#20: Breaking Chains, Healing Pains
A look into our failing prison healthcare system.
Tonight’s Focus: Prison Healthcare
This past October, Last Week Tonight with John Oliver did a segment on incarcerated healthcare. Building on a previous show about who profits from mass incarceration, Oliver calls attention to the major shortcomings of prison healthcare infrastructure and the resulting adverse health outcomes prisoners face.
“Like so many stories that we cover, this one ends at the perpetual elephants in the room, that the US doesn’t guarantee any of its citizens the dignity of good healthcare, and it puts too many of its people in cages. Cages where many will needlessly die.”
~ Prison Health Care: Last Week Tonight with John Oliver
Regardless of your stance on America’s prison system, incarcerated individuals shouldn’t suffer worse outcomes because they are in a cell. Incarcerated individuals are more likely to have mental health and chronic conditions such as high blood pressure, asthma, cancer, infectious diseases, and HIV.
There’s a whole host of reasons prisoners fare worse than the general population. Prisoners have higher rates of substance abuse and mental illness as well as a high burden of chronic and noncommunicable diseases. Also, inmates are getting older. From 1999 to 2015, there was a 264% increase in the number of adults over the age of 55 in prisons.
But above all, it’s the providers of prison healthcare who are most to blame.
Alleged Bidding Wars
Healthcare in prisons used to be provided by local, state, and federal governments. However, in the 1970s, prison systems began outsourcing healthcare to private companies. By 2009, correctional health expenditures going to private companies reached $3b annually.
Today, 60% of jails outsource their healthcare needs to private companies. Local governments set aside budgets to spend on prison healthcare and private healthcare companies submit bids for local and state-wide contracts.
The problem is that only a handful of companies provide healthcare to prisons, so the supposed bidding war rarely occurs. Instead, states must rely on the same five companies for their incarcerated healthcare needs: WellPath, Centurion, Wexford, NaphCare, and YesCare (f.k.a Corizon).
Profiting from Pain
These companies profit from a $9.3b correctional healthcare industry at the expense of patients. Because government contracts pay a fixed rate per prisoner, the less healthcare that is delivered, the more profit the private companies make. Incentives make it easy for correctional health providers to offer substandard care and even deny treatment altogether.
Wexford Health: An inmate was denied care for his injured eye because of Wexford’s “one good eye” policy.
Wellpath: Providers were caught forcing harmful chemical restraints on patients.
YesCare: A $100k settlement was reached after an Arizona prisoner went blind in one eye due to poor medical care.
Centurion: “Deliberate indifference and medical negligence” led to a $20,000 fine.
NaphCare: A female prisoner was denied care at Washington’s Spokane County jail for her ruptured intestine that led to a fatal infection.
From failing to diagnose and provide care for life-threatening illnesses, to allowing common infections to become fatal, these companies have contributed to the 5,000+ people who died in custody over the last decade. Wellpath specifically has had over 300 medical cases that have gone more than 2 weeks without being addressed by a healthcare professional.
As if it wasn’t already clear, jails with private healthcare contracts suffer a higher death rate than jails whose healthcare is managed by the government.
Shady Business
Senators Warren, Durbin, and Grassley have also urged the Department of Justice to look into YesCare’s corporate structure. A shady ownership “shell game”—uncovered by Business Insider—has allowed YesCare to funnel profits while dodging accountability for their one thousand or so malpractice lawsuits.
Still, YesCare has jail and prison contracts in a dozen states and oversees the health of about 40,000 prisoners. They even secured a $1b contract with Alabama making them responsible for 20,000 more convicted persons.
Reform and Innovation
When it comes to private prison healthcare providers, the government has its hands tied. Some cities have gotten rid of privatized healthcare and are finding other providers to care for the incarcerated. In 2015, New York City refused to renew contracts with Corizon and instead returned management of correctional health services back to the Health and Hospitals Corporation. Los Angeles has since done the same, while Washington D.C. utilizes community-based health centers to care for prisoners.
The Biden-Harris administration also outlined a strategic plan to support rehabilitation during incarceration. As part of the proposal, prison-tech startups creating solutions in education, job training, and social connectedness are further incentivized by equity-free funding opportunities (mostly federal grant funding). However, there needs to be an overhaul of the system before founders can directly target incarcerated healthcare.
Complete Overhaul
Healthy Returns has explored pressing challenges in healthcare such as clinician burnout, declining teen mental health, and skyrocketing rates of chronic disease. All require a coordinated effort between public health agencies and private sector innovators and stakeholders.
I’m hard-pressed to find startups directly addressing incarcerated healthcare, but maybe there’s a way to incorporate value-based care. Given the existing nature of prison healthcare, there may not even be a remedy to the current system.
After writing this week’s newsletter, I have more questions than answers regarding a path forward for incarcerated healthcare. If you know of any non-profits providing stellar healthcare to prisons, let me know in the comments!
This week in healthcare:
U.K. researchers warn about biases in medical devices, health care algorithms, Stat
Blockbuster obesity drug leads to better health in people with HIV, Nature
How Food-as-Medicine Execs Are Responding to Kellogg CEO’s ‘Let Them Eat Flakes’ Remarks, MedCity News
Mark Cuban’s Cost Plus Drugs will begin manufacturing its own medications this week, Fortune
How Marketing Fueled the Opioid Overdose Crisis and What We Can Learn From It, MedCity News
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