Many in this country have by now heard about the most recent case of a California inmate successfully suing that state for a sex change, setting taxpayers back about $100,000.
A federal judge ruled in favor of the inmate, stating that under the 8th Amendment within the United States Constitution, any denial of treatment “violates her rights to adequate medical care.
On the surface, this may seem absurd: a man, who committed a crime and was sentenced to spend time in jail, can receive funds to undergo a complete sex change.
But believe it or not, if the person who is imprisoned can prove that the services to be rendered to them are behavioral, then that person is protected by the 8th Amendment, which states that “no cruel and unusual punishment can be inflicted.”
Thus, services have to be rendered, and such was the case in Massachusetts where a “transsexual inmate convicted of murder” was “entitled to a taxpayer-funded sex change operation as treatment for her severe gender identity disorder.”
Granted, that while the three-judge panel of the US Court of Appeals for the First Circuit that approved the operations in Massachusetts seemed baffled, they did state that “courts must not shy away from enforcing the rights of all people, including prisoners. And receiving medically necessary treatment is one of those rights, even if that treatment strikes some as odd or unorthodox.”
And this is where the issue of health care and the costs associated with it will quietly take a disastrous turn…
Even though the United States only imprisons about 0.6875% of the total population, there are still roughly 2,266,800 adults incarcerated in U.S. federal and state prisons, and local county jails.
When we look at this latest ruling along with the one in Massachusetts, it would appear that every inmate, if needed, could demand such medical treatment that they claim to require no matter the cost. And the problem is even larger than projected.
According to Chad Kinsella, who back in 2004 was warning us all in his “Corrections Health Care Report” of the potential issue, “from 1998 to 2001, state corrections budgets grew an average of eight percent annually, outpacing overall state budgets by 3.7 percent”.
His report also found that “During that same three-year period, corrections health care costs grew by ten percent annually, and comprised ten percent of all corrections expenditures. Alarmingly, recent spikes in corrections health care costs are a leading factor driving growth in corrections. Unchecked, these costs will surely plague cash-strapped states for years to come”.
But was Mr. Kinsella correct? Well, if we were to take a look at The Daily Dayton News in Ohio, we’d see officials there reported that in 2011 “Ohio’s prison system spent $222.8 million per year on medical care for its approximately 51,000 inmates, including $28 million for prescription medications.”
An even more frightening number: in just 10 months, Ohio spent close to $4 million on just six inmates due to their health conditions deteriorating as they aged.
The main driver of these costs, according to a recent PEW report, is that “inmates typically experience the effects of age sooner than do people outside prison because of issues such as substance use disorder, inadequate preventive and primary care before incarceration, and stress linked to the isolation and sometimes-violent environment of prison.
“And, like senior citizens outside prison walls, older inmates are more susceptible to chronic medical and mental conditions, including dementia, impaired mobility, and loss of hearing and vision”.
The other, often neglected, driver of these costs: there is no insurance to offset the costs for the facilities that house these inmates, and there is no indication that the problem will get any better if and when they are released.
With many in the prison population not exactly being what one would deem “model citizens”, the odds that they qualified for health coverage through employment are probably pretty low. In order to qualify for Medicare coverage, the rules are the same as for Social Security: one must work for 40 quarters in employment that pays taxes to the federal government.
Again, there is a high probability that many of these inmates will not qualify for this coverage, and will then become even more of a burden to the individual states in which they reside.
Those career criminals may also come to the realization that when they are older, the possibility of enrolling into any health plan may be prohibitively expensive, or even impossible, which could lead them back into the warm, welcoming arms of the prison system.
Look at the case of the notorious John Gotti, for a prime example. A career criminal who never held a job that paid taxes on a consistent basis (or probably ever), he banked hundreds of millions of dollars throughout his life, and in the end when he was finally caught, he was extremely sick.
Mr. Gotti died in prison in 2002 due to complications from throat cancer, a disease that if he tried to battle on his own without insurance, would most likely have cost him tens of millions of dollars. But while in prison, he had access to physicians, medications, and treatments all at no cost to him or his family.
And believe or not, the health care system within our own penitentiaries is not as horrific and antiquated as most of us may believe.
In many of today’s prisons, inmates have access to care through firms like Southern Health Partners, who tailor “medical, dental, and mental health services” to each jail facility with which they work.
These services include “on-site nurse staffing and a physician and/or physician provider/extender who visits the facility on a regular basis”, as well as Health Education programs, Mental Health Services, and even Dental Services that can be performed off-site if needed.
More positive developments for those that sit behind bars and would like to have adequate health care: according to CNN Money, “more doctors are dropping their private practices, choosing to go to work behind bars treating murderers, rapists, and other hardened criminals.”
The reasons? “Better pay, better hours, retirement benefits and free malpractice insurance.” And the trend is not just for established health care providers, as the same article reported that in 2012 “at the University of Massachusetts Medical School, 22 of 150 new students chose the correctional health care clerkship as their first choice.”
And why not? According to Dr. Michelle Staples-Horne, medical director for the Georgia Department of Juvenile Justice, “students are looking for an employer who offers flexible work hours and a steady paycheck. Correctional health care offers both,” and “correctional physicians can earn starting salaries of around $140,000.”
The problems and the costs related to health care for the incarcerated are much bigger than the attention the subject is receiving, and if left unchecked, it would appear that Mr. Chad Kinsella was spot on in 2004 when he stated that “these costs will surely plague cash-strapped states for years to come.”
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