Poor health care moving from prison to jails

Photo via Thinkstock.
Photo via Thinkstock.

California’s sweeping criminal justice reform plan was meant to sharply reduce the state’s prison population. But the changes may have also had the unintended consequence of passing along to county jails the biggest problem associated with overcrowding – poor health care.

The reform, also known as prison realignment or AB 109, transferred authority for people convicted of certain non-violent felonies from the state to the counties in 2011.

The changes were based in part on the idea that counties, which provide public health and social services, are better suited to meet the needs of the non-violent inmate population. The switch was California’s solution to alleviate the swollen populations of its state prisons, which had reached 200 percent of their designed capacity.

While the counties were encouraged to pair incarceration with options like treatment and community supervision rather than replacing prison time with jail time, they were not required to do so. Counties can and do decide to send people to jails, which were intended for short stays, for long sentences.

In some counties the inmate population has surged, while in others it’s been a mere trickle. The counties’ ability to attend to their population – and provide adequate health services – varies from one county to the next, and some are finding they’re not up to the task.

“The biggest challenge is that the scope of the mission has changed,” said Aaron Maguire, a Legislative Representative for the California State Sheriffs Association.

County jails are typically meant to house people for up to a year, he said, and even then that’s only in rare cases (say, someone awaiting a murder trial). Now jails are getting inmates sentenced to up to five years, some over 10. In Los Angeles County, an inmate has been sentenced to over forty years, Maguire said.

“That’s not someone moving out of the system,” he said. “And if they have health care needs, whether it’s a chronic illness or whatever, the delivery of that care becomes much more challenging.”

The effects of overcrowding on inmate populations are not new territory for California corrections facilities. In the past, two federal class action lawsuits alleged the California Department of Corrections and Rehabilitations (CDCR) committed constitutional violations of inmates’ health rights. They determined that the overcrowding of the prisons was the primary reason for what was considered cruel and unusual punishment.

The first case, Coleman v. Brown, involved inmates’ mental health care and the second, Plata v. Brown, involved inmates with serious medical conditions. The lawsuits led to the formation of a three-judge panel that eventually ordered California to reduce the prisons population by 30,000 inmates – or to 137.5 percent of capacity – by 2013.

But now the health problems related to overcrowding are starting to plague county jails. Law firms advocating inmates’ rights have filed lawsuits in several counties, including Riverside, Fresno and Alameda.

Three prisoners in the Riverside Jail system have filed suit alleging that the County is subjecting them to cruel and unusual punishment for denying them adequate mental and medical health care.

The lawsuit points to specific cases of failures in the jail health-care system. For example, one female plaintiff had a temporary filter placed in her heart before entering the jail system. Because the jail failed to provide proper follow-up care, the suit alleges, scar tissue developed and the filter could no longer be removed safely. As a result, the 26-year-old inmate will remain on anticoagulation medications and will be at risk of fatal bleeds and other complications for the rest of her life.

Riverside County declined to comment on the accusation, citing pending litigation. According to the complaint, Sheriff Stanley Sniff informed the Board of Supervisors that the lack of infrastructure and staff to deliver life-saving care had resulted in a “crisis in the jail system.”

The lawsuit against Fresno County alleges the jails’ poor design and inadequate staff makes inmates vulnerable to attacks from other inmates. It also alleges that its inmates are continually denied treatment for medical issues, mental health and dental problems.

In Alameda, a disability advocacy group alleged that the county facilities lacked infrastructure accessible to inmates in wheelchairs, and that disabled inmates weren’t able to access programs and services.

While Maguire and others are concerned these may be the beginning of many more lawsuits aimed at counties, not everyone is stumbling.

“For us, it hasn’t been an abrupt shift,” said Susan Kole, Director of Correctional Health in San Mateo County.

Kole said that while she and her staff are seeing an increase in the number of patients requiring multiple medications, they hadn’t yet experienced many changes in the medical conditions that inmates were presenting. She said the county had plans to build a new jail in a few years to allow for more space, “but for now, the space and staffing we have is adequate to meet treatment standards.”

San Mateo’s success may be in how it chooses to spend its state aid: a whopping 58 percent of their 2011-2012 realignment funds from the state were spent on health, treatment and services. Riverside and Sacramento counties, in contrast, allocated 20 percent and 0 percent respectively on health, treatment and services.

However, many of those funds were not intended for direct health care. Instead, they went to continue support programs for inmates on their way out of the system. Louise Rogers, Deputy Chief for San Mateo County Health System, said that while there was much controversy about how to use state funds, the county opted to focus on decreasing the likelihood of inmates returning to jail.

“We’ve had some pretty active reentry efforts historically here,” she said.

In 2009, San Mateo was awarded a grant that funded a program they dubbed Achieve 180, which created support networks for former inmates based on their particular needs. Securing housing and employment, substance abuse treatment or gang prevention counseling are some of the services the county focuses on in an attempt to reduce recidivism.

Another advantage is that San Mateo is not dealing with a huge jail population. “Our numbers are not enormous compared to other counties,” she said.

Maguire agrees. He suggests that a county’s success in delivering health care to its inmate population depends largely on the number of inmates it took on under realignment, and the length of their sentences.

While some counties in the state don’t have any inmates serving more than 10 years, Los Angeles County has approximately 40 people sentenced to more than 10 years.

“Health care needs are different for those people than someone who’s there for six months,” he said.

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