Inmate health care and communicable diseases.

Position:Survey Summary

For fiscal or calendar year 2009, 44 U.S. correctional systems reported actual expenditures of S4.38 billion to pay for medical care for the inmates housed in their facilities. The average amount spent per inmate indicated by 39 of the reporting systems that were able to provide actual figures was $4,940. Information received from the two responding Canadian systems is not included in this summary but is noted on the individual tables.

Thirty-one of the reporting systems stated that their health care budgets had increased from the previous year and cited the following reasons: population growth, rising medical costs, budgetary increases, contractual services, inflation, the aging inmate community, staff-related issues. skilled nursing upgrades, the return of out-of-state inmates and opening a new facility. Only nine reporting systems showed a decrease in their health care budgets. Connecticut cited that its reductions were a function of cost-containment measures and efficiencies regarding pharmacy and overtime, whereas Nevada decreased costs because it closed a facility. Alaska, Delaware, Mississippi and North Carolina cited minimal or no changes to their budgets compared with the previous year. Mandated consent decrees were imposed in Colorado, Connecticut, Kentucky, Michigan, New Hampshire and Ohio. An increase in staffing positions was noted in 20 of the reporting systems, while nine systems decreased their numbers.

Within their health care budgets, all of the reporting systems offered on-site OB/GYN services to female inmates, as well as tuberculosis, HIV/AIDS, cancer and diabetes treatment, dental care and dialysis. Utah is the only reporting system that did not offer internal services for hepatitis C patients. Services vary within the budgets for alcohol/drug addiction treatment, sex offender treatment and mental health. Contracted/outsourced services included in the systems' health care budgets were: doctors, advanced clinicians, nurses, medical staffing or management, pharmacy, laboratory, radiology, dental care, eye exams, mental health, hospitalization, podiatry, medical transportation and physical therapy.

Services that were not covered by state health care budgets but funded elsewhere in the overall departmental budgets were: medical transport in Alabama and Wyoming: substance abuse treatment in Kansas, New York. Oklahoma. Oregon, Tennessee, Texas and Washington: and sex offender treatment in Kansas, Massachusetts. New York, Texas and Washington. Washington also identified budgeting for correctional officers who accompany inmates for off-site services. Seven of the reporting systems received funding from other sources outside of the overall departmental budgets, and Kentucky and New York specified that other state agencies covered costs for mental health services.

Specialized Services

Elderly. Percentages for this category of inmates age 55 and older ranged from a low of 2 percent in Georgia to highs of 17.2 percent in West Virginia (for inmates older than 50) and 26.28 percent in Oregon (for those older than 46). Although the reporting systems primarily cited providing services based on specific needs, such as separate units/facilities, annual physicals were prevalently indicated.

Females. Each of the reporting systems provided pelvic examinations, prenatal and postpartum services, mammograms and Pap smear testing for female inmates. Twenty-six of the reporting systems offered reproduction counseling. Additional offerings for females included STD treatment, colposcopies, methadone maintenance and adoption information. A Women's Social Rehabilitation Unit was operational in Missouri, and in Washington, qualified offenders with short sentences could keep their babies on site while receiving parenting skill training. The cost of medical care for these babies was covered by the health care budget.

Chronic Care. Nine of the reporting systems were unable to identify the percentage of inmates needing chronic care, but the highest percentage of such inmates reported was in West Virginia (59 percent). New Jersey (54.9 percent) and Missouri (54.4 percent). Forty percent to 50 percent of inmates were identified as chronically ill in Kentucky. Massachusetts, New Hampshire and Wisconsin, while 12 other systems noted that 30 percent to 39 percent of their inmate populations were being treated for chronic diseases. Chronic care clinics were in use in nearly all the reporting systems and were serving patients with a multitude of diseases. New York operated regional medical units that offer subacute, skilled nursing services, and special community care was provided when necessary in Oregon.

Terminally ill Although there were low percentages of inmates considered terminally ill among all the reporting systems, specialized services were provided for their care. Hospice was offered in the vast majority of the reporting systems, along with palliative care and transfers to an infirmary or hospital when required. Ten of the reporting systems stated that they either did provide or there was the potential for compassionate release for this segment of their population. Maine and Minnesota particularly noted that there was a supervised community confinement program in effect for their medically incapacitated inmates. In addition, inmate aides helped oversee patients in Alaska, New Jersey and South Carolina.

HIV/AIDS. Thirty-four reporting systems tested for HIV/ AIDS at intake (24 of which did conversion tracking); 33 systems tested at an inmate's request; 36 systems tested at a physician's request: and only two (Nebraska and Virginia) tested inmates at random. Arkansas continued with repeat testing at 90 and 120 days following the initial testing at intake. Other instances for testing included: after exposure, at discharge, when court ordered or as a volunteer in a seroprevalence study (as in New York). Only South Carolina specifically indicated that it transferred inmates to and provided treatment in a therapeutic community.

Hepatitis B and C. While many of the reporting systems could not determine the number of hepatitis B vaccinations they administered, all but South Dakota did offer vaccinations. Regarding hepatitis C, 15 systems tested at intake; 28 tested at an inmate's request; 38 tested at a physician's request; and 33 systems tested when risk factors were present. New York was the only state to test at random. Thirty-eight of the reporting systems that tested for the disease did track positive results of prior testing. Treatment for hepatitis C-infected inmates included the introduction of Interferon and Ribavirin in a number of the systems.

Active cases of tuberculosis. As indicated in Table 7, the percentage of active cases of TB among total inmate populations was negligible to nonexistent; however, testing for the disease was conducted at some point in each of the reporting systems. All of them tested at intake, in addition to 12 systems testing at an inmate's request; 33 systems testing at a physician's request; 38 systems testing on an annual basis; and Massachusetts testing at random. All of the reporting systems, with the exception of Alaska and Idaho, tracked their active tuberculosis cases. Arkansas also tested after receiving a request from any state health department, and Georgia would test if there is a facility outbreak.

Other communicable diseases. Syphilis testing was conducted by 40 of the reporting systems, and 38 of the systems tested for gonorrhea and chlamydia. Some states noted testing for other diseases, such as staph infections, herpes, the flu and scabies.

Medical co-pay plans. There was no operational medical co-pay plan in Georgia, Missouri, Montana, Nebraska, New York or Wyoming. Oregon only required a co-payment for eye examinations. Co-payments for the other reporting systems ranged from $2 for a routine visit in Ohio to $7.50 in Wisconsin and $8 in Nevada. Exemptions to co-payments included inmates who are deemed indigent, those with chronic diseases, for emergency care, for work-related injuries or when it is staff-ordered. Several of the systems also noted waiving co-payments for mental health consultations when required by existing policy or for repeat visits for unresolved acute problems. Arizona also...

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