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

August 16, 2010

John Laird

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.



  1. Army says:

    What has been put aside and forgotten, is that prison is a punishment. As a punishment, living conditions should be just this side of hell in a 6’x6′ cage. Got sick? Too bad, here’s some aspirin and cleaner blanket. Got AIDS while in prison? Sucks to be you, dead guy.

    Is my version of what prison should be too harsh? Easily remedied……………..Don’t break the law.

    (1) 3 Total Votes - 2 up - 1 down
  2. Saveslocounty says:

    This single issue appears like an overall diversion for a broken government system. Solving the financial bleeding within the prison system is just one tiny (albeitmanymillions of dollars) area where the precious financial resources are wasted. There is not one single state agency that is free from squandering the tax dollar when we need it most. Repairing ahealth care program that only serves 160,000 inmates in a huge system shouldn’t be beyond reach for an efficient legislature. But therein lies the real problem. It comes across all too trendy to release prisoners and reduce costs. But then, the burden would shift back to us in the community by an increase in crime. It is no coincidence that our crime rate plummetted with the implimentation of the three strikes law. But that is a different topic all together. In the meantime, cash is flowing out of Sacramento at a record pace on everything from rehiring retirees, 911 phones along the highways and new lavish public toilets throughout the state. Take 5% of the toilet reconstruction money and contract with McDonalds to allow public use. Problem solved and millions saved. But, we can’t stop there, the entire government service system needs a fresh look. For Laird to focus on this one issue shows a lack of depth. But, I am certainly happy to read his opinion. At least Blakeslee had actual numbers and a more global approach to fixing the state budget problems.

    (2) 2 Total Votes - 2 up - 0 down
  3. Califam says:

    All the $ goes to administration and staff,period.The 17,000 they say goes to “inmate” care is a joke,it all goes to staff costs,than a big 5 dollars,maybe,for one tylenol for the inmate.The taxpayers are getting bilked,the prisoners are getting bilked,and only administration is getting fat and happy on our dollars.Welcome to the Dept. of Corrections,the great California joke!

    (4) 4 Total Votes - 4 up - 0 down
  4. Vinny says:

    My brother in law is scheduled to retire this December from the Dept of Correction as a CCPOA member, less than 30 days after his 50th birthday. He will receive a $96,000 per year pension plus life time benefits. On the Monday following his friday retirement, he will report for duty to the same desk he has occupied for years, the only difference being he will be a Retired Annuitant and paid his previous sallary under a new classification – bringing his total yearly salary / pension compensation to $192,000.

    He has never, ever in his life stepped foot into a college classroom.

    There are hundreds, if not thousands, just like him.

    (9) 9 Total Votes - 9 up - 0 down
  5. mkaney says:

    The problem, Mr. Laird, is not an underfunded prison healthcare system. The problem is an overpopulated prison system. A huge number of prisoners shouldn’t even be behind bars (while plenty of crminals who SHOULD be walk freely). The United States has the largest prison population in the world, not just per capita, but total overall population, at almost 2.5 MILLION people.

    So though your heart may be in the right place, though I seriously doubt it (can anyone say union shill?), you are fine with allowing the status quo to go on and trying to provide more humanitarian services. You, and we, would be better served by politicians’ efforts to immediately change the laws and sentencing which got us here. Not only would you wind up with a lower overall prison population, but the criminals that would be in prison would be a much more despicable lot; which may lead you to have less desire to improve their healthcare. See how easy it is to save money? Get a backbone.

    (5) 11 Total Votes - 8 up - 3 down
    • marypress says:

      Had you been to one of the debates, you would have heard this exact issue addressed by Laird. This is a huge topic involving many issues. Laird is not the type of politician who shows up for a fundraiser for a few minutes and then stays in hiding. The reason he received the awards he did in the Monterey area was because of his willingness to talk to people and listen to the issues. Laird immediately set up an office here where he made himself available to the public, had meet and greet functions, and encouraged public forums.

      Rather than getting on a forum like this with constant sarcasm and talking about what or who he looks like, I think we would all be much better off in the job we do as voters to actually meet the politician and have conversation regarding what issues are important to you. Then you know where he stands and can agree or disagree. Most of the comments made here make it obvious that the effort to talk with Laird, or even listen to him, was never made.

      (-2) 6 Total Votes - 2 up - 4 down
      • racket says:


        Do you have a dog in this fight?

        Seems to me, you came to this board about the time Laird announced. Seems to me you post little other than support for Laird.

        Are you a shill for the Laird camp? Are you a union rep? Or am I paranoid, and you’re simply a regular joe who supports John Laird?

