Prison Affliction: A Reporting Series on Prison Health Care in CA

Today, KPCC broadcasted the first in a series of reports by Julie Small on the California health care system. Examining the changes and improvements to the system, Small finds mixed results. Among her discoveries:

  • While the overall number of deaths of inmates decreased, the number of inmates whose deaths might have been prevented with better care actually increased.
  • Independent reviews of medical facilities conducted by California’s inspector general for prisons reveal that California’s prisons routinely violate medical policies and protocols, leading to delays and denials of treatment for inmates.
  • California officials’ repeated refusal to fund the receiver’s turnaround plan has delayed construction of sanitary medical facilities, computerization of health records and hiring independent executives to oversee medical care at prisons.
  • The lack of infrastructure improvements and systemic change contributes to lapses in care for inmates that range from dangerous to deadly.

The presentation comes accompanied by a slideshow, but the images represent the situation a few years ago.

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props to my colleague Gail Silverstein for the link.

State Appeal to Terminate Receivership Denied

In a recent decision from April 30 that received surprisingly low coverage, the Ninth Circuit dismissed the State’s appeal to terminate Clark Kelso’s receivership of the prison health care system.

The state’s arguments targeted the District Court’s jurisdiction in appointing the receiver, as well as the receivership itself not being the “least intrusive” measure and the receiver’s construction plans.

In reviewing the District Court’s decision de novo, the Circuit Court found that the Prison Law Reform Act did not bar the appointment of a receiver. Moreover, given the horrifying standards of medical care, the receivership was the least intrusive measure, and the state did not oppose it at the time of the receiver’s appointment. In addition, the state’s inability to comply with its own plans necessitated external intervention.

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Props to Aaron Rappaport, as well as to Shaun Martin over at the California Appellate Report.

Receiver Advocates Medical Parole

Clark Kelso encourages voters to endorse medical parole for chronically ill inmates as a measure for significantly reducing expenditures on the prison health system. This morning’s Sac Bee reports:

“I am keenly aware, as are the courts,” Kelso said, “that a dollar that we can save in the prison health care program is a dollar that can be spent on other important priorities for the state, such as education, money for children, the elderly, other health care programs.”

An aide in Kelso’s office said that, conservatively, the prison system could save $213 million over five years by paroling just 32 inmates identified as severely incapacitated.

Twenty-one of those 32 inmates are in nursing facilities or hospitals outside prisons, which requires spending for expensive guard time – including overtime – as well as huge health care costs.

These 21 inmates’ average annual health care and guard costs total more than $1.97 million apiece – a total of $41.4 million a year for 21 individuals, said Kelso aide Luis Patiño.

The bill was introduced by Mark Leno. Interestingly, the bill would do something else that reverses a 40-year trend: it would give parole boards some of their power and discretion back. Medical releases would depend on a parole board determination that the inmate no longer poses a danger to society due to his or her medical condition.

As I told my students last week, one of the most significant implications of the shift from indeterminate to determinate sentencing was a shift in power within the system. The most noticeable effect of this change was the transfer of power from judges to prosecutors and legislators; determinate sentencing “locked” the defendants into a sentence based on the charge, and therefore awarded prosecutors a powerful bargaining chip in deciding which offense to charge. However, these changes were accompanied by “truth in sentencing” laws, requiring that inmates serve the majority of their sentence, stripping the parole board from its previously immense power to assess rehabilitation and risk.

It seems that the new proposal would reinfuse parole boards with some of that discretion, but keep it within reasonable boundaries. The concern about disparities and inconsistent criteria for release is significantly narrowed when the parole board has to hear evidence from doctors about the extent to which a certain inmate might be incapacitated due to his or her illness. This seems to be a not-unreasonable assessment, especially since much of the argument against early releases has to do with the concern about putting violent, dangerous people back on the streets. If someone’s illness renders him or her non-dangerous, the only argument remaining for keeping them behind bars is retribution. And the question is whether we can afford pure retribution, as things stand today.

Schwarzenegger Proposes UC Oversight over Prison Health System

The L.A. Times reports:

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.

Thoughts?

New Bill introduced: Pregnant Inmates and Wards’ Conditions

Assembly Bill 1900, authored by Assemblymember Nancy Skinner, advocates for special standards of care for pregnant inmates and wards.

