State of the State: Illinois Has Too Many Inmates Who Get Health Care Too Late

May 1, 2013

Jamey Dunn
Credit mattpenning.com 2014 / WUIS/Illinois Issues
Illinois should provide mental health care and addiction treatment to those who truly need it instead of incarcerating thousands of the addicted and the mentally ill, making taxpayers shell out for care in the much costlier settings of prison and jails. 

And when people with these issues land in the corrections system, treatment should be easily accessible. The state should also work to ensure that when inmates are paroled, their mental health care and addiction treatment continues in the community, thus reducing the odds that they will return to the state’s crowded prison system.

But at a recent hearing on health care in the state’s correctional system, Nick Little, Wexford Health Sources vice president of quality, compliance and business affairs, said the company, which administers health care in Illinois prisons, struggles with ensuring that parolees get follow-up care on the outside. “That’s a difficult issue for us. We try. At least we give them info as to where there [are] clinics available, but that again is a challenge for us because a lot of these offenders are not insured. And there are some providers who will not take them,” he says. “I think the hardest one for us probably is mental health.” 

In 2011, the state entered into a 10-year contract with Wexford Health Sources to provide health care to the 49,000 prisoners held by the Illinois Department of Corrections. Wexford estimates that at least 15 percent of the prison population — more than 7,000 — suffers from “severe mental illness.” Little said that inmates are supposed to receive a two-week supply of medication, or in some cases a prescription, to give them time to find treatment once they are released. But Democratic Rep. La Shawn Ford says he gets complaints from residents of his district, which is on the west side of Chicago, that former inmates don’t have access to their medication. “It’s not happening,” he says.

Little acknowledged that there could be some cases where offenders do not get their medication, but he said it is not the norm. “I’m sure there are cases where people are paroled on a very quick basis and may not get the medication, but this is standard practice throughout our system.”

Some may argue, and often do emphatically in Internet comment sections almost any time there is a story about the state’s prisons, that inmates are criminals who deserve what they get behind bars. So who cares if their health care isn’t so great? This idea, like many other comments in the same vein, misses a key point: Most inmates are getting out eventually and will bring all the problems, including their health issues, they had in prison with them when they return to society. “IDOC’s health care system is not just an issue for the state’s prisons. Every year, almost 35,000 inmates leave IDOC to return to their communities. If the prison system is not able to meet its health care obligations, cities, counties and the general public will inevitably pay a higher price when inmates are released, with increased transmissions of infectious diseases, emergency room visits and higher recidivism rates,” said a report on health care from the John Howard Association, a Chicago-based prison watchdog group. 

Certain communicable diseases, such as hepatitis C and HIV, are more prevalent in prison populations. For example, Wexford estimates that more than 15 percent of the prison population has hepatitis C. Only about 1 percent of the general population has chronic hepatitis C. (According to the Centers for Disease Control and Prevention, somewhere between 15 percent and 20 percent of those infected with hepatitis C will clear the disease without medical treatment.)

“Most inmates come from medically deprived backgrounds and lack access to basic preventative medical care,” says John Maki, executive director of the John Howard Association. The association’s analysis and the work of some media organizations, perhaps most notably among them public radio station WBEZ Chicago, has helped to prompt lawmakers to look into the state of prison health care in Illinois.When reporting on the untended health care needs of several inmates — including a man who had a growth inside his hand that he says prison doctors told him to have taken care of as soon as he was released — WBEZ reporter Rob Wildeboer asked one warden how he can ensure that Wexford is doing its job at his prison. “OK, I don’t have an answer for that,” said Victor Dozier, warden of the minimum security Vandalia Correctional Center.

Under House Resolution 57, an outside group would audit the company’s work in Illinois. Rep. Greg Harris says it is time to follow-up on complaints about prison health care and find out what is happening under the $1.3 billion contract with Wexford. “This is a huge issue, moneywise, peoplewise and community-impactwise,” he says. Little says Wexford would welcome the additional oversight. 

