Let’s get prison healthcare out of the Intensive Care Unit

August 16, 2010

NOTE: John Laird and Sam Blakeslee are both candidates for the 15th State Senate District. CalCoastNews asked Laird and Blakeslee to give their opinions on the prison system in California. In a previous set of opinions, the two candidates gave their view on economic issues facing our community.

OPINION By John Laird

California’s prisons face many, many challenges. Overcrowding. Violence. Gutted rehabilitation programs. An aging, and unhealthy, inmate population.

And let’s be frank, spending more money—or worse yet wasting it—on our prisons and inmate healthcare during the current budget crisis and down economy is a bitter pill to swallow. Teachers are being laid off, children’s healthcare is being cut, public safety budgets are threatened, and maintenance in our state park system is a decade or more behind.

In 2005, a federal judge appointed a Receiver with broad authority over reforming California’s prison healthcare system. The Receiver found the system to be so inadequate that a life was being lost nearly every week in our prisons due to inadequate healthcare.

As bad as things are today, much improvement has actually happened in the last five years. Preventable deaths have been drastically reduced, which saves the state millions in litigation costs, and the healthcare system is evolving to become more efficient.

It is a painfully slow evolution. The prison healthcare system serves roughly 160,000 hardcore felons. Many of these inmates have a lived a life of drug and alcohol abuse or are in dire need of significant mental health treatment.

We need to have much more efficient chronic care for inmates with diabetes, hepatitis, HIV/AIDS and other afflictions that without proper ongoing treatment result in suffering and enormous hospital bills.  I’m pleased that the Receiver is working on exactly these issues.

And just like our local hospitals – and even in this Great Recession – hiring adequate nursing staff and doctors, particularly in some of the remote areas our prisons are located in, is a challenge.

The problems faced in the prison’s healthcare system are similar to the ones we face in regular society. Skyrocketing costs, lack of specialty care and a dwindling number of providers who will accept low state reimbursements.

The 2010-11 state budget cracked down on what outside hospitals and doctors can charge the state prison system for care. Because prisons are located in more rural areas with fewer healthcare resources – and because patients come in wearing orange jumpsuits and shackles, and are escorted by two correctional officers – negotiated fees were often much higher than standard charges. The reforms capped those charges, so California should see significantly less spending on outside inmate care.

As an aside to those reimbursement rates and the requirement for specialty care – cardiologists, neurologists and the like – many prisons end up transporting inmates hundreds of miles to receive care. If a local physician charges too much and has a full load of regular patients, a prison is forced to find other care.

To this end, the Receiver is instituting a medical classification system and a utilization management program to better manage these costs and address transporting.

Utilization management is basically a medical data collection system that scrutinizes what health issues the population of inmates has and matches it up with the amount of care being provided. This system, typically referred to as “UM,” helps manage quality and quantity, cutting costs. Many large HMO’s like Kaiser uses UM to control their costs. California’s prison system has just in the past year started to use this smart system of cost control.

Medical classification is a system that houses sicker inmates in need of more outside healthcare in prisons near large urban areas that have a much greater number of specialty care providers. This provides more competition for these services, driving the state’s costs lower.

These steps are not a cure-all, but they are a good start. We’re better off than we were five years ago.  But there’s a long way to go, and I continue to be concerned about fraud aimed at our prison system—it’s simply inexcusable. Those who commit it will surely find themselves on the receiving end of the prison system.

Prison reform, especially with regard to healthcare, is a key issue facing California during the ongoing budget crisis.  Having a strong understanding of this complex issue, and how it relates to the rest of the state budget, is one of many dividing lines between the candidates in this Special Election.  Election Day is this Tuesday.  Please remember to vote.

John Laird is a former Assemblymember, who represented the 27th Assembly District on the Central Coast. For more on John’s endorsements and key issues in the race, visit www.lairdforsenate.com.