Dayton
Daily News...
Health care for
prisoners costs Ohio more than $200M annually
By Laura A. Bischoff, Columbus Bureau
Sunday, May 15, 2011
COLUMBUS — In the last 10 months, just six patients at the Ohio State
University Medical Center ran up more than $3.9 million in hospital
charges — all billed to state taxpayers.
Each one suffered from conditions such as cancer, heart failure and
pulmonary disease that could have killed them without 24-hour medical
care.
And each one has something else in common beyond their free medical
care and potentially fatal conditions. They all are Ohio Department of
Rehabilitation and Correction inmates, some shackled to their hospital
beds and watched by armed guards.
Ohio’s prison system spends $222.8 million a year on medical care for
its approximately 51,000 inmates, including $28 million for
prescription medications.
Each week, a high-cost case summary comes to Medical Services Chief
Stuart Hudson. He watches it closely, mindful that any of these cases
could become “million-dollar inmates” who could swing his budget out of
whack.
They are being treated for serious conditions such as hepatitis C,
renal failure, quadraplegia from gunshot wounds, liver cancer, bone
marrow transplants, brain tumors, sickle cell anemia, abdominal aortic
aneurysms and gangrene.
One inmate was admitted Nov. 29 for surgery to reverse an ileostomy — a
surgery done when there is a problem processing intestinal waste — but
he developed post-op complications and required a ventilator and
trachea tube. The prisoner’s hospital stay at OSU’s locked prison ward
extended for months and ran up charges of $802,827. DRC typically pays
25 percent of the billed charges.
On April 27, a court granted a judicial release for the inmate and he
was discharged to a hospital, DRC officials said.
As in the private sector, health care costs have exploded in the prison
system over the last decade. Last year’s average of $4,371 per inmate
was an 85 percent increase over the $2,365 per inmate cost in 2001.
But Ohio is in the middle of the pack among state prison systems:
California pays $14,012 per inmate while Texas gets by on $2,733,
according to a report by the Correctional Institution Inspection
Committee.
The Kaiser Family Foundation has estimated that the average annual
health care cost for Ohioans is $5,725, which comes to about $1,400
more than the average for Ohioans in prison.
The steady climb in Ohio’s prison medical costs is attributable to
health care inflation, an aging inmate population and a federal class
action lawsuit filed by state inmates in 2003 and settled in 2005.
Attorneys for the inmates argued that Ohio’s failure to provide
adequate health care amounted to cruel and unusual punishment.
Prisoners are the only Ohioans who are constitutionally guaranteed
health care.
“Conditions were absolutely deplorable. In 2003 when we filed (the
federal lawsuit), there was no question in our minds that the level of
care was so inadequate as to be unconstitutional,” said attorney David
Singleton of the Ohio Justice Policy Center. “And just so we’re clear
about that, you don’t have to do much to satisfy the constitution. It’s
not Cadillac care by any stretch of the imagination. And what we found
was woefully inadequate. Folks were not getting emergency situations
treated. If you had a chronic disease — good luck getting an
appointment to deal with that. There were instances where prisoners
were literally dying as the result of the lack of care.”
The settlement led to the hiring of 310 more medical staff and spending
an additional $28 million a year on health care, according to the
Correctional Institution Inspection Committee, a bipartisan legislative
agency that keeps tabs on prison issues.
Singleton recognizes that some taxpayers may object to spending so much
money on inmate medical care. But aside from the constitutional
requirement, Singleton said preventative care makes good fiscal sense —
addressing chronic diseases before they get very costly to treat.
Likewise, he said, it is good public health policy to treat inmates
with infectious diseases before releasing them to the community.
Eventually virtually all prison inmates — about 98 percent, Singleton
said — get released from prison.
Managing chronic diseases
Robert Frost, 46, of Dayton is somewhat of an expert on the prison
health care system. After all, he’s been an inmate at the Southern Ohio
Correctional Facility in Lucasville for 18 of the last 20 years.
Frost, wearing a bright orange jump suit and foot shackles as he
prepared for a CT-scan at the Corrections Medical Center, said, “I
think it’s a little better, given what it used to be. They act on
serious matters a little quicker than they used to.”
He first complained about a testicular problem about three months ago
and by early May he was getting a scan.
“They want to find out if this is cancer or not so they got right on
it,” said Frost, who was sentenced to 15 years to life for stabbing a
man to death in a Dayton alley.
Also suffering from high blood pressure, Frost is one of the more than
18,000 inmates enrolled in a chronic disease management program
designed to cut costs and prevent problems. Staff now checks him
regularly and makes sure he is taking his medications. “They didn’t
used to do that,” he said.
The prison system introduced heart-healthy menus in the cafeterias in
2007 and banned tobacco use beginning in 2008.
But despite the progress toward meeting the constitutional mandate, the
state still has room for improvement, according to Fred Cohen, an
independent monitor hired by the federal court. Cohen identified a
number of lingering problems, including salaries that he said are
inadequate, and a need for more staff doctors and nurses. He also said
there is a persistent backlog of chronic disease appointments, and a
lack of accountability for the care provided by medical vendors.
DRC recently replaced five civil service advanced level providers —
doctors, nurses and physician assistants — because of poor performance,
including a doctor assigned part-time to a state prison in West Dayton.
The physician’s medical charts were hurried, chaotic and in
“indecipherable handwriting,” she exhibited inappropriate anger, had a
history of poor interpersonal skills, often called in sick and failed
to order labs on a timely basis, according to a monitoring report
issued in September. The report did not include the full name for the
physician, who no longer works for DRC, according to prison officials.
