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National: Editorial on prison (PHS) health care.

Death Behind Bars
EDITORIAL
March 10, 2005

The United States has about 2.1 million people behind bars - a larger proportion of its population than any other nation in the world. The correctional system's price tag is more than $60 billion - up from just $9 billion two decades ago - and states are understandably eager to shave costs. Some are attempting to do it by cutting back on already dismal prison medical care.

Prison inmates are literally the sickest people in our society. States and municipalities frequently try to dodge the bill for treating them by ordering up bids from private providers and signing up with the cheapest, most bare-bones plan. Paul von Zielbauer of The Times recently opened a window onto this aspect of the problem with a harrowing series of articles about Prison Health Services, the nation's largest private provider of jail and prison medical care, handling about one in every 10 people who live behind bars in this country.

Among the horrific deaths described in the series is that of Brian Tetrault, a 44-year-old man with Parkinson's disease who died after an upstate New York jail's medical director drastically cut his medicine. Officials then falsified records to make it appear that Mr. Tetrault had been released before he died. Another upstate inmate, 35-year-old Victoria Williams Smith, died of a heart attack after being mocked by a prison nurse and denied treatment for days. Equally as troubling were accounts of how Prison Health Services failed to keep a close eye on inmates who later committed suicide, and its habit of sometimes employing doctors with criminal records and doctors who lacked state certification.

Shoddy care and the denial of care are unfortunately not unique to private companies, which do not provide the majority of the health care that is supplied to inmates. Many publicly run systems, which provide most of the care for the nation's inmates, are equally bad. The root problem is that the country has tacitly decided to starve the prison system of medical care, even though AIDS, tuberculosis and hepatitis are rampant behind bars, and roughly one in six inmates suffers from a serious mental illness.

The corrections system is largely cut off from the public health system, in part because of federal rules that deny Medicaid assistance to inmates. The denial of benefits is based on the notion that people who break the law don't deserve public help, a theory that has helped spread tuberculosis, AIDS and hepatitis from prisons to the world outside. Privatization of services is no magic cure for this growing threat to public health. The common-sense response would be a coherent, publicly subsidized program of testing, counseling and treatment that would slow the spread of disease, both behind bars and after inmates were released.

http://www.nytimes.com/2005/03/10/opinion/10thu2.html?th