By: David Chamberlain, Dan Clark, and Audra Lenczowski - PowerPoint Presentation

Slide1

By: David Chamberlain, Dan Clark, and Audra Lenczowski

Health Care in Incarcerated PersonsSlide2

Objectives

What rights do incarcerated persons have?What costs are involved and who is responsible

Medical care in correctional facilities

Possible Solutions and ClosingSlide3
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Cruel and Unusual Punishment Slide7
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Department of Oregon Corrections 2011—2013 BudgetSlide9

Health Services : Medical, Dental, Mental Health and Pharmacy ( with reserves)

2011-13 legislatively Adopted BudgetSlide10

2011-13 legislatively Adopted

Budget By Divisions Slide11

Cost of Incarceration in Oregon Correctional System

$82.48 per inmate per day Slide12

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 CareSlide13

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 CareSlide14

Medically Mandatory- Level 1

Care that is essential to life and health where surgical intervention outcome makes a significant difference and has a high costExamples are: Repair of deep open neck wound, myocarditis, myocardial infarction, appendectomy for appendicitis, maternity care

Medical Care - PrioritizedSlide15

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 - PrioritizedSlide16

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 - PrioritizedSlide17

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 - PrioritizedSlide18

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 HealthSlide19

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 state’s largest mental health providers

Mental HealthSlide20

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 HealthSlide21

Mental Health Courts

Only handle cases involving offenders with mental disordersSpecial 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 HealthSlide22

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)

Oregon’s 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

RECIDIVISMSlide23

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=13UsUSjv1TM

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=__v7BHd5lZmU1rwKGxsT52ERlDsBY=&docid=6L5B-zuf6t55BM&hl=en&sa=X&ei=0u8RUbKzMqTBigLp44GIDA&sqi=2&ved=0CFkQ9QEwBQ&dur=2534Slide24

http://

www.youtube.com/watch?v=eZZT1dkSF14Kenneth Pike

https://www.google.com/search?hl=en&q=kenneth+pike&bav=on.2,or.r_gc.r_pw.r_cp.r_qf.&biw=1619&bih=737&wrapid=tlif136013085550910&um=1&ie=UTF-8&tbm=isch&source=og&sa=N&tab=wi&ei=JPMRUc6-Osa0ygHh94HIDw#imgrc=BFSOq4k4q0upjM%3A%3B2_hJbwUQzMdaQM%3Bhttp%253A%252F%252Fa.abcnews.com%252Fimages%252FUS%252Fht_kenneth_pike_nt_110425_wg.jpg%3Bhttp%253A%252F%252Fabcnews.go.com%252FHealth%252FHeartHealth%252Fconvicted-rapist-kenneth-pike-turns-organ-transplant%252Fstory%253Fid%253D13458512%3B640%3B360Slide25

Kidney Organ Transplant

Horacio Alberto Reyes-Camarena

(Special Cases)Slide26

Moral and Ethical issue

Future Liability Issues

Rising Cost of Inmate Healthcare

Relevant Problems and IssuesSlide27

StartSMALL

How Do We Fix?Slide28

Approximately 15% of inmates are incarcerated while addicted to heroin

The majority of US jails do not provide any medication for opioid detoxificationMuscle relaxers, sedatives, anti-nausea medications

Detox While IncarceratedSlide29

Needle sharing and HIV

Vomiting and diarrhea spreads diseaseFictitious 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?Slide30

“…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 don’t 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 didn’t I probably would had died.”

Cruel and Unusual Punishment?Slide31

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

D

eath Sentence/

LiablitySlide32
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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 SolutionsSlide35

LAW ENFORCEMENT ASSISTED DIVERSION

LEADBest Solution

Financial and MoralSlide36

Early 90’s 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 BeginningsSlide37

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

LeadSlide38

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 FactsSlide39

Reduce number of low level drug offenders entering the system

Redirect public safety resources to more pressing priorities, such as serious crime and violent crimeImprove 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 GoalsSlide40

First time felony arrests cost the taxpayer between $3,000 to $7,500

On average a 2nd 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 LivesSlide41

The 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.

ConclusionSlide42

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 ContinuedSlide43

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 DUI’s to receive treatment rather than jail time. It cost’s the county $3 a day rather than the $50 per day price tag of a prison bed.

Texas Follows ExampleSlide44

http://www.youtube.com/watch?v=gBzJGckMYO4