Prison Health Care: New York Times Series Brings Attention

by John S. James

Summary: A three-part series and an editorial in The New York Times, the result of a year's investigation, has brought attention to the bad medical care in prisons in the U.S. -- deficiencies that kill prisoners and allow epidemics to spread. The wrong funding arrangements, incentives to make money by reducing care, and the huge growth in the number of prisoners in the U.S. are major causes. We also comment on shortage of social space as a potential root cause of prison and other problems.

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On February 27 through March 1 The New York Times published an excellent "Harsh Medicine" series on prison health care, based on more than a year of research [1]. It focused on Prison Health Services, the largest for-profit prison medical company, though the problems are similar with other private and public prison health as well. A March 10 New York Times editorial [2] noted, "The root problem is that the country has tacitly decided to starve the prison system of medical care..."

Prison Health Services, with contracts in 28 states, is responsible for the medical care of about ten percent of the 2.1 million persons incarcerated in the U.S. -- which now has a higher rate of imprisonment than any other country in the world. "Harsh Medicine" shows how the horror stories that often led to deaths of prisoners result from financial incentives, as prisons are often required by law to accept the lowest bidder, so companies bid low amounts that could not possible pay for adequate care. Then they must cover expenses and make money by denying treatment.

On March 4 the TV and radio news program Democracy Now! [3] broadcast a discussion with Paul von Zielbauer, the reporter who researched and wrote the series, Dr. Bobby Cohen, appointed by a Federal court to monitor prison health care in New York and three other states, and Barbara Ferguson, sister of an inmate who died after his prescriptions medicines were withheld. Dr. Cohen noted that private health-care companies cannot complain and fight the prison system when necessary, if their want their contracts renewed. In addition to that, they make their money by denying care, "in a contract where there's a fixed amount of money, and whatever they don't spend, they keep." Most but not all private prison health care is through such contracts.

Comment

Why is there so much human degradation in today's world, when industry could produce enough to meet almost everybody's basic needs? Why is it so hard to get governments to save lives with standard medical care, when unnecessary killings, wars, imprisonment, and mismanagement of epidemics keep happening on a large scale? One theory for discussion and investigation is that for many reasons societies may not have room for all the people being born or otherwise entering -- leading to pressures to get rid of the excess.

The excellent movie Hotel Rwanda, a true story from the slaughter of about 800,000 people in that country in 1994 (around a tenth of the entire population), failed to emphasize that Rwanda is the most densely populated country in Africa -- and had widespread hunger and even starvation for years, as the land could not produce enough food for all the people. For a short history of modern Rwanda before the genocide, see "Remember Rwanda?" [4], written by a former Minister of Agriculture of Rwanda and published by Worldwatch Institute. For example, this article notes that no violence occurred in communities where food production was over 1,600 calories per person per day (with 72 communities reported).

The U.S. is far from exceeding the carrying capacity of its land (the problem in Rwanda), but it has a different population pressure. Increasing globalization and computerization mean that the economy no longer needs the contribution of millions of people, who are nevertheless still being born. Without enough roles or slots in the system, projects develop to create other roles -- relieving pressure by removing people through prison, wars, violence, depression, and an underclass pushed out of sight and with bad healthcare and low life expectancy. Political leaders may not plan to kill excess people, or to humiliate them or make them less than full members of the human community. But this keeps happening anyway.

Incidentally, adolescent rebellion may mean that the family or larger society has too few roles for new adults. As a result, young people have to fight for a place -- and can end up in criminal or other unplanned or undesirable roles. This can happen in any social class, although it is most likely in the underclass. Also, excessive or pointless scandal may reflect the lack of social space, churning people out of offices or other roles so that others can take their places.

Meanwhile, globalization brings people together who would have had no contact before, allowing the development of conflicts and wars (as well as beneficial relationships) that otherwise would have been impossible. And in mass society, social space may be filled by mass institutions, reducing meaningful roles for people.

If lack of social space or roles is a fundamental cause of serious human problems today, what can be done? A first step is to investigate what has already been learned [5], and then find examples of successful uses of that information.

References

1.The first of the three-part series by reporter Paul von Zielbauer has an overview of many of the problems of prison health care. The second focuses on suicide (a leading cause of death in U.S. prisons), and the third focuses on health care for children in prison. Note: The New York Times charges for downloading articles or editorials more than one week old.

* As Health Care in Jails Goes Private, 10 Days Can Be a Death Sentence. February 27, 2005,
http://www.nytimes.com/2005/02/27/nyregion/27jail.html

* In City's Jails, Missed Signals Open Way to Season of Suicides. February 28, 2005,
http://www.nytimes.com/2005/02/28/nyregion/28jail.html

* A Spotty Record of Health Care in City Detention. March 1, 2005,
http://www.nytimes.com/2005/03/01/nyregion/01jail.html

2. Death Behind Bars. Editorial, New York Times, March 10, 2005,
http://www.nytimes.com/2005/03/10/opinion/10thu2.html

3. Harsh Medicine: New York Times Exposes How Private Health Care in Jails Can Be a "Death Sentence" for Prisoners. Amy Goodman, Democracy Now,
http://www.democracynow.org/article.pl?sid=05/03/04/1437213

4. Remember Rwanda?, by James Gasana, published by Worldwatch Institute. September/October 2002, http://www.worldwatch.org Search for "Gasana" to find the article; the download is free, but you need to register with the site.

5. For example, see "Coping with Crowding," Scientific American, May 2000. After describing the classic "behavioral sink" of crowded rats, the article shows that humans and other primates have learned how to handle crowding fairly well -- reducing conflict, although sometimes at a cost in personal stress, as people or animals work hard to maintain the peace. The author notes that crowding plus resource scarcity may be much more serious than crowding alone. Note that crowding is different from the theory I suggest -- a lack of social or institutional space that can occur for various reasons, whether there is physical crowding or not.

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