Older prison inmates run up state health costs

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Capital News Service
LANSING — The number of prisoners older than 50 has increased 146 percent since 1998, according to Michigan prison officials.
This jump from 3,589 prisoners in that age group to 8,819 in 2014 creates a number of health care and cost challenges for state prisons, said Chris Gautz, public information officer for the Department of Corrections.
The aging of inmates between 1994 and when she retired in 2012 was stark, said Carol Howes, a retired warden who worked at the Lakeland and Coldwater prisons.
“The prisoner population was much sicker,” she said.

Lakeland houses elderly inmates and it wouldn’t be uncommon for them to arrive from a hospital for post-operative care, Howes said.
“Of Lakeland’s 80 elderly prisoners, around 30 were in wheelchairs, many had heart problems, COPD (chronic obstructive pulmonary disease) or Parkinson’s,” she said.
The trend reflects the outside world. “A 20-year-old prisoner is going to get sick and need to see a doctor less often than an older prisoner,” Gautz said.
Michigan’s prisons have tried to address this change in demographics.
“We have a prison hospital in Jackson, one of our Detroit prisons has a dialysis unit and our Jackson prison now has a chemotherapy clinic,” Gautz said.
The prison in Coldwater was intended to house elderly prisoners, Gautz said.
“We try to group older prisoners together when we can,” Gautz said. “There are more medical services offered at the prison. There are enlarged doors for wheelchair-bound prisoners. They are around people their own age and less likely to be preyed on by younger prisoners.”
But advocates say there are many more older inmates throughout the system.
“Coldwater only holds 1,700 inmates and another 14,800 prisoners are probably in the same category of care needed as the inmates in Coldwater,” said Daniel Manville, director of the Michigan State University College of Law Civil Rights Clinic.
As prisoners age, preventive care is vital to lowering the cost of prisoner medical care to taxpayers, according to Michael Steinberg, American Civil Liberties Union of Michigan legal director.
Those costs could be lowered by releasing elderly prisoners who no longer pose much threat to society, Steinberg said.
“This aging of the prisoner population is really turning correctional facilities into nursing homes,” Steinberg said. “It’s a waste of taxpayer money and lives.
“The number of repeat offenders drops dramatically when people reach the age of 50 and even further for people age 65 and over,” Steinberg said.
Coldwater costs $24 million annually to operate at a daily cost to taxpayers of $50.18 per prisoner, Gautz said.
“Our health care costs are on the rise,” he said. “Obviously caring for older prisoners is more expensive and that does add to our bottom line.”
The current Corrections health care budget is $300 million, Gautz said.
Steinberg said these costs could be lowered if the Legislature reexamines the minimum sentencing mandates for drug-related crimes put in place during the 1980s and 1990s.
“The place to start is with elderly inmates in prison as a result of the war on drugs,” he said.
Gautz said health care services in Michigan prisons are provided by private contractors,.
Michigan switched from prison-staffed medical facilities to privately contracted staff in the 1990s as a cost-cutting measure, but quality of care suffered as result, according to Manville.
“The less medical service provided, the more profit these companies can make,” Manville said.
Some former Michigan prison officials shared Manville’s sentiment.
“I noticed a difference in care quality after we switched to private care providers,” Howes said. “Some of the care decisions I felt were made more based on cost.”
Private care providers make the final decisions on the medical treatment that prisoners receive.
“You and I can call up our doctor if we have an emergency and can see them in the next day or so,” Manville said. “Inmates don’t get to decide if they see a doctor when they have an emergency.”
One particular prisoner’s case stood out, Howes said.
“We had a prisoner in his 50s or 60s who had colon issues and they (privately contracted prison doctors) detached his colon,” Howes said. “He was told they would reattach it but then they said it would cost too much. We appealed it three times because we didn’t want him to spend the rest of his life using a colostomy bag, and they reversed their decision.”
“I didn’t think it was right to tell him they were going to reattach his colon to get him to have the surgery, then back out of that after the fact,” Howes said.
Privately contracted providers often ignore preventive medicine, critics say.
The Corrections Department “does not have a policy per se to catch things early on,” Manville said. “It’s the way they should do it and they would save money, but you’d have to spend money now to set that up and people tend to not look past next year’s budget.”
This lack of resources means that basic medical needs of elderly prisoners often go unmet, he said.
“Lakeland has been without a dentist on staff for some time,” Manville said. “The people they bring in can’t even handle the volume of dental emergencies they receive, let alone issues with dentures.”
Manville is currently working on a class action lawsuit against dental directors at Lakeland and  other Michigan prisons.
The issues with medical care in Michigan prisons ultimately boil down to prisoners’ constitutional rights, according to Manville.
“Common sense says you should treat everybody with serious medical issues with the quality of care they need, regardless of if they are a prisoner or not,” Manville said. “Right now they are basically getting the minimal level of care.”

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