DRC is switching from contract doctors to state-employed physicians so
that the department has more control over the quality and cost of care,
said Hudson, the Medical Services chief. About 70 percent of prison
doctors are state workers.
Cohen’s latest report to the court detailed problems but noted, “With
few exceptions ... there exists a system of medical care that provides
access for inmates to appropriate bed space and clinicians.”
An expansive system
The state prison medical system is both expensive and expansive. Each
year, it provides 6,000 video consults, dispenses 1.4 million
prescriptions, manages 18,300 inmates with chronic conditions such as
diabetes, asthma, hepatitis and heart disease, covers 2,250 local
emergency room visits, runs a hospital lab that processes 3.5 million
tests, and tends to 309 broken jaws and 260 broken hands — usually the
result of prisoners fighting.
The money to run it isn’t just for doctors, nurses, MRIs and lab tests.
Each day DRC guards shuttle inmates to emergency rooms, the Corrections
Medical Center, the Frazier Health Center (housed within the Pickaway
Correctional Institution at Orient) and the OSU Medical Center. Two or
three guards are typically required for each high-security inmate.
Corrections Officer Cassandra James has seen it all while guarding
inmates at OSU Medical Center: babies being born, limbs being
amputated, open heart surgery. Guards like James escort inmates to
surgery, wearing sterile coveralls and sidearms.
“We get to see all that stuff without having to go to medical school,”
the Dayton native said while posted outside a hospital room with four
men shackled to the beds. “Sometimes it can be sad ... but then you
have to shake it off.”
The Frazier Health Center houses DRC’s kidney dialysis center — the
state’s largest with 28 chairs. The center operates two shifts a day,
seven days a week.
As a reporter and photographer watched earlier this month, inmate
Taywyn Mason sat in a vinyl-covered reclining chair as his blood was
drained out, mechanically filtered and returned to his body. The veins
along his left forearm bulged out in two places, as though small
balloons were lurking below his skin — the result of 17 years of kidney
dialysis, three times a week for four hours at a pop.
Mason, who is serving a 15-year sentence for robbery and kidnapping,
said the new dialysis center is a big improvement over DRC’s older and
now-closed facility at Orient Correctional Institution, which was so
untidy Mason said he was afraid to use the bathroom.
The new center, on the other hand, gleams like a shiny, new penny. The
room is open, brightly painted and the windows overlook farmland and
prison grounds. It smells of vinegar —a primary component in the
cleaning solution used on the $13,000 dialysis machines.
Many of the staff caring for the inmates prefer not to know their
patients’ crimes.
“They’re all patients, regardless of their crimes,” said Missy Roush,
nurse supervisor at Frazier. She started in corrections health care 13
years ago as a single mom needing a stable job. “If one of my kids —
God forbid — were to end up in prison, I wouldn’t want them to be
treated bad,” she said.
Terry Harris, Pickaway Correctional’s acting Medical Operations
manager, said she felt a calling from God to work in corrections health
care after watching the 1993 Lucasville prison riots on TV. She said
she never feels conflicted about caring for criminals.
“They are patients to us, not inmates,” Harris said. “We are going to
take care of these guys. That’s the right thing to do.”
There could soon be less money to provide that care.
State lawmakers are now debating the upcoming two-year budget, which
calls for an 18.4 percent cut to prison medical services between 2011
and 2013. If adopted as is, the state would trim the medical services
budget from $239.1 million this year to $209.2 million in 2012 and
$195.2 million in 2013.
“We are hoping it is not going to undo the progress. We’re going to be
watching that very carefully. If it undoes the progress to the point
that care is unconstitutional, we’ll be back in court,” said Singleton.
“I don’t think it’s going to improve care. I can pretty much say that.
But whether it makes the system unconstitutional, we’ll have to wait
and see.”
Prison system officials have taken other steps to control medical
costs. Ohio uses a managed care contractor to review hospital stay
bills to see if the state is overpaying and keep tabs on hospitalized
inmates to make sure they’re discharged and returned to state care as
soon as possible. The contractor, Permedion, is paid $1 million a year
but state officials estimate $24 million a year in costs are avoided.
The state is also renegotiating its contract with Ohio State University
Medical Center, which currently costs about $65 million a year, or
about a third of the entire prison health care budget.
Reducing care not an option
DRC occasionally seeks court permission to release inmates with
significant or terminal medical conditions. Since late 2006, the
Corrections Medical Center has had 35 medical judicial releases and is
requesting six more.
But state law and DRC policy bars medical release for anyone serving a
death sentence or life without parole or a sentence for murder or was
convicted as a violent sexual predator.
On the second floor of the Corrections Medical Center, in rooms off of
the dimly lit hallway, is the end of the line for bedridden and
wheelchair bound inmates, many of whom are not eligible for a medical
release and are too infirm to live in the general prison population.
“Nurse?” a reedy voice calls out. “I need a nurse.”
The smell of a soiled bed is unmistakable.
A few doors down, a man speaks to his roommate through a trachea with a
robotic computerized voice.
Across the hall from him, a scrawny, wizened old man is so frail that
he needs help putting on a jacket. His roommate sits in a wheelchair,
staring at the concrete block wall.
In their younger years, these men killed, raped and preyed on others.
But these days they are debilitated by illness, injury and old age and
are living out their final days in what is essentially an acute-care
nursing home within the state prison system.
“This is the realization of why we are spending so much on medical
care. You come here and see the gravity of it. We have a lot of sick
inmates. That is the bottom line,” Hudson said. “Even though they’re in
the physical or mental state that they’re in, we can’t release them by
law. We have no other option other than to care for them.”
Read it at the Dayton Daily News
|
