Inmate health care and communicable diseases.

Position:Survey Summary

Budget and Staffing

Of the 38 systems that reported daily population rates for 2012 in Table 1, Texas reported having the highest average daily population with 154,933 inmates. Georgia, New York, Ohio and Pennsylvania reported having around the same daily populations, and were the highest after Texas with an average of 52,393 inmates. Vermont reported the lowest population at 1,555 inmates.

The average percentage allocated for inmate health care among the systems is 17 percent. Several of the systems' mental health care budgets are also included in this number. Nineteen systems indicated that their health care budgets increased from 2011-2012, 13 systems decreased and six stayed the same. Budgetary restrictions, population growth and cost of contractual services were the top three reasons behind the budget changes. For the mental health care budget, 17 systems reported an increase, while seven reported a decrease and seven stayed the same, with the systems reporting mostly the same reasons for change as for health care.

When asked if the system was under a constant decree, 30 systems reported no and six reported yes. Connecticut indicated that they were under a couple of specific decrees for HIV, and Hawaii noted the U.S. Department of Justice settlement agreement for mental health care services at their largest jail--the Oahu Community Corrections Center.

For medical staff changes. 14 increased, eight decreased and 16 stayed the same from 2011-2012. Population growth and budget changes were the top two reasons for change. Other reasons include challenges of hiring staff, reorganization of departments, expansion or addition of correctional facilities, and a decrease in contracted temporary agency staff nurses.

Services and Funding

For Table 2. the systems were asked to note the medical services they provided and that were included in their health care budgets. This included treatment for alcohol addiction, drug addiction, dental care, sex offenders, mental health, obstetrics/gynecology. tuberculosis, HIV/AIDS, hepatitis C, cancer, diabetes, dialysis and more. The systems in Table 2 were asked to note the medical provisions that were contracted or outsourced, but were included in their health care budgets. In Table 3, there were also a number of medical services provided by the systems that were not included in their medical care budgets, but the costs are located elsewhere in the overall departmental budgets. Alcohol and drug addiction treatment and medical transportation were the main two nonbudgeted medical services funded elsewhere.

Specialized Services Elderly.

On average (as shown in Table 4), 11 percent of the 35 reporting systems population consists of inmates 55 or older (50 in New Jersey). Arkansas reported having the lowest percentage of elderly inmates at 0.09 percent, and Louisiana and New Hampshire had the highest with 18 percent. There were many special provisions made for this group such as special needs housing units, chronic care clinics, skilled nursing and palliative care.

Females. All

the reporting systems provided pelvic exams, prenatal/post-partum medical care, mammography and pap smears--except for Nevada, which did not provide pap smears. Reproductive counseling was provided by 18 of the 38 reporting systems. Other specialized services provided to females included OB-GYN care in Virginia. a program for pregnant offenders in Minnesota. and Methadone treatment for pregnant inmates and STD counseling for females in Massachusetts.

Chronically ill. Twenty-seven systems reported an average chronically ill population of 35 percent. South Dakota had the lowest number of chronically ill with only 1 percent, while Washington had the highest with 57.1 percent. The majority of the systems provided chronic care clinics, while other provisions provided included specialist's referrals, assisted living, inpatient infirmaries, hospital care and oncology services.

Terminally ill. Eighteen of the systems reported that less than 1 percent of their populations were terminally ill. Only three systems had percentages greater than one: Alabama reported 5 percent, Michigan reported less than 5 percent, and Ohio reported between 1 and 5 percent. Hospice and palliative care were offered by the majority of the systems for the terminally ill.


All 38 reporting systems in Table 5 tested for HIV/AIDS. Twenty-six of the systems tested automatically at intake. 32 tested at the inmate's request, 33 tested at the physician's request and none of the systems reported testing at random. The number of conversions from negative to positive was tracked by 20 of the systems. In Virginia, the Health Department tracked the conversions. Approximately 12,367 inmates are infected with HIV/AIDS in the 37 systems that provided numbers. Twenty-one of the systems reported that less than one percent of their populations had HIV/AIDS. Michigan reported the highest percentage with 9 percent. Each reporting system that provided their percentage of males and females with HIV/AlDs all reported significantly higher numbers for males compared to females. The treatments offered for HIV/AIDS varied among the systems.

Hepatitis C and B

All of the 38 systems responding systems in Table 6 tested for hepatitis C. Eleven tested automatically at intake, 22 tested at the inmate's request and 35 at the physician's request. Oklahoma is the only system that reported testing at random, while 27 systems tested when risk factors were present. Other testing times that were reported include after exposure, as clinically indicated and upon discharge. Thirty-seven systems reported that they tracked positive results. The percentage of the systems' total populations with hepatitis C varied greatly among the systems from less than 1 percent in South Dakota and Kansas, to 45 percent in New Mexico. The types of specialized treatment offered varied among the systems, but the common treatments were dual and triple therapy. Thirty-four of the systems provided vaccinations for hepatitis B. with the number of hepatitis B vaccinations given in 2012 in 19 reporting systems ranging from 23 in South Carolina to 12,920 in Pennsylvania.

Active Tuberculosis and Other Diseases

In Table 7, 37 systems reported that they tested for tuberculosis. Thirty-six tested automatically at intake, five tested at the inmate's request. 27 tested at the physician's request and 27 tested annually. Oklahoma is the only system that tests at random. Thirty-seven of the reporting systems tracked inmates with active tuberculosis. None of the responding systems reported a population of inmates with tuberculosis at greater than 1 percent. Negative pressure rooms were offered for treatment by the majority of the systems, along with other various treatments. Other communicable diseases were tested for by 37 of the systems. Twenty-four of the systems tested females and males for syphilis, gonorrhea and chlamydia. HPV, herpes and methicillin-resistant Staphlyoccucus aureus (MRSA) are some other communicable diseases that are tested by the systems.

Medical Co-Pay Plans, Telemedicine and Release Provisions

In Table 8, Missouri, Montana, Nebraska, New Mexico, New York, Texas and Vermont indicated that they did not have a medical co-pay plan for sick call visits. Texas had a $100 health care fee that covered offender requested visits for one year. The medical co-pay cost for sick calls ranged from $2 in several of the systems to $8 in Nevada. Twelve of the systems had a plan in use for medical co-pay plans for pharmacy. The price ranged from $1 to $5 for pharmacy co-pays. The amount collected in 2012 for pharmacy is included as part of the amount that was collected in 2012 for sick visits. Telemedicine was used by 28 systems for medical services, 30 for mental health services and 17 for staff training. Other uses of telemedicine include specialty clinics in Connecticut, meetings in Louisiana and Ohio, and emergency triage in New York.

In Table 9, each of the reporting systems indicated that they provided services to infected inmates who were being released from their care. The majority of the systems provided inmates with a supply of medication and a referral or appointment with an outside service. Eighteen of the systems reported that they made plans based on the Patient Protection and Affordable Care Act, and Arizona was making plans to do so. Ten systems operated as a unified correctional system in which both the local detention and prison systems were operated by the state. A number of the systems declined to participate in this survey because of legal concerns.

Alcohol and drug addiction treatment and medical transportation were the main two nonbudgeted medical services funded elsewhere.

For more information about surveys featured in this or past issues of Corrections Compendium, contact Shelby Hajek, researcher, CEGA...

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