The provision of health care in prisons has mushroomed into a large, often ignored, global issue of concern. While prisoners are secured behind high fences wired with electronic sensors and cameras or brick or stone barriers, locked doors and barred windows, and cells encased in thick concrete, the probability of developing an illness or disease while incarcerated is quite high. Prison overcrowding, a universal problem, is an instant recipe for spread of disease both within the confines of the prison as well as to the outside population. For example, in New York City in 1989, an outbreak of multidrug-resistant tuberculosis (MDR-TB) was later linked to prisons that had given inadequate treatment. Indeed, the public health implications of the provision of inadequate health and medical care in prisons are potentially serious; inmates released back to the community more often than not have communicable diseases such as TB, HIV/AIDS, and hepatitis C that could be spread to the general population.

The spectrum of health problems in correctional facilities is significant. Inmate health and medical conditions range the gamut from minor (colds or viruses) to the significant (HIV/AIDS and TB). In addition to the communicable diseases, the prevalence of mental health and psychiatric diseases and substance abuse is higher among the prison population than the general population. The scope of this chapter is to provide an overview of the state of health among prisoners, to assess the provision of health care to those incarcerated, to examine the policies regulating care of prisoners including the challenges governments face in their ability to provide health and medical care to inmates, and to discuss the pros and cons of having the private sector (privatization) involved in prison health care delivery.

Problems persist in prison health care system
The poor conditions in California state prisons have come under intense scrutiny the past few years. In fact, a federal receiver had to be appointed to make sure that health care for inmates improves to meet even the minimal standards. But, the problems persist.

Teddie Rowe is 48 years old. Doctors have given him just weeks, perhaps days, to live.

“There’s times I’m afraid to go to sleep because I don’t know if I’m going to wake up,” Rowe said.

Rowe’s heart is operating at just 14 percent. He has a Comfort Pak in the fridge for when the pain gets to be too much.

Rowe: “And it’s got stuff in it to make my dying a little more easier.”
Dan Noyes: “Is it to make it easier or to speed it, as well?”
Rowe: “Both.”

Prison activists point to Rowe as a prime example of the lack of health care behind bars.

“Access to care, access to medications in the prison system is very poor,” Prison Law Office spokesperson Don Specter said.

Berkeley’s Prison Law Office filed a class action lawsuit, Plata v. Schwarzenegger. It is on appeal to the U.S. Supreme Court; a ruling is expected in June. But, a lower court found that the system is broken beyond repair and cited overcrowding as the primary reason.

“There are too many people in too small a space with not enough staff to provide adequate medical care to everyone, and as a result, many prisoners fall through the cracks,” Specter said.

That appears to be what happened to Rowe. He served the bulk of a 10 year sentence at Mule Creek State Prison in Amador County.

Designed to handle 1,700 inmates, it is packed with 3,769.

Rowe lived in what was supposed to be temporary housing - a gymnasium with inmates stacked on bunks three-high.

Rowe: “There’s lights on all the time.”
Dan Noyes: “Even at night?”
Rowe: “Even at night.”

Before he went to prison, Rowe stayed in relatively good shape. He kept his diabetes in check with a proper diet and exercise. But, he could not get a special diet for diabetes in prison and he says it was difficult to get his medication.

“And to get your insulin shot or your pills, you had to stand in line for hour, hour and a half in the rain, if it was raining,” Rowe said.

Failure to treat chronic diseases such as diabetes is a central problem cited by a recent inspector general’s audit of 17 California prisons. It found “nearly all prisons were ineffective at ensuring that inmates receive their medications” and “the second recurring problem…was poor access to medical providers and services.”

The warden at Mule Creek, the secretary of the Department of Corrections and Rehabilitation and the federal receiver for prison health all declined to be interviewed. A spokesperson for the receiver told the I-Team they are making progress, but “it’s like turning a battleship.”

Long-time family friends like Lettie May Baker watched Rowe’s health deteriorate while he was in prison.

Dan Noyes: “What was the change like?”
Baker: “White to dark. We can’t get through to anyone’s thick head that these inmates are human beings and they’re dying.”

Adding to his problems, Rowe contracted a highly-contagious bacterial infection in prison, methicillin-resistant staphylococcusaureus or MRSA. It almost killed him, after he left Mule Creek in 2007.

“I was hospitalized with gangrene of the groin caused by MRSA and was in a coma and my family was told I had a 50-50 chance of surviving,” Rowe said.

There is another twist to Rowe’s story. He went to prison for child molestation. He claims, and members of a Sacramento-area church confirm, that his accusers came there last year, after he served all that time, to recant their story.

Dan Noyes: “I have got to ask you point blank, did you ever touch a child in a sexual way?”
Rowe: “No.”
Dan Noyes: “Any child?”
Rowe: “No.”

Rowe says prosecutors told him he faced 45 years to life in prison if he went to trial, so agreeing to a 10-year sentence seemed like the only choice.

“There was no evidence, there was no DNA, there was nothing to prove he should have gone to prison,” prison rights activist Cayenne Bird said.

Bird says with such poor health care, any prison sentence can become a death sentence.

“Teddy didn’t have a death sentence, but it certainly turned into one for him,” Bird said.

The I-Team tried to reach Rowe’s accusers and their family members in Southern California, but were unable to.

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Madelon L. Finkel, PhD
Madelon L. Finkel, PhD, is professor of clinical public health and director of the Office of Global Health Education at the Weill Cornell Medical College in New York City, NY. Dr Finkel is an epidemiologist whose work focuses on women’s health issues. Her interests also include global public health issues with ongoing research projects in rural India and Peru. Dr. Finkel has published extensively, including Praeger’s Understanding the Mammography Controversy: Science, Politics, and Breast Cancer Screening and Truth, Lies, and Public Health: How We Are Affected When Science and Politics Collide.

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REFERENCES

1. Walmsley R. World prison population list. 7th ed.
2. Wikipedia. Prisoner population rate 2007-2008.
3. Mauer M. Comparative international rates of incarceration: an examination of causes and trends: Presented to the US Commission on Civil Rights; June 20, 2003; Washington, DC.
4. US Department of Justice, Bureau of Justice Statistics, Office of Justice Programs. Correction statistics.
5. Ibid.
6. Federal Bureau of Investigation. FBI uniform crime report.
7. Maruschak LM for US Department of Justice, Bureau of Justice Statistics, Office of Justice Programs. Medical problems of prisoners.
8. Griefinger RB, Heywood NJ, Glaser JB. Tuberculosis in prison: balancing justice and public health. J Law Med Ethics. 1993;21:332-341.
9. World Health Organization. Tuberculosis in prisons.
10. Shalit M, Lewin MR. Medical care of prisoners in the USA. Lancet. 2004;364:34-35.

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