A new report by the Prison Policy Initiative analyzing the causes of poor healthcare in correctional settings around the country argues that prison healthcare is designed to limit costs and ward off lawsuits rather than provide adequate care for the people it is ostensibly supposed to be serving.
The report, entitled "Cut-rate care: The systemic problems shaping 'healthcare' behind bars" utilized research, news investigations, government reports, and contractor documents to better understand the “big picture” relationship between healthcare providers, government agencies, and incarcerated people.
“With prison healthcare, you regularly see that incarcerated people’s complaints get ignored, their requests for exams get denied, and their care gets slow-walked,” said author Brian Nam-Sonenstein, in a press release. “That’s because prison healthcare systems are really more like liability management systems, and what’s bad for patient care can actually be good for limiting liability.”
While state and local governments are on the hook for the substantial burden of funding medical care for people in their custody, they’re blocked from receiving crucial federal subsidies to fund that care. As a result, they often look to private health care companies that look to keep costs down above all else. They do so by refusing, limiting, or altering treatments and prescriptions; denying and slow-walking care; limiting staff expenditures; and severely limiting and/or rejecting patient preferences.
Private correctional healthcare providers also take extra care in shielding department officials from the costs of lawsuits, by relying on what’s known as “indemnification” — which means that if an incarcerated person sues over medical care, these contracts specify that that the contractor will assume some or all of the financial risk of the lawsuit.
“Private or public, the goal of prison healthcare providers is to provide the minimum amount of care possible in order to avoid claims of negligence,” said Nam-Sonenstein. “These are medical systems caught up not just culturally, but systemically, with the handing out of punishment. That won’t change until we take correctional healthcare out of the hands of departments of corrections and give it to professionals who are solely focused on public health.”
The report issues several recommendations to prioritize the health needs of incarcerated people over the budget and security needs of prisons. It suggests ending contracts with for-profit healthcare providers, and removing healthcare from corrections departments entirely.
It also suggests improving quality and performance indicators for healthcare in prisons, calls for more independent oversight and accountability, and removing obstacles to litigation when incarcerated people have not received adequate care.
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