        (For my part, I am a disconnected right-leaning observer. No connections to either candidate, or any other issues of the day, simply expressing my opinions.)

        (1) 5 Total Votes - 3 up - 2 down
        • marypress says:

          I support Laird. I have nothing to do with Laird’s campaign or unions. I’ve never been in a position to be a member of a union. I am left-leaning and have decided that it is time to get involved and know who I am voting for. I do not support corporations taking over the decision of who we should elect because they happen to have the power of money on their side. I’m more worried about that than unions.

          (-6) 8 Total Votes - 1 up - 7 down
          • easymoney says:

            It is quite simple really, just look at their records and what they have actually done that is positive. Mr. Laird has a clear record of being a teacher and a politician beholding to unions, he also raised his own salary.
            Blakeslee has a positive record of actually running a business, being a proven leader and giving back to the voters.

            “(For my part, I am a disconnected right-leaning observer. No connections to either candidate, or any other issues of the day, simply expressing my opinions.)”
            And I am also from this same school of thought, question every politicain and look at their history, then I vote accordingly. I have no connections to either, but I am a taxpayer who will wind up paying for one or the other…

            (7) 7 Total Votes - 7 up - 0 down
          • racket says:


            Thank you for clearing that up.

            (1) 1 Total Votes - 1 up - 0 down
  6. Cindy says:

    I have to agree with Marerob, We need to clean up the corrupt system and those that are taking advantage of this unfortunate situation need to be held accountable. You can not incarcerate a human being and deny them “necessary” medical care. I do place the accent on “necessary”. We are also housing the mentally ill in prisons and they belong in a facility that is equipped to treat them rater than a prison that exacerbates their illness with isolation cells. Laird doesn’t have a grip on this problem on this problem and doesn’t seek to address the reason so many are incarcerated in this Country. I’m not crazy about Blakeslee either but I’ll address that on his opinion piece.

    BTW, Is it just me or does Laird kinda look like David Edge?

    (5) 7 Total Votes - 6 up - 1 down
    • racket says:

      Cindy, I think it’s just you … Laird looks less like David Edge, and more like a casting cut from the Muppets tryouts.

      I agree with the hard truth that when you incarcerate someone, you take away their ability to go get healthcare and therefore have some obligation to provide it. That’s the nut of the problem, and I do not have any real solutions, just the knee-jerk solutions that are fun to say but do not further any rational arguments.

      (2) 4 Total Votes - 3 up - 1 down
  7. Marerob says:

    I have read both this one and the one from the other canidate. I am saddened that both are not coming up with real solutions. Have either one of you gone inside and actually taken a look around? I have. There is a lot more too it then just cutting the budget and not sending inmates out for needed care. It involves more training for these doctors to start with. More than half of the inmates come from backgrounds where their families were either migrant workers or farmers. Instead of just putting inmates head on the chopping block maybe we need to take a look at why so many are sick in prison. Obama is a man before his time. He released a report called EDSTAC and reopened it to study the effects toxic chemicals and pesticides have on all of us. It is online and easily accessible. The endocrine system especially for men can affect all sorts of things including behavior. Releasing hormones also control our internal stop and go sign. We need to be looking at this from a different perspective. What if and how come should be questions the CA legislature should be asking. Inviting NORD the center for rare diseases and the NIH National Institutes of health to take a look at why so many are sick would be a good beginning. Inviting specialty doctors to come to the prison itself once a month to see many inmates at once to evaluate then recommend follow up tests for those that need it would eliminate the need for many hrs of guard escorts. Then only those who truly need to go out wouyld do so. Proper evaluation and care is a must! For one day these people might just be your next door neighbor. What kind of neighbor would you like to have living next door to your children? Figuring how the whys and how comes are just a beginning on how to fix this broken system.

    (1) 3 Total Votes - 2 up - 1 down
    • easymoney says:

      I tend to agree with mkaney on this one.
      Instead of crying wolf why not come up with some realistic solutions. Yeah the system is broken, we all know that.
      It is simple economics too many perps, not enough money, not enough prisons to house or treat the rising numbers of “guests”. Until the courts get their heads right and the three strikes law is amended to remove minor offenses from the heinous crimes so the crowding is reduced, this will only get worse. And until the SOP under which perps are handled for even minor illness or trauma is changed we will continue to see this increase in costs.
      It is long over due for a change in our courts, prisons and the way perps are handled. You can’t have it both ways, either reduce the numbers of minor offenders or increase the number of prisons, guards and doctors. Time to step up, emotional reactions are just a waste of time…

      (4) 4 Total Votes - 4 up - 0 down

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