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Illinois Ends Medical Co-Pays for Prisoners, 
But DOC Healthcare Criticized

by Derek Gilna

In June 2018, Illinois lawmakers voted to end the practice of charging $5.00 co-payments to state prisoners for each medical visit – a disproportionate fee, since prison wages in the state range from $0.09 to $0.89 per hour. The move came shortly before the release of a scathing report that documented over a dozen preventable deaths among the 41,000 prisoners held by the Illinois Department of Corrections (DOC).

The October 2018 report was prepared by court-appointed experts in a federal lawsuit, Lippert v. Ghosh. The experts said that compared to conditions when the case was filed in 2012, prison medical care is “either no better or in fact worse in 2018.” The suit was certified as a class-action in April 2017. [See: PLN, Feb. 2018, p.35].

Led by correctional health expert Dr. Mike Pusis, the report found that of 36 fatalities in the year ending June 1, 2014, more than one-third could have been prevented with adequate healthcare. The state chapter of the ACLU, which joined the case as a co-plaintiff in 2013, decried the unnecessary deaths.

“We knew four years ago that prisoners in Illinois were subject to needless pain and suffering,” said Camille Bennett, staff counsel at the ACLU of Illinois. “This latest report shows that the lack of adequate care is lethal.”

The report was the second produced by the court-appointed experts; an initial study conducted in 2014 was filed with the court the following year. The most recent report concluded that “overall, the health program is not significantly improved since the First Court Expert’s report.”

According to Harold C. Hirshman, an Illinois civil rights attorney with the Dentons law firm, “This report tells a remarkably ugly story. Once again, a carefully-drafted, professional report concludes that the quality of care provided to Illinois prisoners is atrocious and leads to death.”

Hirshman said many DOC doctors are “incompetent,” even though at least 15,000 of the state’s prisoners are seriously ill – points agreed to by “every expert who’s looked at it,” he said.

“The state has hired its own internal experts. They say it’s bad. The only thing that doesn’t change is anything to make it better,” Hirshman added. “[Prisoners] start complaining about something and they’re given a couple of aspirin and told to come back and they’re told that time and time and time again so that no one even tries to figure out what’s happening to them.”

Hirshman is the lead attorney in a separate class-action lawsuit against the DOC on behalf of approximately 12,000 prisoners who suffer from inadequate mental health care. That suit, filed in 2007, resulted in a 2016 settlement agreement. But in April 2018, U.S. District Court Judge Michael Mihm ruled the state had failed to follow through on the agreement, violating prisoners’ constitutional rights.

The DOC responded the following month with a plan to comply with the settlement, but Judge Mihm blasted Assistant Chief Deputy Attorney General Douglas Rees for his two-step plan, which would first identify prisoners at highest risk of harm and then provide them with additional care.

“It’s not a plan. It’s nothing, really,” Mihm stated.

In over a decade since the suit was filed, he said, the state had already identified affected prisoners – most of whom are housed in isolation cells due to lack of mental health care providers.

Hirshman agreed, calling the DOC’s plan “almost laughable.”

Of the 1,100 prisoners held in segregation, 900 have been diagnosed with mental health problems. In testimony presented earlier in 2018, a court-appointed monitor said the DOC had identified a need for 65 additional psychiatrists but only half had been hired by the prison system’s for-profit medical contractor, Wexford Health Sources.

Understaffing also pervades the rest of the DOC’s healthcare system. The most recent expert report in Lippert v. Ghosh, U.S.D.C. (N.D. Ill.), Case No. 1:10-cv-04603, found the DOC short of both qualified doctors and medical support staff. As a result, prisoners are not sent to outside medical facilities for emergency or specialized care they need, the ACLU’s Bennett said. She added that prisoners who need long-term skilled nursing care are instead kept in understaffed prison infirmaries.

“Based on record reviews, we found that clinical care was extremely poor and resulted in preventable morbidity and mortality that appeared worse than that uncovered by the First Court Expert,” the report noted, adding the DOC could not even provide documentation for its healthcare expenditures.

To address such problems and improve the operation of the DOC’s medical system, the report concluded with two recommendations: 1) Remove responsibility for medical services from DOC wardens and place it under the management of medical staff in the DOC’s Office of Health Services (OHS), and 2) Increase OHS staff to better monitor prisoner healthcare and oversee vendor contracts.

“Governance of the medical program must change,” the court-appointed experts insisted.

As for funding healthcare costs, the state can no longer look to prisoner co-pays. Until lawmakers ended that practice, Illinois was one of 42 states that charge prisoners to see medical staff. The national average is $3.47 per visit; the highest is in Texas, which charges prisoners a $100 annual co-pay for medical care.

“We want a real-world environment for the prisoners because in the real world you and I would be required to have a co-pay,” explained spokesman Mark Myers with the Oklahoma Department of Corrections.

Prisoners in Illinois earn as little as $.09 per hour, which made the $5.00 co-pay equivalent to $458.33 for a minimum-wage worker outside of prison. In states that require co-pays, prison officials insist they are necessary to discourage frivolous medical visits. A 2014 analysis by the Pew Charitable Trusts found that about 20 percent of all prison spending, on average, goes towards healthcare – about $3,000 to $10,000 per prisoner annually, depending on the state. Which indicates that co-pays do little to defray the expenses that prison systems incur for providing medical care. 


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