By: David Chamberlain, Dan Clark, and Audra Lenczowski
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Objectives What rights do incarcerated persons have? What costs
are involved and who is responsible Medical care in correctional
facilities Possible Solutions and Closing
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Cruel and Unusual Punishment
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Department of Oregon Corrections 20112013 Budget
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Health Services : Medical, Dental, Mental Health and Pharmacy (
with reserves) 2011-13 legislatively Adopted Budget
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2011-13 legislatively Adopted Budget By Divisions
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Cost of Incarceration in Oregon Correctional System $82.48 per
inmate per day
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Oregon Department of Correction is responsible to provide
healthcare to over 14,000 prisoners across the State. Medical
issues that are seen range from: major to minor problems, acute
illnesses or injuries to ongoing care for chronic diseases,
preventative healthcare to end-of-life care Nurses engage in over
1000 patient care contacts each day in Oregon statewide
Physician/Family Nurse Practitioner/Physicians Assistant staff
provide more than 250 on-site appointments each day Medical
Care
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These inmates enter the system with a lower than average
educational level, lower than average income, and a higher level of
chronic disease and illnesses. It has also been reported that they
have had poor medical care 12% have respiratory or heart disease
18% have moderate to severe mental health problems 70% have drug
and alcohol problems Health care is provided at a cost per inmate
per month, which is lower than any other comparable insurance
including Oregon Health Plan. It is prioritized by medical
relevance in a ranking system. Medical Care
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Medically Mandatory- Level 1 Care that is essential to life and
health where surgical intervention outcome makes a significant
difference and has a high cost Examples are: Repair of deep open
neck wound, myocarditis, myocardial infarction, appendectomy for
appendicitis, maternity care Medical Care - Prioritized
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Presently Medically Necessary- Level 2 Care without which the
inmate could not be maintained without significant risk of either
further serious deterioration of the condition or significant
reduction of the chance of possible repair after release or without
significant pain or discomfort. Examples are: medical management of
insulin dependent Diabetes, pain management for hospice or end
stage diseases - AIDS, medical management of Asthma, hypertension,
immunizations, preventative care Medical Care - Prioritized
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Medically acceptable but not medically necessary- Level 3 Care
for non-fatal conditions where treatment may improve the quality of
life for the patient. Examples are: routine hernia repair,
treatment of non- cancerous skin lesions, corneal transplant for
cataract, and hip replacement Medical Care - Prioritized
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Limited Medical Value- Level 4 Care that is less likely to be
cost effective or to produce substantial long term gain. Examples
are: tattoo removal, minor nasal reconstruction, elective
circumcision, common cold, etc. Medical Care - Prioritized
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At intake all inmates are screened for mental illness, and
on-going evaluations and continue throughout their incarceration if
severe mental health problems arise. Mental illness inmates are
assigned mental health case managers who work closely with
psychiatrists and psychiatrist nurse practitioner in prescribing
the appropriate medications as needed Individual and group therapy
for severe and persistent mental illness Individual sessions are
short term and only for crisis situations Group therapy focus on
learning skills to manage mental illness within the institution and
in the community after prison discharge Mental Health Infirmaries
are available for short and long-term needs Mental Health
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7 out of 10 Oregon inmates need some type of mental health care
Oregon Corrections Department has added 525 beds for mental health
care since 2005 for a total of 900 which is more than the Oregon
State Hospital Mental illness is most prominent among prisoners
younger than 24 Women have a far higher rate of mental illness than
men The loss of mental health services in communities has turned
prison system into one of the states largest mental health
providers Mental Health
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Oregon is expected to spend more than $100 million in health
care in the next year, with about $16 million going to mental
health No psychiatrists will work for a prison in eastern Oregon so
health professionals have resorted to teleconferencing with inmates
Corrections officials elected to bring the most severely ill
inmates to the Willamette Valley, but where to put them SUPERMAX- a
high-security setting for the most dangerous offenders. In fall of
2011 they opened with a 187 bed Mental Health
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Mental Health Courts Only handle cases involving offenders with
mental disorders Special training has been given to the judge,
prosecutor, court staff, and defense attorney in community health
services Defendants can have their charges or jail sentences
deferred if they agree to participate in mental health services
such as: medication management, substance abuse treatment,
psychosocial rehab, and job training Found in four states
throughout the Country, Alaska, Washington, Indiana and Flordia.
Mental Health
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Automated Criminal Risk Score to identify offenders most like
to recidivate- In Oregon is considered a reconviction of a felony
within three years of release Age, time earned, sentence length,
revocation, number of prior incarcerations, prior theft convictions
and type of crime (person, property or statutory) Oregons rate fell
from 29.8% in 2005 releases to 27.5 % in 2008 releases which is an
8% decrease Reducing recidivism by 1% saves $4.3 million in annual
taxpayer and victims costs
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27 W. New Eng. L. Rev. 219 (2005) Criminal Law - Kosilek v.
