Wednesday, April 18, 2018

Why do we pay big money to keep old, sick people in prison?

I wanted to draw your attention to a great article in today’s Milwaukee Journal-Sentinel by Gina Barton that discussed the question of what to do with older and/or disabled Wisconsin prisonsers.

This is an offshoot of 1980s and 1990s “tough-on-crime” policies in the state (including the “truth in sentencing” law authored by a young state rep named Scott Walker), leading to an increasing amount of state prisoners are growing old and medically needy inside the walls of correctional facilities.

For these types of situations, Barton mentions that the state has a program that allows for early release of individuals. The only two conditions are that people with life sentences and convictions for serious violent crimes are not eligible, and a committee of corrections staff and social workwers agrees to do so.
To qualify, a prisoner must be at least 65 with five years served, or 60 with 10 years served. Prisoners with chronic health conditions also may apply regardless of age or time served if two doctors — either inside the prison or outside — certify the illnesses can't be properly treated in prison.

People convicted of some of the most serious felonies, such as first-degree sexual assault, are not eligible, nor are those serving life sentences.
But Barton says that only 25 individuals were released from Wisconsin prisons under this program from 2011 to 2017, while more than 1,200 people over the age of 60 were housed in Wisconsin prisons at the end of 2016.

One of the individuals profiled in the story is Nancy Ezell, who was sentenced 20 years ago for selling cocaine and trying to buy stolen goods. In the time she has been in prison, Ezell has suffered from many health issues.
Ezell, then 47, was sentenced to 65 years under the parole system, in which inmates become eligible for release after serving a quarter of their sentences.

Within about a year and a half of her arrest, Ezell had five angioplasties and underwent open heart surgery, according to a transcript of her sentencing hearing.

Ezell, who will turn 66 later this month, uses a wheelchair and a breathing machine. She takes some 30 pills a day to control more than a dozen health conditions including heart disease, diabetes and kidney disease, according to her medical records. Two years ago, she was diagnosed with breast cancer, which required a mastectomy.

Menace to Society

The article mentions Ezell's family figures her medical costs have been more than $1 million due to her many needed treatments.

And due to state law (and human decency), taxpayers have been on the hook for the medical care for inmates such as Ezell and others housed in the state’s correctional facilities. And that cost has been going up by a large amount over the last decade.
In 2007, the Wisconsin Department of Corrections budgeted $2,856 per inmate for health services, after adjusting for inflation. By 2017, that figure had grown to $4,712, an increase of 65%.

On top of the cost of prisoners' medical treatment, departments of correction must pay for transportation and staff time. They also must provide security, even for people who are incapacitated.
And those higher costs came home to roost in today’s Joint Finance Committee, as the committee had to deal with a Corrections shortfall of more than $10 million due to the costs of inmate health care and medical treatment. The Legislative Fiscal Bureau describes the specifics behind these extra costs.
Prescription Drugs. Pharmaceutical costs for the treatment of inmate health conditions in the last three fiscal years have increased. Corrections spent $25.4 million GPR in 2014-15, $25.9 million GPR in 2015-16, and $36.7 million GPR in 2016-17. For 2017-18, pharmaceutical costs are projected to be $35.8 million, a decrease of $900,000 from the previous year. According to the request, almost 60% of drug expenditures in 2017-18 involve three treatment categories: Hepatitis C Virus (HCV) medication, Human Immunodeficiency Virus (HIV) medication, and Biologics used to treat severe inflammatory diseases. Corrections indicates that there has been an increase in the number of prescriptions dispensed compared to 2016-17 (514,177 prescriptions dispensed between July, 2016 and February, 2017, compared to 531,059 dispensed between July, 2017 and February, 2018)….

Hospital Costs. Medicaid covers costs associated with hospitalization of inmates. However, the Department [of Corrections] is required to pay for inmates in "observation status" days, which is not covered by Medicaid. Observation status are hospital outpatient services given to help the doctor decide if the patient needs to be admitted as impatient or can be discharged. While the total use of observation days as a whole are fewer year-to-date in 2017-18 compared to a similar time period in 2016-17, health care expenditures have been impacted by increased costs of drugs administered to inmates while hospitalized (both under observation status and as an admitted patient) as well as hospital visits of the Department's aging population who typically require more medical care. Corrections expended $30.4 million GPR in 2016-17 and projects spending $32.2 million GPR in 2017-18 related to hospital expenditures.

Contracted Nursing Services. Corrections continues to utilize contracted nursing services to address continued recruiting and retention difficulties: "due to a variety of factors including but not limited to a statewide shortage of trained shortage of trained personnel, market pressures which raise salaries in rural areas, and driving distance to prisons from urban areas." According to the Department, contract nurses conducted 677,574 inmate medical visits in 2016-17 and are estimated to conduct approximately 700,000 in 2017-18. The Department has been able to cover a portion of contracted nursing costs with funding from health position vacancies, but projects spending $10.1 million GPR on contracted costs in 2017-18, compared to $9.3 million GPR in 2016-17.
So what is the Walker Administration reducing to pay for this $10 million deficit? I’ll let Wisconsin Public Radio tell you.
To help cover the shortfall DOC earlier this month asked the finance committee to transfer $5.3 million from the agency's contract beds account and $1.8 million from a fund that covers services for drunken driving offenders. Both accounts are projected to have surpluses.

The agency expects to fill the rest of the deficit by reallocating expenditures and with salary savings from vacant positions.
So we’re spending more tax dollars to keep older people locked up in our overcrowded prisons, and on top of that, we can only pay for their health care by lowering staff levels, having fewer juvies being housed, and reducing drunk driving services? Does that seem like a sustainable or sensible policy on ANY level?

Seriously, how is it better to have senior citizens and the disabled taking up space in our prisons instead of being in the community, possibly with connections to family and friends, and likely able to access health care at a lower taxpayer cost? Maybe that whole “lock ‘em up forever” mentality of the 20th Century needs to be thrown into the dustbin of history. Not only for humanitarian reasons, but because it has cost a whole lot of money for a corrections strategy that doesn't seem to have done much to improve society.

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