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The Invisible Crisis of Correctional Health Care

After 33 years behind bars, Alvin Entzminger, who was released in March, needed immediate medical attention for a host of chronic illnesses.

“I went into prison a healthy individual and came out suffering,” claimed Entzminger, now in his late 50s.

Entzminger’s story was one of several poignant testimonies provided by ex-prisoners at an October 9, 2013 conference on the health care challenges facing corrections systems.

As their stories demonstrated, such care is desperately needed by former prisoners like Edwin Lopez, 59, who had cycled in and out of jails and prisons since he was in his teens following the death of his mother. When he left prison, his HIV was untreated.

The lack of care has consequences far beyond its effect on an individual prisoner, Lopez warned.

“The community forgets we won’t spend all of our life in prison – we will come home,” Lopez told the conference. “If there is no medical or other support, we mostly will turn to violence and crime.”

The prisoners were joined by correctional care physicians, researchers and academics from around the U.S. at the New York Public Library’s Schomburg Center for Research in Black Culture in New York for a conference entitled, “Making the Invisible Visible: Addressing the Health Needs of the Formerly Incarcerated.”

The conference, sponsored by the Spencer Cox Center for Health of St. Luke’s and Roosevelt Hospitals, covered the broad range of health issues affecting incarcerated populations, including mental illness, HIV/AIDS and substance abuse.

Almost 85 percent of the 2.3 million people currently incarcerated and the almost 7 million people under correctional supervision (parole and probation) in the United States have chronic medical conditions like HIV or diabetes when released from prison, said Yale Assistant Professor Dr. Emily Wang, founder and co-director of Transitions Clinic.

Almost 40 percent of individuals are first diagnosed behind bars, noted Dr. Wang, whose clinic provides treatment for individuals with chronic diseases recently released from prison.

Yet while primary healthcare is a constitutional right in prisons and jails, the population is mostly served by a patchwork of providers and many don’t have access to consistent care, the conference was told.

Burden on Hospitals

Over 85 percent of recently released prisoners are uninsured. Most utilize hospital emergency rooms for chronic care, severely overburdening public hospitals.

“There are significant health-related barriers to people returning home from prison,” said Wang. “Often there is no discharge planning and short or no amounts of necessary medications upon release.”

Sometimes those barriers result in tragedies.

In Albany, New York, a lawsuit was filed against Correctional Medical Services, Inc. (which has since merged with Prison Health Services to become Corizon, the largest prison health care provider in the country) in the case of Irene Bamenga, who died at the Albany County Correctional Facility while awaiting deportation to France. She had a severe heart condition and never saw a doctor the week she was there.

While programs like Transitions Clinic and the Coming Home Project (based at the Spencer Cox Center) help reduce emergency room visits, some consistent issues in correctional health care can be easily resolved, said Lopez, who is now a peer supporter at Spencer Cox.

For example, he noted that people who cycle through prison and/or jails often lose their Medicaid or Medicare eligibility.

“We take it out on who?” he asked rhetorically. “We take it out on the community.”

Once prisoners are released into the community, they have to reapply for health care – a process that can take up to three months, possibly endangering their health and that of their families and neighbors.

Dr. Homer Venters, medical director for New York City’s Department of Health and Mental Hygiene (DOHMH) at Rikers Island jail and Bellevue/NYU Program for Survivors of Torture, said keeping adequate electronic records is crucial in order to provide continuity of care at community clinics and hospitals.

“Jails are chaotic,” said Venters. “There is not a lot of time to sort out these things with resources, and most jails don’t have resources.”

Venters touched on the other major concerns of medical professionals involved in correctional healthcare, such as not giving wrong medications and dosages – which is why correct information is so important.

He noted the dual loyalties of doctors and nurses: in a correctional setting, security is often a more important issue than patient care.

Another challenge is to maintain health and discharge plans for patients reentering the community.

Treating Addiction

Other speakers discussed treating substance abuse addiction, prevalent in many prisoners in the correctional system.

Dr. Joshua Lee, Assistant Professor at New York University Medical Center and a jail physician, spoke about different types of treatment for opiate addicts.

He mentioned a new medicine, naltrexone, which when injected every 4 weeks shows great promise for managing addiction.

“We need to start treatment in jail and continue afterwards in community,” said Lee, adding that Rikers has a long-successful methadone program while other major jails such as those in Baltimore and Newark do not.

Panelists also discussed aging in prison, HIV/AIDS in the correctional population and the effect on families and communities.

Soffiyah Elijah, Executive Director of the Correctional Association of New York, which monitors conditions in state prisons, was accompanied by Muhjahid Farid, who spent time in the corrections system and started the program Release of Aging People in Prison (RAPP) to advocate for the release of elderly and sick prisoners.

Elijah noted the high cost of care – approximately $240,000 annually per prisoner – to imprison elderly patients, while Farid spoke about the emotional costs of being separated from family while incarcerated, old and sick.

“If the risk is low, let them go,” he said.

Cara Tabachnick is Managing Editor of The Crime Report. An earlier version of this article appeared in The Crime Report (www.thecrimereport.org), the nation’s most comprehensive source of criminal justice news and resources, on October 11, 2013. It is reprinted with permission, with minor revisions.