My View: Inmates' behavior fuels prison health crisis

My View: Inmates' behavior fuels prison health crisis
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By Christine K. Holmstrom
Special to The Bee
Published: Sunday, Feb. 08, 2009 | Page 5E

In the debate over funding a constitutionally adequate prison health care system in California, most people, including politicians and administrators, are missing a key point – the role of personal responsibility.

I worked in the Health Care Services Division of the California Department of Corrections and Rehabilitation, or CDCR, for nearly eight years. I was appalled by the system's inability to prevent or discourage irresponsible behavior by prisoners that resulted in substantial medical bills for CDCR, ultimately paid by the overburdened taxpayer. No one seems to be talking about this vexing problem.

J. Clark Kelso, the federal receiver for California's prison health care system, wants $8 billion in taxpayer funds for construction of expanded prison health and housing facilities for the burgeoning prison population. The price alone is enough to outrage many Californians who believe that the state cannot afford such expenditures when it's suffering a major budget deficit.

The economy is in recession, and many workers and families are unable to purchase basic health insurance. Californians may wonder: Do convicted felons deserve better health care than the state's law-abiding citizens?

Regardless of whether or not you believe that prisoners deserve or are constitutionally entitled to state-of-the-art health care, you should be thinking about the medical costs created by the outrageous acts and self-destructive behavior of a few prisoners. What is the state's obligation, ethically and morally, to inmates who abuse the system and their own bodies? Why should the taxpayer foot the bill? This is a complex problem with no easy solution. Let me offer a few examples.

My job in the Health Care Services Division included placing inmates with renal failure at one of the few correctional institutions that provided on-site or community-based hemodialysis. Most dialysis patients complied with their treatment protocol, but the few who didn't racked up medical bills faster than a shopaholic at the mall can max out a wallet full of credit cards.

One inmate at a Central Valley prison was notorious for refusing dialysis treatments and ignoring dietary restrictions. The result would be a health crisis requiring transport to the local emergency room. The inmate would be admitted to the hospital, where he would spend the weekend luxuriating in a private room, attended by nurses and doctors while he watched his favorite TV programs. The institutional "utilization management" nurse, who was responsible for managing health care spending, complained every time this inmate manipulated himself into another hospital admission.

We were helpless to change his behavior or hold him accountable. The inmate was examined by psychiatrists, who found no diagnosable mental illness. He was counseled by doctors who warned him that his behavior could result in death. For this inmate, the rewards of deliberately ignoring doctor's orders apparently outweighed the potential risk. And cost was no object – it wasn't his dime.

Unlike medical patients, mentally ill inmates usually don't run up hospital bills. They must be housed in state facilities, either in the Department of Mental Health or in CDCR. The major cost involves mental health crisis bed placements. Not every prison has crisis beds. Correctional officers, often working overtime, transport the inmate by state car to a crisis bed institution with an available bed. Sometimes the destination is hundreds of miles away. An inmate who claims to be suicidal can be sent on a scenic tour of our lovely state.

When I worked in health care, this form of travel had become a game to a group of manipulative inmates. Staff dubbed these inmates "frequent fliers" – men who'd insist they were suicidal the moment they returned to their home institution after treatment at a crisis bed facility.

Using the appropriate section of the Diagnostic and Statistical Manual of Mental Disorders, a few doctors labeled such egregious fakers as "manipulators" and refused to refer them to crisis beds. However, most doctors were afraid to take such a bold step for fear that the inmate might actually attempt to kill himself or, even worse, succeed. Staff knew that an inmate suicide could lead to job loss and a lawsuit. It was safer to add the inmate's name to the lengthy waiting list for crisis beds rather than stand up to the system.

I don't claim to have an answer to the problem of manipulators, fakers and noncompliant inmate patients. I do know that this matter should be addressed. The federal receiver was given the task of creating an adequate prison health care system; I believe he also has a fiduciary obligation to Californians.

Taxpayers deserve more than an $8 billion tab. Kelso and the CDCR have a rich resource – the many experienced line staff in our prisons who have innovative ideas about promoting responsible inmate behavior and reducing abuse of the system.

Taxpayers ought to demand that their ideas be evaluated and that the best ones be implemented. After all, it's our dime.
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Christine Holmstrom worked as a correctional officer, sergeant and correctional counselor at San Quentin State Prison. She lives in Fair Oaks and is working on a memoir about her experiences.

http://www.sacbee.com/opinion/story/1606001.html