Care needs of prisoners put Oregon in a bind November 12, 2007
Posted by FairSentencing in : Current News , trackbackA lawsuit by an Oregon inmate demanding a sex-change operation spotlights the increasing complexity and cost of providing health services to the state’s 13,500 prisoners.
Anny May Stevens, a Portland man serving an 18-year sentence for manslaughter, contends in court papers that prison officials denied him medical treatment for transsexualism.
“I didn’t ask to be born this way,” Stevens, 45, said in an interview from Snake River Correctional Institution in Ontario. “But I sure don’t want to die this way.”
Prison officials don’t dispute Stevens’ diagnosis, but they rejected his request, arguing in court papers that neither hormone treatment nor surgery is medically necessary.
Though transsexual inmates are rare, prison officials report a surging demand from inmates for a wide array of conditions, diseases and mental illnesses.
Since 1995, the annual cost of providing health services to Oregon inmates has risen from about $20 million to $60 million. That threefold jump far exceeds the inmate population increase over that period.
“When you lock them up, there is an obligation to feed them, to shelter them, to clothe them and give medically necessary care,” said Dr. Steven Shelton, medical director of Oregon’s prison system. “I don’t get to choose who comes in the front door, and I can’t turn away anybody.”
Mandatory prison sentences helped increase the Oregon prison population by 80 percent in the past decade.
And inmates are arriving sicker than they used to, with higher percentages suffering from diseases and mental health conditions, according to Oregon prison health officials.
Longer sentences also increase the number of elderly inmates with all the health problems associated with age.
And although Oregon officials refuse to give Stevens a sex change, they agree that they are required to provide the level of medical treatment an inmate would receive in the community — regardless of cost. For instance, cancer treatment that required taking inmates outside prisons cost $3.5 million in 2005-07.
Involving the courts
Not providing medical treatment invites lawsuits.
Last summer, Oregon agreed to pay nearly $800,000 in damages and attorney fees to settle a class-action lawsuit about the treatment of prison inmates with hepatitis C.
More dramatically, a federal judge in 2005 took control of California’s prison health care system after ruling that it was so inadequate that it violated the constitutional ban on cruel and unusual punishment.
“Obviously, we don’t want to go there,” said William Hoefel, state corrections health services administrator.
Stevens, who stabbed a man in downtown Portland in 1997, is one of more than a dozen transsexual prison inmates across the country who have sued over medical treatment in recent years. A federal judge last summer ordered Idaho prison officials to provide hormones to a transsexual inmate while his lawsuit is under way.
In Wisconsin, a lawsuit by a transsexual inmate sparked a political backlash. The Wisconsin State Assembly in 2006 passed a law prohibiting prison officials from providing hormone treatment or sex reassignment surgery to transsexuals.
“Taxpayers should not have to foot the bill for people desiring to enhance their breasts or change their sexual organs,” Rep. Mark D. Gundrum, a Republican from suburban Milwaukee, said in an interview.
Michelle Burrows, a Portland attorney who has frequently filed lawsuits on behalf of inmates, criticized state prison officials for their treatment of transsexuals.
“They won’t even let them shave their legs,” Burrows said.
Burrows filed the hepatitis C lawsuit against the Oregon prison system. There were 3,000 to 3,500 inmates involved, and prison officials “were saying we can’t afford to do it,” she said. “Well, you can’t say you can’t afford to do it.”
For more than 30 years, the federal courts have said it is cruel and unusual punishment to deliberately withhold medical care from inmates.
Still, Burrows credits Max Williams, the state corrections director, with making improvements in recent years: “I think Max Williams has made a concerted effort to do the right thing.”
Inmate health declines
Prison officials will not discuss Stevens’ case, but they said providing medical treatment is growing more complex and expensive. Shelton, the prison system’s medical director since 1993, said he has seen a huge change in the health of the inmate population.
“Almost 27 percent in the prison system have severe or moderate mental illness, up from 15 percent,” Shelton said. “The percentage of people with heart disease, diabetes, respiratory disease, cancer — all have increased at a faster rate than the population in general.”
Part of the increase can be attributed to older inmates, those held much longer under mandatory prison sentences. But Shelton said that doesn’t explain all of it, and he doesn’t know the answer.
“They’re just coming in sicker,” he said.
Medical advances increase the costs. Knee surgery wasn’t commonplace 15 years ago, Shelton said, but inmates now receive it when necessary. Drugs for diseases such as AIDS are multiple — and expensive.
“If we do an appendix surgery, we will do it with aproperly qualified surgeon,” he said.
The California prison system, with 173,000 inmates, is an example of what can happen when health care is mismanaged.
A 2001 lawsuit culminated in a takeover of the system by a federal judge, who appointed an outside administrator to run it last year.
The administrator — not the California Legislature — will decide whether to raise salaries, streamline drug-buying policies and more.
Rachael Kagan, a spokeswoman for the administrator, said there is a $1.5 billion annual budget for health, mental health and dental care in California prisons.
“It is very likely that that amount will go up,” Kagan said.
Loading ...
Comments»
no comments yet - be the first?