What's the health care system like in prison?

Answers to your questions about the news.
March 25 2009 5:28 PM

Jailhouse Doc

What's the health care system like in prison?

Taking blood pressure.
A patient getting his blood pressure taken

A federal judge denied Gov. Arnold Schwarzenegger's request to take over California's prison health care system, which has been out of the state government's hands since 2006. What's the health care like in prison, anyway?

It depends on the state. At best, it's about as good as a low-income health plan. At worst, it's almost nonexistent. In general, when a prisoner gets sick, he tells the on-duty guard. If it's not urgent—a sore throat, say, or an ear infection—the guard will put his name on a list, and an appointment with the prison's in-house doctor may be set up for as soon as the next day. To handle emergencies, most prisons have a nurse on duty 24 hours a day. The majority of ailments are treated on-site, but inmates who are gravely ill can be taken to the nearest hospital. Sick prisoners must make a nominal co-payment for each visit to the jailhouse doctor—usually $5 or so, taken from an hourly wage that typically runs between 19 cents and 40 cents an hour. Costs above that are covered by the state.

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Prisoners get checkups, too, but probably not as often as most people. Incoming inmates always get a physical, blood test and all, to check for diseases or drugs. (There are horror stories about new arrivals dying from withdrawal.) After that, the period between checkups varies. In Pennsylvania, men under 40 are supposed to get physicals every three years, complete with rectal exam, vision screening, and a risk assessment for chronic diseases. Women get pap and pelvic exams every year. Inmates of both genders older than 60 get a yearly electrocardiogram.

At least that's the theory. In practice, many prison systems are so overcrowded that prisoners have to wait days to see a doctor, even in emergency situations. The California penal system, for example, has 170,000 inmates in 33 jails. To make things worse, insurance companies sometimes fail to provide medication and treatment to needy prisoners, and inmate medical records get misplaced regularly. (Read the New York Times' investigative series on insurance giant Prison Health Systems here.) The quality of care also depends on the kind of prison facility. In maximum security prisons, an inmate may be taken to see the doctor in arm and leg chains, and left to wait in a cage. Those who are elderly or chronically ill might qualify for a special treatment facility—like Pennsylvania's Laurel Highlands, where inmates receive constant care.

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Explainer thanks Susan Bensinger of Pennsylvania Department of Corrections and William DiMascio of the Pennsylvania Prison Society.

Christopher Beam is a writer living in Beijing.