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With prison costs and populations soaring and more than half of the incarcerated grappling with mental illness, addiction and/or infectious disease, it’s time for doctors to step up and advocate for prison health care reform, using the Affordable Care Act to make many of those reforms possible.

That’s the conclusion of 15 national experts in medicine and law, includingScott A. Allen, former medical director for the Rhode Island Department of Corrections who is now a professor of medicine and associate dean for academic affairs at the UCR School of Medicine. The panel’s recommendations were published this month in the journal Health Affairs, in an article titled “How health care reform can transform the health of criminal justice-involved individuals.”

“There is a false perception that the people in our prisons and jails are isolated, locked behind walls with no connection to the community, but the reality couldn’t be further from the truth,” said Allen, who is also an internal medicine doctor at Riverside County Regional Medical Center. “The majority of the people who are behind prison walls will be released to the community without any linkage to healthcare, or way to get it, since when the typical prisoners leaves jail or prison, they’re often excluded from all sorts of safety net programs. So we’re setting them up to fail, and failure has high costs to the community.”

This is particularly problematic when you consider that the United States has the highest incarceration rate in the world—“5 percent of the total world population but 25 percent of its prisoners,” Allen said, and many prisons are losing lawsuits because of substandard health care—including the state of California. Allen testified as an expert witness in the ongoing case called Plata v. Brown.

“The state of California is now spending more on prisons than on higher education, and it’s fair to ask, if the state is spending so much money, what are we getting for it?” Allen said. “The Supreme Court—a pretty conservative court—has found that prison medical care is so bad it constitutes cruel and unusual punishment. Even if you ignore the human rights issues and only look at it from the taxpayer standpoint, this is still a very bad deal.”

Increasingly, Allen said, progressives and conservatives are in agreement that “the way we’re doing business is insane,” but most politicians are afraid to take a stand on prison reform because they don’t want to be labeled soft on crime. “So enter the physicians into the public policy arena,” he said. “We, as physicians, have failed to leverage our influence and standing in the community to advocate for a saner approach.”

The article notes that “unprecedented incarceration rates in the United States began their dramatic increase in the 1980s….(when) incarceration became the favored punishment for drug crimes and nonviolent offenses.”

Simultaneously, state mental health institutions were largely being emptied but, but with few resources to follow to provide community support. “Now our mentally ill are in jails and prisons,” Allen said. “Flawed as those state (mental) institutions were, the net effect is that we’ve shifted from a therapeutic model to a punitive model for our mentally ill, which, as a physician, I believe has been a total disaster.”

Recommendations of the physician panel:

  • Develop and support alternatives to imprisonment, when appropriate, for first-time, nonviolent offenses related to drugs for personal use. Specialized drug diversion and mental health diversion courts have been shown to improve treatment retention and reduce recidivism.
  • Improve care within prisons and jails by applying the same rules and regulations that govern health care in our communities. Prisons have been permitted to use lower standards. “If it was anyone else, we would demand accountability and standards,” Allen said.
  • Sign prisoners up for coverage under the Affordable Care Act to standardize their care in prison, and ensure they continue care once they are released. Presently prisoners are released into the community with no medications or treatment plan, and multiple concerns about finding food and shelter. Most lack the money to purchase traditional health insurance, and can’t apply for Medicare or Medicaid until after they are released, Subsidized health insurance and expanded Medicaid coverage through the Affordable Care Act could potentially help them stay out of prison.
  • Evaluate prisoners for mental illness, addiction or disease, and match them to programs that can provide care once they are released. Their health records should be digitized so they can be easily forwarded to those facilities for consistent treatment, and providers in the community should be setting up transition clinic programs that create a “medical home” for people with chronic diseases who are leaving prison.
Scott A. Allen is a professor of medicine and associate dean for academic affairs at the UCR School of Medicine. (Photo: UCR School of Medicine)

Scott A. Allen is a professor of medicine and associate dean for academic affairs at the UCR School of Medicine.(Photo: UCR School of Medicine)

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Allen and the article’s lead author, Brown University Medical Professor Josiah Rich, are co-founders of The Center for Prisoner Health and Human Rights in Providence, Rhode Island. While at Brown, Scott Allen studied infectious diseases and international health. His mentor was Dr. G. Richard Olds, the founding dean of UC Riverside’s Medical School.

Allen has studied the role of medical practitioners in interrogations and hunger strikes, and in 2006 was the lead author in an article about 112 detainee deaths in Abu Ghraib and other U.S. controlled prisons in Iraq and Afghanistan between 2002 and 2005.

He abandoned his early career plans to go into international health when his first child was born with brain malformations and massive disabilities. “Seven years of prep became irrelevant because you do not live internationally with a special needs child,” Allen said. “He was born a quadriplegic who required total care. He’s 19 now, and I think his vulnerability and disenfranchisement in society has affected how I look at people who are not in a position to advocate for themselves in society.”

He said prisons are places with high levels of illness and health disparities and unmet need, and a lot of vulnerability in the health care population.

“This is an opportunity—a kind of perverse opportunity, since I don’t like the phenomenon of mass incarceration largely driven by poorly thought-out legislation—but an opportunity to at least engage with the people in these facilities and try to address their medical conditions. If we use the Affordable Care Act to better integrate health care expenditures and permeate the prison walls, we can have more effective health care in the long run, for the betterment of the people involved and the community at large.”

Jeanette Marantos
UCR Strategic Communications

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