his 40s when he went to prison the first time. He had a felony conviction when he was in his 20s, but only got probation. Twenty years later, when he got in trouble again, he was sent to prison in part because of that earlier felony. In between, he had his own construction business, got married (like many people, more than once), and had kids. Although he had a 3 year sentence for drunk driving and possession of a gun as a felon, he was only in the state prison for 3 and a half months. The previous 8 months in jail and credit for good behavior, allowed him to leave on parole quickly. Several interviewees reported that if you are in for less than a year, there is no effort given to enrolling you in a class for anything or forcing you to work. So he didn’t do much while he was in prison.
As an aside, a 60 Minutes segment on television in August, 2017, highlighted Cook County Sheriff, Tom Dart’s efforts to make life behind bars more productive. “Dart says the jail — with a population today of about 7,500 — has become a dumping ground for the poor and mentally ill. For most inmates, Dart says, the biggest problem is they simply don’t have enough money to make bail. As a result, inmates often spend their entire prison term in the Cook County Jail — sometimes more time than their sentence.
Dart has instituted programs to give inmates tangible skills. These programs include culinary skills, photography classes and other programs to help inmates change the way they view the world, and provide them with employment skills. But these improvements came long after Benny left the jail.
Sheriff Tom Dart
As a further aside, in 2018, California changed it’s law to eliminate cash bail so situations like Sheriff Dart referenced don’t happen. Judges can use their discretion about either keeping people incarcerated or allowing them to remain free as they wait for their court date. The freedom minimizes the impact on families and people’s ability to earn a living while they wait for their day in court. Other states, like New Jersey have significantly reduced the use of bail as well. This saves taxpayers significant money as well.
A parole violation put Benny back in prison a year and a half later and he stayed more than a year. He got sober again, and chaired AA meetings, which he said saved his life. His worse day in prison was when the medical services unit refused to give him his anxiety medication. He had been on it for a while, but they thought he might be selling it to other inmates so they stopped giving it to him. This made him feel like he was going crazy.
Opinions on medical services in prison were mixed. They consistently reported there was a cost of approximately $5 to see the nurse which came out of the prisoner’s commissary account. Given that prisoners make so little money per hour, $5 is a lot of money! Prisoners who did not have the money are still charged, and eventually either their commissary account will be charged when the balance is substantial enough or they will receive less when they leave prison. There were limitations on the medicine provided for pain relief. It appeared only Tylenol or aspirin were available. This may be policy because so many residents have addictions or to reduce the possibility of the pills being sold among the prisoners.
To avoid prisoners selling their “mind altering” drugs to other inmates, prisons have a pill line. Once they got a prescription for medication, the recipient went to the pill line when they were supposed to take the medication, when they got to the head of the line, they got their pill, a cup of water, and stood in front of a correctional officer; they drank the water, took the pill, and then showed the officer the pill was not in their mouth any more. If the inmate had a chronic condition that required daily pills that were not “mind altering”, they would be given a longer supply that they could take by themselves, e.g. cholesterol and high blood pressure drugs or diabetes medication.
The Pew Charitable Trust reported in October 2017, that in 2015, the average state spent over $8 billion dollars a year for medical care for their prisoners. By state it ranged from a little over $2000 per inmate in Louisiana to close to $20,000 in California. The highest costs are related to staff and prescriptions. But states use different measurements as to the cost and quality of the services they provide so it is hard to compare.
There are higher levels of mental health issues, drug addictions, HIV, and Hepatitis C in prison than in the outside world. Many chronic diseases, like asthma, hypertension and arthritis are also more prevalent in the pressured, very close quartered, prison environment. Despite the stereotype of buff prisoners, the Pew Report asserted in 2011-2012, almost three quarters of prisoners were significantly overweight, leading to more health issues. And the prison population is aging. From 1999 to 2015, partly as a result of mandatory life sentences that started in 1994, the number of people age 55 or older in state and federal prisons increased 264 percent, rising to 11% of the population. Medical costs are going to continue to rise.
Given most prisons are in isolated areas, hiring qualified medical staff is likely difficult. Many of the medical services are contracted with outside providers, such as Corizon Healthcare. Arizona uses Corizon. In 2014 there was a class action law suit settled against the state related to the inadequate health care provided to inmates by Corizon. Three years later, there are hearings about the state’s inability to carry out improvements promised under the settlement of that lawsuit and the possibility that there was retaliation against participating inmates. As of 2018, the case is ongoing. Corizon is a defendant in many lawsuits across the country. Unfortunately, lawsuits are the only available redress for inmates. They can’t choose to switch doctors.
Many of Corizon’s contracts with state prison authorities are fee based on average daily population. Prolonged stays in the hospital take a chunk of their revenue. There have been many lawsuits regarding Corizon delaying or not allowing inmates to go to the hospital, or requiring convicts to leave the hospital before the doctor treating the patient at the hospital considers the inmate ready to be moved.
One interviewee who had been to 11 different prisons in Florida from the time he was 17 to when he was interviewed at age 53, said health services used to be very good, but not anymore. Interviewees who went to both State and Federal prisons reported the state prisons had lousy medical care but the Federal prison was pretty good. The Federal bureau of prisons health care management guide is available on line.
The interviewees differed on their assessment of the healthcare they received. Some found they got adequate and timely care, but Benny said he broke his foot and they did nothing for over a month. Another ex-offender I interviewed, David said he had an infected tooth and it took a month to get a dentist to treat it. In most cases, rather than providing extensive dental services, the prison’s solution is to just pull the tooth.
Several women interviewed in Arizona, had various medical procedures shortly after their release because they could not get the services while they were in prison. One had an operation once she was able to get state Medicaid. She had an infected ovarian cyst. Another found she had breast cancer.
Another interviewee who served in both Federal and State prisons indicated there are similarities in the prison world and the outside world. Sometimes the medical services and the administrative services you get depends on who you know. This woman had a job cleaning the warden’s office and other administrators’ offices when she served 11 years in Federal prison. Because she was there so long, her relationship with the people who ran the prison was friendly and trustful. She was treated like a person. When she got breast cancer, she felt she got very good care quickly. In her subsequent year or so in State prison (she had concurrent sentences with a bit of an overlap with the state), she didn’t need any health care, but could see it was not as good as the Federal program.
One person indicated that if the prison was prodded by family outside the prison to get their loved one some medical attention, the process seemed to be expedited. This comment is supported by a website I found called inmateaid.com. There are questions and answers there about many aspects of prison life. In regard to the question of medical services, it indicated that if someone from the outside requests medical or other help they should be humble in their approach rather than adopting a demanding tone. You can identify the case manager and start with that person. If that doesn’t work, try the chaplain, then assistant warden. As the prison residents are well aware, prison management doesn’t take kindly to being bullied, they are used to being in charge. So, treat with respect and deference.