America Has a Health-Care Crisis — in Prisons

Prison is no place to get sick. The nation’s incarcerated population is aging rapidly, with nearly four times as many inmates 55 or over as there were at the start of this century. That’s led to increased rates of diabetes and heart disease, among many other problems. Younger offenders are hardly the picture of health, given their high rates of addiction. Altogether, prisoners make up 1 percent of the population, yet they account for 35 percent of the nation’s total cases of hepatitis C. “They are the most expensive segment of the population,” says Marc Stern, a public health professor at the University of Washington, “and they are the sickest.”

For all the care that inmates need, they’re unlikely to receive adequate medical attention. Over the past dozen years or so, a majority of states have contracted out prison health care to private companies. The leading vendors have all been on the receiving end of hundreds of lawsuits. Some are frivolous, but some have led to multimillion-dollar judgments and court orders to change their practices. It’s a problem that could get worse.

Horror stories of needless deaths abound. From Arizona to Florida, prisoners with cancer have been treated with nothing more than Tylenol. A recent Columbia University study found that 97 percent of inmates with hepatitis C do not receive the expensive medication they need. Inmates routinely have to complain of the same symptoms multiple times before they even get to see a doctor, sometimes waiting weeks. There’s no doubt that prisoners have faked illnesses, and escape attempts during medical transfers to hospitals are a real problem. But too often the default attitude among guards and other staff is that inmates are lying about being sick, says Susan Lawrence, a physician and attorney who has worked in prisons.

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