Inmates' rising medical costs weigh on prisons

CHESTER COUNTY In July, inmates were removed on 38 occasions from the Chester County Prison for medical treatment.

Six received orthopedic care. Three went to an eye doctor. One saw a podiatrist. Ten were taken to the emergency room - for everything from a ruptured appendix to labor pains.

And all contributed to what prison officials say is a significant increase in inmates seeking complex medical care that prison infirmaries can't provide, adding significantly to the costs of incarceration.

To date, the county prison has reported 34 hospitalizations this year, and that's not counting the number of inmates who sought specialized care at cardiologists' offices or dialysis clinics, Chester County Prison Warden D. Edward McFadden said.

By comparison, in all of 2012, only 21 inmates were taken to hospitals. In 2011, there were 20.

"What we're finding is more and more patients really have complicated medical histories," McFadden said.

Those complicated histories can prove costly. In Chester County, the prison has a multimillion-dollar contract with PrimeCare Medical, a health-care contractor that works in about 35 prisons across the state.

PrimeCare officials estimate sending an inmate to the hospital can easily surpass $1,000 a day - and visits to an outside doctor can run from $100 to $200 each.

The company also has to pay legal bills. Last month, a federal lawsuit was filed on behalf of the family of Rae-Mone Carter Jr., 26, who died March 16 of acute-onset diabetes. According to the suit, Carter's death was preventable, and PrimeCare workers failed to provide the treatment that would have saved him.

Carter's family seeks up to $900,000 in damages from the company and Chester County. An attorney for the company said it would defend itself "aggressively."

For McFadden, taking a prisoner to the hospital involves another issue.

"The amount of transports - not only is it an issue financially, with the individual going and getting services, but that's a security cost for me," McFadden said. "Those trips can be rather costly. I have to cover that person around the clock. If they're hospitalized, that's 24 hours, seven days a week."

Part of the problem, officials say, is that many inmates don't have access to health care or preventive care until they're in prison. Some arrive at the county prison with substance-abuse issues. In July, 24 inmates participated in the prison's outpatient drug and alcohol programs.

"Sometimes, the best health care individuals receive is when they are incarcerated," McFadden said.

And even that care isn't enough sometimes. PrimeCare gives all inmates a medical assessment upon their arrival, asking up to 100 questions about their medical history, and oversees basic medical care at the prison, but it can't provide services like dialysis or prenatal care. (In July, prison officials recorded six medical transports for prenatal care. Four emergency-room visits were for inmates with labor pains.)

There isn't a cure-all for a prison population with increasingly complex medical issues, experts say.

"Providing people who don't have appropriate medical care through prisons and jails is just about the worst way you could do it," said Amy Fettig, senior staff counsel for the ACLU's National Prison Project. "A lot of the story here is a lack of community-based health care."

Though rising health-care costs are a problem nationwide, Fettig said, prison health-care costs tend to rise even more rapidly because transportation and logistics costs are added to the mix.

"This is a social problem that goes well beyond the corrections field. They don't control their front door," she said.

Access to preventive care could help prisoners stay healthy and ease costs for prisons, McFadden said. But for those already on the inside, it's often too late.

"How do you go about providing preventative care to those on the street, the mentally ill, the homeless?" he asked. "That's a heavy question with not an easy answer."