Corrections officials say using a vendor allows the state to give quality care to prisoners at a lower cost. “We feel that the inmates receive a higher level of care through a vendor who specializes in prison health care than they would through any state operated system,” says Bryan Gleckler, chief fiscal officer for IDOC. “Having a health care vendor enables the department to provide quality health care based on national standards and provides substantial savings.”

However, anecdotal accounts seem to indicate problems. Doris Green, director of correctional health and community relations for the AIDS Foundation of Chicago, has worked for many years advocating for inmates. But she says the death of her incarcerated husband made her feel powerless to deal with the system. “I did not know how broke the system was until my husband was diagnosed March 3, 2011, with stage IV bone cancer and prostate cancer,” she says. Green says she was unable to ensure that her husband received a medication that his doctor had prescribed.

“It was just impossible. I did everything. I did everything. ... Me, as an advocate for 30 years with all the experience that I have with working with the Department of Corrections, and all the influence that I have with working with the prison system.” She said that eventually, her husband did get the treatment, but “by the time he got the medication, it was too late.” This is just one of many stories of inmates who say there were denied treatment or their treatment was delayed and their conditions worsened. 

More than 300 health care professionals employed by the state work alongside Wexford employees in the prisons. Mary Johnson, who worked as a registered nurse for 12 years at the medium security Graham Correctional Center, says Wexford did not provide enough medical supplies to the prison. “We ran out of temperature probes during a flu epidemic; we have run out of gloves on more than one occasion. I find it very, very sad that I had to file a grievance with my union because we had no gloves,” she says. “It was constantly an ongoing struggle to do my job and take care of people when I didn’t have supplies to do it.” Johnson says that an EKG machine was broken for five months, and inmates had to wait for six months to get psychiatric care. 

It is easy to point fingers at a contractor providing services in prisons for a profit, but if there are breakdowns in Corrections’ health care system, state bureaucrats and elected officials also share the blame. “Decisions to lengthen sentences, mandate harsher punishments for drug-based offenses and close public mental health institutions have filled IDOC with inmates who are drug addicted, mentally ill and growing older. As a consequence, state prisons have become de facto hospitals, asylums, drug treatment facilities and retirement homes,” said the John Howard report. 

The report said that these policies crafted a prison health care system without direction, public policy goals or even a specific moral compass. “Through decades of passing laws and supporting policies that have filled our prisons with an unprecedented number of inmates, we have built a prison health care system without asking difficult and yet fundamental questions about what we have created. Where will we find the resources to ensure our prison system can provide constitutionally adequate health care? Given Illinois’ fiscal crisis, is prison the most cost-effective way to treat people with special health care needs? Do we want our prisons to double as hospitals for the mentally ill or the elderly?”

According to HR 57, the state faced an estimated 250 lawsuits related to prison health care when it put out the bid that eventually led to Wexford getting its 10-year contract. If Illinois fails to provide adequate health care for prisoners, it could face sanctions similar to California. A U.S. Supreme Court ruling in 2011 found that the conditions in California’s overcrowded prison system violated prisoners’ constitutional rights because the system equaled cruel and unusual punishment. The court ordered the state to cut its prison population by 30,000 inmates. In the ruling, the justices focused on the degradation of the prison system’s health care and mental health care. And as Illinois closes prisons and houses inmates in gyms, it is beginning to look more and more like California did a few years ago. 

A January story from The New York Times recalled what one California prison was like before the state’s lockups shed several thousand prisoners.

“The gymnasium in the state prison here is hardly glamorous, just some concrete walls and a couple of basketball hoops. With fewer prisoners, and less fear of tensions caused by overcrowding, inmates at Chino are getting more time in the yard. But a year ago, those hoops were nothing more than ornaments. The gymnasium at the California Institution for Men was neither alive with the sound of thumping basketballs, nor used for workout. Like any other space in the state prison system, it was used for housing. It teemed with far more inmates than it was meant to handle, and officials lined any open space they could with bunks crammed so close together that it was sometimes difficult to squeeze between them.” Sound familiar?

Illinois Issues, May 2013