Complex Health Issues
Medical neglect kills hundreds of incarcerated individuals each year, despite the fact that they are the only group of people in the United States with a protected constitutional right to healthcare.
In 2015, a report from the U.S Department of Justice found that from 2011-2012, over 40% of incarcerated individuals suffered from chronic health conditions, such as diabetes, hypertension, asthma, high blood pressure, cancer, substance use, and mental health disorders.
In addition to these challenges, the incarcerated population generally comes from disproportionately lower income families, with substantially higher rates of chronic illnesses and infectious diseases than the general population.
Yet, many people in prison find themselves denied, punished, or placed in solitary confinement when requesting access to medical care.
MTIP client Bernard Pease Jr. experienced this firsthand during his 39 years wrongfully incarcerated, facing inadequate medical treatment while suffering from severe vision impairment, hypertension, diabetes, and non-alcoholic fatty liver disease.
“My doctors were always changing, and my conditions were almost never addressed right away when I reported it to a guard,” Bernard said. “It was also hard to get medical staff to believe you when you told them you had a problem.”
After enduring years of pain, Bernard was finally granted pre-release in 2022, and was released in January of 2024. Unfortunately, Bernard’s path forward has not been smooth just because he is now out of prison.
Since his release, Bernard has been diagnosed with Parkinson’s disease, sciatica, and bone spur growth on his spinal cord. These new health conditions have kept him from enjoying his hobbies and doing daily life tasks.
“The shaking in my hands has gotten so much worse,” Bernard said. “It has made it really difficult when I’m trying to hold onto a fishing pole.”
Bernard has also been facing severe throat, neck and back pain due to the bone spurs that developed on his spine, which he plans to have surgery on this summer.
Medical bills from years of inadequate medical care in prison and the high cost of living have continued to weigh heavily on Bernard.
“When I was preparing to leave pre-release they told me that medical resources would be in line for me when I got out. That didn’t end up being true. I was left to figure things out on my own.”
This is too often the stark reality for returning citizens facing major health challenges.
The Prohibitive Cost of Healthcare
Poor access and quality of prison healthcare has long been a common problem in U.S. jails and prisons.
The constitutional right to healthcare for incarcerated individuals traces back to the landmark 1976 Supreme Court decision in Estelle v. Gamble, which determined that denying healthcare to an incarcerated individual is a violation of the Eighth Amendment’s prohibition against cruel and unusual punishment. It noted that, “An inmate must rely on prison authorities to treat his medical needs; if the authorities fail to do so, those needs will not be met. In the worst cases, such a failure may actually produce physical “torture or a lingering death[.] …In less serious cases, denial of medical care may result in pain and suffering which no one suggests would serve any penological purpose.”
The ruling however, did not set the standard for the requisite medical treatment due to incarcerated individuals. It also did not prohibit correctional healthcare from charging copays for medical services. Today, the average copay ranges from $2-5. While that may seem like a low expense, incarcerated individuals typically earn 14 to 63 cents per hour, thus making it cost nearly a week’s worth of their income per medical visit.
Due to the inmate exclusion policy, established in 1965, programs like medicare, by law cannot be used once a person is in jail or prison even if they are eligible for the services.
As a result, many incarcerated people are forced to forgo requesting healthcare services, due to the risk of medical debt, and the burden of having to request appointments through correctional staff.
MTIP spoke with a former DOC medical doctor to discuss prison healthcare in today’s system, and future reforms to improve access and quality of care for incarcerated individuals. This individual chose for their identity and state of employment to remain anonymous for reasons of job security.
The anonymous source noted that, “Sometimes management is so strict that access is curtailed. I have seen some instances where there is a test that needs to be done with a patient, but the doctor has to go through too many barriers to get it done timely.”
Correctional facilities are frequently understaffed, causing delays in processing inmate healthcare requests, or reduced quality to the care they provide.
“Staffing is also always a challenge,” the source said. “But I think it’s fair to say that correctional healthcare is expensive, so you will see efforts to manage that cost. When you over manage costs, I think that’s necessarily at the expense of quality and access to care.”
Medical staff often also struggle developing rapport with their patients, as they are forced to only address the issues at hand, not the history of their medical conditions.
“When I worked with patients, I would be provided with a chart filled with 800 pages of their medical history,” the individual said. “The critical 100 pages were always spread out all over the chart, and you have no way of efficiently learning at the moment of how to treat your patient.”
They proposed that the industry should gravitate towards a “patient centered medical home model” as a way to transform the delivery of care given to patients in the future.
They described this model as a way to improve prison healthcare by putting the patient at the forefront of care. This model allows medical staff to build stronger relationships with their patients and develop an understanding of their full medical history to provide timely and quality care.
“When you remember that the constitution guarantees access, you can’t just put someone in prison and say ‘call us if you need healthcare,’” the source said. “You have to do an intake physical and you have to give them their medicines.”
Although correctional facilities are supposed to make efforts in the planning and implementation of continuum of care outside of prison, many formerly incarcerated individuals are left to figure things out on their own.
“Discharge summaries never happen in correctional healthcare,” the individual said. “I think there is tremendous room for improvement for release planning moving forward.”
The Long Term Impact
Studies have shown that each year spent in prison takes 2 years off an individual’s life expectancy.
Without timely medical attention, many people develop worsening effects, or even death due to exacerbated conditions.
Many individuals still face significant barriers to accessing healthcare and other supports they need upon reentry. Transitions of care are often poorly coordinated between the prison and community systems, leaving people with limited access to medications, medical records, or health insurance.
Other barriers include stigmatization, negative stereotypes, and public mistrust that often keeps formerly incarcerated individuals from accessing primary care, housing, education and employment.
The carceral environment can be inherently harmful to one’s physical and mental health, causing rippling, negative effects long after they leave prison.
Emerging evidence suggests that these harmful effects can also detrimentally impact the health of families and communities.
Nationally, 1 in 2 adults (45% of people) have an immediate family member who has been incarcerated. These statistics suggest that the negative health consequences of mass incarceration harms public health and well being, through the emotional and financial strain that the loved ones of incarcerated individuals experience.
The Need for Improved Oversight and Rehabilitation
Every year, more than 640,000 people return to our communities from state and federal prisons. Therefore, correctional healthcare has the opportunity, and the responsibility, to improve and provide better access to medical services for incarcerated people in need.
Improving transparency and accountability in correctional facilities is necessary to ensure that incarcerated individuals are treated humanely, that their needs are not overlooked or neglected, and that their rights to healthcare are protected.
By enhancing communication between correctional facilities and community health services with a focus on rehabilitation, trauma care, and post release healthcare planning, we as a country can move towards more positive health and wellbeing outcomes for incarcerated individuals, their families, and communities.