Health Care in US State & Federal Prisons

The purpose of this research is to examine the current status of health care within the American state and federal correctional systems. The plan of the research will be to set forth the context in which prison-related health care takes place, and then to discuss the administrative environment in which treatment takes place, the availability of primary, maintenance, and rehabilitative health-care services for the varieties of both major and minor medical problems and where they are provided, the quality of care and how it is monitored, and the economic aspects of health-care services in prisons.

In 1971, describing prisons as "factories of crime," Ramsey Clark (1971, pp. 212-13) wrote that "ninety-five per cent of all expenditure in the entire corrections effort of the nation is for custody--iron bars, stone walls, guards. Five per cent is for hope--health services, education, developing employment skills." One might reasonably expect that, between 1971 and 1996, conditions had changed. But the record indicates that health-care issues for prisoners have not only not been resolved but for a variety of reasons have become more complex. The prison population, as reported by the U.S. General Accounting Office, doubled in the 1980s (National Pages, 1989), and by 1994 it had increased to more than one million (Thomas, 1994; Shogren, 1994), as a number of sources report. Sources disagree, however, on the consequences of such numbers. Shogren (1994) points to a reduction in crime rel

1996 has been unprecedented in the increase of TB and that prison populations are among the highest risk groups for this disease. Some sources suggest that prisons might be a mechanism for halting the spread of a whole range of diseases. Valway, et al. (1994) recommend that inmate transfers be evaluated with reference to the need to control infection and prevent the spread of TB. Along the same lines, Glaser and Greifinger (1993) say that the corrections system could play a positive health-care role, particularly in if it were more attuned to the epidemiology of such diseases as AIDS, TB, and venereal disease The reason is that, because of prisoner demographics, most prisoners have limited experience of medical care. Ideally, they say, a sentence period could be used to educate prisoners on health care both during and after the term. However, the record appears to be that the amount and quality of health care is in many cases substandard. Meanwhile, a few facilities appear to virtually foster poor health owing to long-term policies. Skolnik (1990) says that the hazards of tobacco use are essentially ignored by correctional facilities that sell cigarettes at deep discounts or have cigarette-manufacturing facilities on the premises