Maloney: In Prison While Imprisoned in the Body of the Opposite
Sex: Examining the Issue of Cruel and Unusual Punishment Presented
by an Incarcerated Transsexual; Andreopoulos, Nikolas
http://www.youtube.com/watch?v=13UsU Sjv1TM Michelle Kosilek
http://www.google.com/imgres?imgurl=http://4.bp.blogspot.com/-HHbLsruEeXE/UEjLpJq3Y2I/AAAAAAAAcdw/wfgVvIejg-
I/s320/Michelle%2BKosilek.jpg&imgrefurl=http://transgriot.blogspot.com/2012/09/conflicted-about-kosilek-
case.html&h=306&w=265&sz=22&tbnid=QbX8_A73op0QIM:&tbnh=90&tbnw=78&zoom=1&usg=__v7BHd5lZmU1rwKGxsT
52ERlDsBY=&docid=6L5B-
zuf6t55BM&hl=en&sa=X&ei=0u8RUbKzMqTBigLp44GIDA&sqi=2&ved=0CFkQ9QEwBQ&dur=2534
Kidney Organ Transplant Horacio Alberto Reyes-Camarena (Special
Cases)
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Moral and Ethical issue Future Liability Issues Rising Cost of
Inmate Healthcare Relevant Problems and Issues
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Start SMALL How Do We Fix?
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Approximately 15% of inmates are incarcerated while addicted to
heroin The majority of US jails do not provide any medication for
opioid detoxification Muscle relaxers, sedatives, anti-nausea
medications Detox While Incarcerated
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Needle sharing and HIV Vomiting and diarrhea spreads disease
Fictitious symptoms and dangerous medications. Untreated inmates do
not look for treatment outside of incarceration. Untreated inmates
are at an extremely high risk of receding back to criminal behavior
after release. Why is it a Moral/Ethical Issue?
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the first time I kicked I had a heart attack. Well you start
(the withdrawal) the hot and cold sweats. And with the diarrhea,
stomach cramps and you throw up and you do that for like three days
straight or four days straight. And then you be has weak as I dont
know what. And when I had my heart attack I was sleeping and it
woke me up out of my sleep Luckily the officer recognized what was
going on and they rushed me to the hospital. And if they didnt I
probably would had died. Cruel and Unusual Punishment?
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The loss of tolerance after detoxification contributes to the
risk of fatal overdose after release. Washington State Prison
Survey (based on 30,000+ inmates) found that inmates have a death
rate 12.7 X the normal citizen in the first 2 weeks of release.
That rate significantly drops to 3.5 X the rate of a normal citizen
after 5 weeks of being released. Drug overdose was the leading
cause of death by far. Is it a Death Sentence/Liablity
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Naloxone Inmates who request could be trained on how to use the
antidote Naloxone and be given a prescription prior to release.
This has been used in several trials across the country since 1999
with great success. Really?! We are going to spend more money and
time training prisoners on how to stay alive, therefore increasing
the chances of spending more money to arrest them again? Possible
Solutions
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LAW ENFORCEMENT ASSISTED DIVERSION LEAD Best Solution Financial
and Moral
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Early 90s petty drug crimes represented 1/3 of felony cases and
tough sentences Early 2000 a Seattle public defense firm began
filing lawsuits on the police department involving racial disparity
which led to many cases being dismissed The result of lawsuits led
to the creation of LEAD Lead Beginnings
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New program in Seattle that has captured nation wide attention
Gives offenders (low level drug dealers and addicts) the choice
between rehab or jail time. Green light night Front line cops
decide who gets in Lead
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Is aimed at frequent flyers Offers a hot meal, a warm coat, a
safe place to sleep as well as long term services for drug
treatment, stable housing and job training Violent offenders or
larger dealers do not qualify Lead Facts
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Reduce number of low level drug offenders entering the system
Redirect public safety resources to more pressing priorities, such
as serious crime and violent crime Improve individual and community
quality of life through research based, public health-orientated
interventions Sustain funding for alternative interventions by
capturing and reinvesting criminal justice system savings Lead
Goals
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First time felony arrests cost the taxpayer between $3,000 to
$7,500 On average a 2 nd or 3 rd felony guilty plea will spend a
year in jail or prison time costing between $33,000 - $72,000 per
inmate Lives are being turned around and would be frequent flyers
are now becoming productive citizens Lives are being saved r/t
proper rehab and coping techniques taught by counselors resulting
in fewer overdoses. Lead Savings Dollars and Lives
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TThe cost of healthcare for an incarcerated individual can be
effectively controlled by examining the processes of the system. If
the funds are redirected to a preventative system that reduces
incarcerations it would result in a cheaper and more
favorable/moral outcome. The system must start small examining the
cause and cure for each disorder that appears often in incarcerated
healthcare. Conclusion
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As a result of LEAD, Seattle has also been addressing the
mental health concern with the Crisis Treatment Center. This center
provides a 24/7 drop off location for officers to drop of those in
lieu of booking. It does assessments, and referrals to services
rather than jail time. Conclusion Continued
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Also following the example of the LEAD program, Tarrant County
in Texas, has developed the Felony Alcohol Intervention Program.
This gives the opportunity to those found guilty of multiple DUIs
to receive treatment rather than jail time. It costs the county $3
a day rather than the $50 per day price tag of a prison bed. Texas
Follows Example
