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Medical Care Is Too Expensive And Difficult To Access In Louisiana Prisons, Report Says

Angola
msppmoore
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Flickr Creative Commons
The entrance to Louisana State Penitentiary, better known as Angola Prison.

Medical copays, low preventative care measures, poor mental health care treatment plans, expired equipment and low medical staff retention are some of the issues plaguing the Department of Public Safety and Corrections’ health care system.

A recently released report, commissioned by State Rep. Mandie Landry through a concurrent resolution in the House and Senate, indicates that the roughly 16,000 incarcerated people living in Louisiana’s eight state-managed prisons face major barriers to accessing adequate health care.

Landry, whose district is in New Orleans, and the team that produced the report presented the study’s findings to the Louisiana House of Representatives Committee on Health and Wealthfare on Wednesday.

The Medical Co-Pay

One major setback identified is the required copay — $3 for a sick call visit, $2 for a prescription visit and $6 for an emergency visit. Incentive pay for incarcerated people begins at $.02 per hour. According to the report, the $3 co-pay works out to the equivalent of someone who earns the minimum wage of $7.25 paying $1,087.50 for a doctor’s visit.

“Their ability to do a copay or incur medical debt in order to access health care shouldn’t be a factor in whether or not they seek health care,” Andrea Armstrong, Loyola University law professor and co-author of the report, said in an interview.

That medical debt is what gets added to patients’ bills when they can’t pay up-front. Armstrong and fellow researchers argue that debt can dis-incentivize people in prison to seek care.

“If someone were to put money into your account, it would go to pay off the medical debt,” said Bruce Reilly, deputy director of Voice of the Experienced, a nonprofit organization that advocates for restorative justice for people impacted by the criminal justice system.

In an interview, Reilly said the idea that most incarcerated people have family members who are putting money into their accounts is a misconception.

“A lot of people in prisons around the country don’t have families that are connected and supportive,” he said.

Plus, Louisiana’s prison population ranges from age 18 to 91. The older an incarcerated person gets, Reilly said, the less likely it is that their family members are able or even alive to help.

“That grandma’s not going to visit you anymore when you’re 62 years old. So you are left with little income in prison and so that $2 becomes a week’s pay,” he said.

And for imprisoned people with chronic diseases or severe mental illnesses, the co-pays for multiple doctor’s visits and prescriptions can add up quickly.

“The point is not that it’s just $2. The point is that it’s $2 times how many times you really have to be seen,” Reilly said.

Landry, who after the meeting said she is optimistic about pushing through legislation next year to address issues highlighted in the report, said she is particularly “bothered'' by the medical co-pay.

“They shouldn't be charged, period,” Landry said. “Because it's not like they have a choice where they can go. It’s just mean. We don’t need to do that … and I don't see that DOC is in any way depending on that little bit of money.”

Representatives from the Department of Public Safety and Corrections said severe flooding in Baton Rouge prevented them from addressing New Orleans Public Radio’s questions about the report.

The state’s Department of Public Safety and Corrections is required to provide “constitutionally adequate” health care.

High Rates Of Illness And Lack Of Preventative Care

Studies show that incarcerated people have higher than average rates of chronic diseases and severe mental illnesses. The healthcare assessment noted that rates of illness in Louisiana’s prison population are consistent with national statistics. It cited notable numbers for all of the prisons, among them:

  • More than 50 percent of the men incarcerated at Allen Correctional Center have hypertension.
  • 90 percent of incarcerated men at Rayburn Correctional Center are on prescription medication.
  • 17 percent of the men imprisoned at Elayn Hunt Correctional Center have Hepatitis C.

For context, the study’s co-author Ashley Wennerstrom, associate professor at the Louisiana State University Health Sciences Center, told the Health and Welfare Committee that only 1 percent of the general public lives with Hepatitis C.

But Wennerstrom, Armstrong and Reilley’s report noted that incarcerated patients aren’t seeing medical specialists on a scale that matches the high rate of chronic illness within the system. Wennerstrom said she interviewed several specialists who said that by the time they see the imprisoned patients who are referred to them, their conditions have progressed into the late stages.

That could be because the Department of Public Safety and Corrections does not provide preventative care, like annual medical exams, for people in prison who are under age 50.

And the report suggests that many specialty appointments are not being fulfilled. In the Louisiana State Penitentiary, better known as Angola, the team found that doctors ordered more than 8,300 specialty consultations in one year, but only half of them were completed within that time.

How The State Approaches Mental Illness

Multiple Health and Welfare Committee members were concerned with what the team presented on mental health care services:

  • 2014-15 data on the Louisiana Correctional Institute for Women indicates that more than 50 percent of the women held at the facility were on medication for a mental health condition.
  • 30 percent of the men held at David Wade Correctional Center have been diagnosed with an Axis 1 mental health disorder (including, anxiety disorder, post traumatic stress disorder and schizophrenia).

Comparatively, roughly 5 percent of the general population has a diagnosis for a serious mental illness each year, Wennerstrom said. The team depicted an approach to mental health issues that focused primarily on medication distribution and cited some barriers to receiving that medication. In one prison, Armstrong told the committee, patients are solely responsible for waking up to meet a 5 a.m. pill-call.

“Their own mental illness may be a barrier to them getting and taking their medication,” she said, adding that an incarcerated person’s diagnosis and treatment plan often does not travel with them when they are transferred to another prison.

“There was at least one finding in an internal audit by the Department of Corrections that a person who was diagnosed as schizophrenic, their treatment plan said their mental health diagnosis was unclear or there was no diagnosis listed,” Armstrong told Rep. Kenny Cox from Natchitoches.

Medical Records Are Inconsistent

Those details go missing because each prison has its own way of managing medical records.

“There is one prison that will only send a medical summary, but not the actual record,” Armstrong said. “There is another facility, which has an entire elaborate procedure about a red box, and everything goes in the red box with the person and so it's going to depend [on] which prison you're at whether your health records actually get sent to the next place you're going to.”

Reilly said only three facilities are using an electronic records system, which would digitize patients' medical records and make them accessible across the state-managed prison system. Reilly said representatives from the Department of Public Safety and Corrections indicated that the entire system will be digitized by the end of 2021.

More to Work On

Other issues cited in the report include a high rate of emergency visits, which could be related to the lack of preventative care and the sick-call system, which requires a patient to be feeling ill in order to seek a medical visit.

The report noted that multiple facilities failed to replace expired life-saving equipment and medications, including defibrillator pads and insulin.

It also touched on the difficulty of retaining medical staff. One prison had two nurse vacancies for more than a year.

And it mentioned that the licenses of doctors serving Louisiana’s incarcerated population have come into question. A representative at the Department of Public Safety and Corrections said that one doctor is operating on a restricted license. A recent article from Scalawag magazine alleges that “10 out of 11 doctors overseeing healthcare for prisoners have a restricted medical license,” including the department’s medical director, Dr. Randy Lavespere.

The department did not provide researchers with a list of healthcare providers, as it requested.

Recommendations

The report recommends that the Department of Public Safety and Corrections, along with the state’s health department and a group of eternal medical and behavioral health care providers create an oversight committee to, among other things, outline procedural standards and look into the impacts of medical co-pays and access to constitutionally adequate medical care.

Every member of the health and welfare committee appeared eager to work with Rep. Landry to improve the prison health care system in the state.

“It was very pleasantly surprising how intrigued they were,” Landry said. “Several of them wanted to work on this issue more. That doesn't happen very often, especially from some of the conservative members.”

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