Meanwhile, changes in judicial sentencing rules, an epidemic of drug use and decades of tough on crime laws have packed prisons and jails, contributing to overcrowding conditions and quality-of-care problems.
We are on an incarceration frenzy, says Joel Dvoskin, a psychologist and mental health consultant who teaches at the University of Arizona College of Medicine and is president of the American Psychology-Law Society. In 1970, there were fewer than 400,000 prisoners and inmates in prisons and jails. Now were on track to have 2.5 million people behind bars.
Nobody ever got elected promising to raise taxes, Dvoskin says, noting that courts have pushed state and municipal governments to improve medical and mental health services for prisoners. Weve seen an astonishing difference in the quality of mental health services in prisons since 1976. Litigation is a very bad way to improve things. But the threat of (litigation) is a very good way. Jails are public health outposts. Folks who would be running around infecting people sometimes get treatment in jails they wouldnt or couldnt get in the free world.
The incarcerated include a healthy-size portion of unhealthy patients, a captive population that averages 2.2 million daily.
Between 9 million and 11 million prisoners will be released within a given year, often transmitting infectious diseases they acquired behind bars to the general public and back to prison if they return. But it isnt just the fast-growing number of prisoners causing breakdowns in the prison healthcare system.
Though recent, accurate figures are not available, in 1996 between 12% to 35% of those in the U.S. with communicable diseases passed through jails or prisons, according to the National Commission. In 1997 there were 137,000 cases of sexually transmitted diseases among prisoners and three times that numberabout 465,000among released prisoners. More than one-quarter of inmates have some form of hepatitis, 12,000 have active tuberculosis and 135,000 have tested positive for TB.
While the number of both HIV-infected state and federal prisoners and AIDS-related prisoner deaths dropped for the fifth year in a row in 2004, the percentage of HIV-positive and AIDS patients in prison remains disproportionately high compared with the general population, according to the U.S. Justice Departments Bureau of Justice Statistics.
The number of HIV-positive inmates decreased 2.6% to 23,046 in 2004 from 23,663 in 2003, and down 10.7% from a high of about 25,800 in 1999. AIDS-related deaths dropped 28% to 203 in 2004 from 282 in 2003 and the death rate from AIDS dropped as well. But the number of confirmed AIDS cases increased 1.4% to 6,027 in 2004 from 5,944 in 2003.
And the rate of AIDS cases among inmates (50 per 10,000 prisoners) remained more than three times higher than the general population (15 per 10,000 persons). Justice Department statisticians attributed the decrease in AIDS deaths and HIV infection to the introduction of protease inhibitors and antiretroviral therapies.
Government studies also indicate that more than 60% of prison and jail patients have mild or serious mental illnesses or substance-abuse problems. Those addictions aggravate complex respiratory conditions, infectious diseases and chronic conditions, such as diabetes and heart disease, prison health experts say. And the bulk of the cost of caring for them, estimated at between $7 billion and $8 billion annually for all prisons, is footed by taxpayers whose elected officials never want to be viewed as soft on crime or generous with benefits for criminals.
Prisoners typically dont have high-powered lobbyists pleading their cases, as do seniors, people with disabilities and patients with cancer and heart disease. Prisoners are disproportionately black and Hispanic, mostly poor and frequently uneducated, according to federal prison studies and the American Correctional Association.
We serve the most disenfranchised people in this country, says physician Sergio Rodriguez, until recently the medical director of Cermak Health Services of Cook County (Ill.), the largest single-site correctional health facility in the country, which annually provides healthcare services to about 100,000 prisoners at the Cook County Jail.
They never integrate into the healthcare system outside. We are their primary-care provider. They dont see us as jailers, but as advocates. We are their doctors, sometimes the only ones they ever see.