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February 2, 2011

Health care is a "budget buster" ... for inmates in Minnesota

As detailed in this local article, health care costs keep rising for the incarcerated. The piece is headlined "Inmate health care is a budget buster; Demands for medical and dental care are straining jails as never before, and sheriffs are looking for answers."  Here is how it begins:

A Washington County jail inmate, ill with cancer, is driven to a nearby hospital every week for chemotherapy, accompanied by a corrections officer likely to be working on overtime. In Ramsey County, two inmates needed emergency medical care last year that rang up $445,000 in hospital bills and busted the county's budget.  Hennepin County was paying so much for jail inmate dialysis that it bought its own machines to do the job.

As lawmakers in Minnesota and Washington, D.C., debate health care and human service programs, county taxpayers wind up footing the bill for people in county custody -- regardless of whether they're convicted of a crime.  Authorities note a rise in the number of inmates who have mental health problems, expensive medications and treatments, and a general increase in health care costs. For instance, medicine costs at the Hennepin County jail were $156,000 in 2005 and jumped to $300,000 in 2009.  "Add all those things together, and you have a collective mess," said Jim Franklin, executive director of the Minnesota Sheriffs Association.

Federal and state medical assistance programs and many private insurance plans cease once someone enters jail, putting the cost on counties.  It's an ongoing issue magnified as government budgets get tighter and funding is slashed or obliterated.  "Trying to budget for these costs is a little like roulette because you don't know who's going to be booked for what or who's going to be how ill," said Ramsey County Commissioner Victoria Reinhardt. "We just don't know."

What county officials do know is that they're required by law to pay for inmate medical care, even though they likely won't be reimbursed.  They're required to provide essential and reasonable medical and dental care, not things like elective procedures.  And when an inmate goes to a hospital, an officer has to be along to guard him or her 24 hours a day, forcing juggling of schedules that often leads to overtime costs.  The mandate thrust upon counties also forces them to strike a delicate balance between providing adequate care and making sure they don't open themselves up to legal action for neglect.

I have often joked with my students that the United States already has universal health care; the problem is, one has to commit a crime in order to access this system.

February 2, 2011 at 04:42 PM | Permalink


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States should have the right to cap expenditures on a particular inmate.

Posted by: federalist | Feb 2, 2011 9:23:41 PM

They'd all wind up on the taxpayers' dime one way or the other.

Posted by: Bill Otis | Feb 2, 2011 11:53:56 PM

123D. The remaining rare criminal could get top of the line care and cost little. Any judge imposing any more than basic care should be hounded out of office by a strong executive. Expose, investigate, harass. Drive biased federal judges out of state by enforcing every traffic, zoning, tax, and nuisance regulation against these criminal collaborators and enablers. The executive should begin a black list, and urge all local service and product providers to boycott these internal enemies. Any criminal with renal failure should not commit crimes knowing a jail sentence of more than a week without dialysis is suicide. Jails should only be held accountable for injuries caused by them unlawfully in torts, including assaults by other prisoners. They control the bodies of the predators and of the victims. Severe corporal punishment should be meted out to predators to prevent assaults and litigation against the prison. The failure to apply the lash should be considered a deviation from professional standards of due care.

Posted by: Supremacy Claus | Feb 3, 2011 12:29:50 AM

Once again fantasy drives the discussion. Prison health care is usually (unless court mandated) very poor. Sub-standard doesn't even begin to describe it.
I know as I have seen and 'enjoyed' it. I have also fought for basic health care for persons incarcerated with me in Federal facilities.
The glib nonsense of those who decry provision of basic health care demeans all those involved. Perhaps , Prof. Berman, you might recall the "bed-sores case" you cited in this blog some years back with regard to the doctrine of deliberate indifference? It remains the 'standard' response to prison health care.

Posted by: Tim Rudisill | Feb 3, 2011 8:56:42 AM

Tim Rudisill stated: "Once again fantasy drives the discussion." That is an understatement.
You mention the federal system, which definitely can be bad. However, some of the state systems are operated by private corporations and can be much worse. I think they look at the matter in a cost-benefit type of analysis --- with the knowledge that it is terribly difficult for someone to sue. Anyone that knows the law in this area knows this.
Every so often, someone dies, loses a limb or has some other major injury that could have been prevented. The newspapers may give it attention for a little while. A lawsuit may or may not be brought and won. After that, back to the old process.

Posted by: Tim Holloway | Feb 3, 2011 12:19:08 PM

I attended a meeting several months ago of the Iowa Board of Corrections where most of the meeting reports involved prisoner health care. There was a lot of discussion about cost control (telemedicine was reported on) and care of mentally ill prisoners (medication costs are very high and suicide prevention involves high security costs). Developmentally disabled prisoners are normally lumped together with the mentally ill but they are more of a security issue (they have to be protected from the other prisoners) rather than a health issue.

A very large additional cost is secure transportation and supervision of prisoners that are taken to a hospital. Escapes from hospitals do occur (mostly by jail inmates) and serious or fatal consequences can occur. One escaped jail inmate was shot and killed by highway patrol officer when he tried to ram his squad car with a stolen snowplow and more recently another committed two car jackings.

Correction Departments are under enormous pressure to reduce the cost of inmate health care and I do not think that there is sufficient oversight (if any). It does not appear that the public cares much about adequate health care for prisoners. I don't think there is any agreement about what "adequate health care" means. Public indifference and insufficient oversight are a bad combination.

Posted by: John Neff | Feb 5, 2011 10:33:54 PM

Being a prisoner, it is not acceptable that if abide a law, your right to avail benefits as a person already stopped. Government must also see the needs not only those higher people but also those who are at low positions just like prisoners and mentally ill people. They should implement this law in order to be fair and right to all people living in a country.

Posted by: cold sores on lips | Feb 23, 2011 12:19:05 AM

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