There has been some attention to the particular circumstances of pregnancy within bars. This 2006 NYT article exposes some of the less pleasant aspects of care: women in labor kept in shackles, given no more than Tylenol, supposedly out of concerns of escape (though there aren’t any known cases of women in labor escaping. Pregnant inmates experience particular challenges during their incarceration. High rates of drug abuse and addiction complicate medical treatment (also see here). In addition, pregnant inmates report traumatic family histories and require more assistance and support during their pregnancy. A 1997 study suggests that adequate shelter and nutritional support make a big difference in terms of birth outcomes among inmates.
The proposed bill would amend the CA Penal Code to require the usage of the least intrusive methods (consistent with public safety concerns) for restricting pregnant inmates or wards during transportation and incarceration. It also requires monitoring other conditions, such as offering nutritional support and counseling about pregnancy, birth, and childcare options. The Corrections Standards Authority would assume responsibility for the particulars and would consult with a variety of professionals before setting them. Some prohibited measures are listed in the bill (though it is not an exhaustive list): shackling the feet and hands, shackling across the body, or shackling to another inmate.
The bill comes before the Assembly’s Public Safety Committee on March 30.
On a related topic, here’s an interesting blog post from Feministing about inmates’ access to abortion.
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Props to Ocean Mottley for alerting me to this.

BREAKING NEWS: SCOTUS Dismisses Appeal in Plata/Coleman

This morning, the Supreme Court refused to grant cert in the Plata/Coleman case. SCOTUSblog reports:

The Court ruled that it had no jurisdiction, at this point, to review a lower federal court’s order that would require the state of California to release upwards of 40,000 inmates from its state prisons to ease overcrowding that the lower court blamed for inadequate medical care in the 33 prisons. The Court noted, in a brief order, that a new order has been issued in the case, “but that order is not the subject” of the present challenge. It also took note of the fact that the latest lower court order has been blocked pending “review by this Court” — an indication that the Court expects the state to file a fresh new appeal to challenge the order now in effect, issued earlier this month. Lawyers for state officials have said they would promptly file a new appeal. (The cases are Schwarzenegger v. Plata, 09-416, and California Republican Legislators v. Plata, 09-553).

What this means, in a nutshell, is that the new order issued by the court in October, prompted by the state’s noncompliance with the original August 4 order, is now in effect. Since the Supreme Court has been asked, by the state, to review the previous order, it has no jurisdiction now that the previous order has been vacated.

Is this merely a technical issue, which will be sorted out once the state submits an appeal regarding the new order (have no doubt that they will), or does this mean that the Court is signaling its unwillingness to deal with the issue altogether? That’s anyone’s guess. I may be reading too much into this, but it seems to me that SCOTUS is not excited about the prospect of digging into the California issue. In any case, at least for now, population reduction is to go on as scheduled.

Plata/Coleman Missing from List of Certs

What happened today at the Supreme Court? It’s a bit shrouded in mystery. SCOTUS Blog reports on the five cases in which cert was granted. Plata/Coleman is missing from the list.

The folks at Crime and Consequences opine:
We’ll have to wait and see whether the Governator’s case is denied or relisted. There have been further developments in the lower court, and the appellant just filed a second supplemental brief yesterday, so possibly they took it off the calendar to give the opposing party a chance to respond.

We will follow up and keep you posted.

A Personal Perspective on Prison Healthcare

Some readers may recall the excellent posts that appeared in the SF Bay Guardian politics blog for a while, authored by an unnamed inmate in a CA facility. Now released from prison (congratulations, and welcome back!) Just A Guy continues to post about his experiences.

His recent post in the Guardian criticizes Governor Schwarzenegger for the decision to appeal the Plata/Coleman ruling.

Don’t Arnold and the state government see this isn’t about just health care for inmates, but also about rational laws, rational sentencing, and treating human beings with dignity and respect? I know the majority of the public would rather bury its head in the sand than face this issue, but this issue is in your living rooms, in your classrooms, and on your streets. It isn’t just the gang-banging jerk from the hood that’s being thrown in jail for ridiculous amounts of time in California — it’s also middle class addicts, college students etc … It’s your neighbors, your friends’ kids, and your kids that are all affected by this insanity.