Many factors contribute to such an enormous budget. One of the most significant is medical and mental health care for an aging and increasingly ill state prison population.
During the 2011-2013 biennium, the ODOC will spend approximately $203.9 million – or about 15 percent of its budget – on prisoner health care. That number has risen sharply over the past several years, from $50.4 million (6.2% of the ODOC’s budget) in the 2003-2005 budget cycle. Put another way, prison health care is now costing Oregon taxpayers more than $100 million annually.
According to a budget information report issued by the Oregon Legislative Fiscal Office in September 2011, “Rising hospital costs, competition for health professionals, and increasing pharmaceutical costs all contribute to the increase in the health services budget” for the state’s prison system.
Each year the ODOC spends an average of about $567 per prisoner for health care. As prisoners age, however, those costs spike sharply. The annual health care cost for a prisoner in his 40s jumps to $936, but then quickly rises to $1,867 for prisoners in their 50s, $3,514 for prisoners in their 60s and $6,527 for prisoners over 70.
The ODOC has 674 prisoners older than 60, up from 258 a decade ago, and the two fastest-growing prisoner age groups are 46-59 and 60 years and older.
“Over the past 15 years, the average age of an inmate has increased, in part as a result of the changes in sentencing policy that have led to longer sentences,” the budget report by the Legislative Fiscal Office noted. “Since health care costs generally increase as a person ages, the trend of an aging inmate population will likely increase costs in the future.”
Additionally, thanks to hard living, chronic substance abuse and poor health care, many prisoners have medical is-sues that surpass their chronological age, stated Dr. Donald Kern, president of the Society of Correctional Physicians. A 50-year-old prisoner commonly has health care problems seen in 60-year-old patients in the community, according to Kern.
“I’m just seeing sicker and sicker patients,” agreed Dr. Michael Puerini, Medical Director at the Oregon State Correctional Institution.
In 2010 alone, around 24 ODOC prisoners needed medical treatment costing more than $100,000 each. The most expensive case involved $1.1 million to treat a 40-year-old female prisoner’s kidney disease and other ailments. She has since been paroled.
Including that case, the top ten most expensive medical cases cost the ODOC approximately $3.85 million in 2010 – such as $481,889 to treat a 51-year-old prisoner’s aneurysm, $402,457 to treat a 36-year-old prisoner’s cancer and $216,238 to treat a 44-year-old prisoner’s staph infection.
One prisoner abused ibuprofen, requiring surgery and three weeks in intensive care for internal bleeding at a cost of $61,904. In a ten-month period in 2009-2010, the ODOC spent $12.5 million for 4,358 outside hospital visits alone.
“There is an obligation to provide medical care for serious medical needs,” said Dr. Kern. “We’re not talking cosmetic surgery.” ODOC administrators agreed. “If we’re out of money, we still have to provide the treatment,” stated Bill Hoefel, ODOC’s health services administrator. By way of example, Dr. Puerini cited a short-term prisoner suffering from acute appendicitis. “That guy did not get a life sentence, but his illness, left untreated, could end up giving him a life sentence,” said Puerini. “We can’t let that happen.”
Still, prison officials constantly seek to contain costs. In March 2009 the ODOC selected Colorado-based Correctional Health Partners (CHP) to become a “third-party administrator” of the prison health care system. [See: PLN, Feb. 2012, p.46]. CHP was paid $1.2 million in the first year of the contract and continues to receive monthly payments of close to $100,000.
Medical directors meet daily by telephone to quickly move prisoners out of hospital beds, or avoid sending them there at all. Chest pains, for example, may be something serious or simply feigned.
“A weekend in the hospital is a vacation from prison for some inmates,” said CHP’s Jeff Archambeau. Apparently, a weekend in the morgue would be more acceptable to CHP bean counters. The ODOC and CHP scrutinize databases, attempting to detect trends suggesting that a prisoner is gaming the system in order to obtain medication, get out of work or go on “vacation” to the emergency room.
Other ODOC money-saving measures include an in-house dialysis unit that treats 26 prisoners who previously received more expensive community-based treatment, and a cardiology clinic that saves $5,000 a month. A prisoner self-care chronic disease management program “shows real promise” of reducing the need for outside medical care, said Hoefel. Prison officials are also reviewing administrative practices, seeking to eliminate steps that waste time and money.
“We work really, really hard and spend a fair amount of time making sure we are managing taxpayers’ money,” said Dr. Puerini. Of course, some of the greatest cost savings may come from simply being less stubborn when it comes to providing prisoners with necessary health care. For example, ODOC medical staff treated a female prisoner experiencing heart failure with antacid, Tylenol and a heat pack, and told her to eat a sandwich and take a nap. She survived, filed a lawsuit and settled the case for $390,000. [See: PLN, Sept. 2011, p.44; June 2010, p.32].
Mental illness is another major part of the problem. Prisoners are five times more likely than members of the general public to suffer from mental health conditions, according to a 2006 federal Bureau of Justice Statistics study. Ninety per-cent of prisoners with mental illness have also abused drugs or alcohol, the report stated.
In Oregon, about 70 percent of ODOC prisoners need some type of mental health care, costing about $16 million an-nually. That includes over 3,300 prisoners with “severe” mental problems or who have the “highest need” for treatment. Since 2005 the prison system has added 525 mental health beds, bringing the total to 900 – nearly 300 more than Oregon’s state mental hospital.
“The corrections environment is not good for a person with serious mental health illness,” said Jana Russell, administrator of the ODOC’s Behavioral Health Services Division. “We can’t cure most people,” acknowledged Dr. Kern. “We’re managing a chronic problem. Is it an ideal setting? No.”
For years, the ODOC attempted to “manage” the problem by housing mentally ill prisoners in solitary confinement, which exacerbated their mental illness and led to frequent suicide attempts. [See: PLN, Oct. 2008, p.10].
“The potential for preventing suicide attempts, preventing weaker inmates from being victimized and teaching skills to function within a highly charged environment is imperative,” a 2004 mental health task force noted. The task force pro-posed separate treatment units for mentally ill prisoners or a new prison to serve as a mental hospital.
The legislature approved a new facility located in Junction City that would have provided mental health care to Ore-gon’s most troubled prisoners. With a growing budget crisis, however, officials suspended construction plans in 2010.
“We were devastated,” said Russell. “We were hanging on by the skin of our teeth.”
Originally slated to open in 2012, the prison may not be ready for nearly a decade. Until then, too many prisoners will not get the mental health treatment they need, observed Bob Joondeph, executive director of Disability Rights Oregon.
“There is a greater risk of suicide among these inmates,” he said. “There is a greater risk to people who are vulnerable as a result of their mental illness.”
In what Russell described as the “craziest brainstorm,” in the fall of 2010, prison officials converted an Intensive Management Unit (IMU) into a 187-bed mental health unit for the most severely ill prisoners.
“This is not a great environment for doing this,” Joondeph noted following a tour of the unit, “but it’s what we have.” Prisons in eastern Oregon have resorted to teleconferencing to provide treatment to mentally ill prisoners, since psychia-trists are unwilling to work at the rural facilities.
During the last three budget cycles, the ODOC has not received funding for 24-hour mental health staffing. Oregon Governor John Kitzhaber, himself a doctor, did not recommend additional funding for prison mental health care staffing during the most recent budget cycle. Which means that the ODOC, and prisoners with mental health problems, will have to do the best they can with the limited resources they have.
Sources: The Oregonian, www.leg.state.or.us
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