New Prison Policy Initiative report details myriad problems with correctional healthcare systems

The Prison Policy Initiative today released this notable new report titled “Cut-rate care: The systemic problems shaping ‘healthcare’ behind bars.”  This report’s subtitle highlights some of its themes: “In correctional healthcare systems, care is secondary to controlling costs and avoiding lawsuits — a problem plaguing both private and public healthcare delivery. What will it take to get people the care they need?”.   Here are excerpts (with links) from the start of the report:

While people in the United States have long struggled with cost, quality, and access to healthcare, the crisis is particularly severe for people confined in jails and prisons. Since 2000, conditions have been so bad that roughly half of all state prison systems have been court-ordered to improve mental and medical healthcare, according to our analysis of data from The Civil Rights Litigation Clearinghouse. Alabama prisons have been hit with six healthcare-related court orders in that time — more than any other state — followed by California (5) and Colorado, Connecticut, New York, and Wisconsin (3 each). These court orders cover a wide range of healthcare issues, including insufficient policies, understaffing, failure to provide medication and treatments, and lack of quality monitoring and reporting; they paint a frightening picture of the scale of the problem facing incarcerated people. But lawsuits are an extremely limited metric by which to judge the quality of correctional healthcare: it’s very difficult for incarcerated people to successfully sue over their conditions, and many people endure medical neglect and abuse that never makes it before a judge. In other words, the reality is almost certainly worse. 

It’s no secret that incarcerated people are routinely failed by their healthcare providers. Every year, dozens of news articles and broadcasts, government audits, and advocacy groups spotlight healthcare issues in federal, state, and local lock-ups. Yet, the quality of healthcare in jails and prisons remains poor: health issues and mortality rates remain at crisis levels, costs continue to mount, and departments cycle through contracts with various medical providers in just a few short years. Meanwhile, prisons routinely fail to meet the healthcare and treatment needs of incarcerated people. To make matters worse, corrections facilities are designed and operated in ways that actually worsen the health of incarcerated people. Many features of incarceration make symptoms of mental illness worse and aid in the spread of infectious disease. Prisons are also environmental hazards that have serious consequences for the health of people who live in and around them.

What needs to change for incarcerated people to get the healthcare they need? For this report, we pored over research, news investigations, government reports, and contractor documents to better understand the “big picture” relationship between healthcare providers, government agencies, and incarcerated people, and to identify system-level targets for improving care outcomes. Since so much analysis overlooks the experiences of incarcerated people, we also turned to dozens of people inside for their input.