Transcript Health-Care-in-La-Prisons-Dr.-Singh

Health Care in
Louisiana Prisons:
An Overview
Raman Singh, M.D.
Medical/Mental Health Director
Louisiana Department of Public
Safety and Corrections
Overview Louisiana Corrections
Health Care
• Our great nation also has the highest incarceration rate
in the world and many of the incarcerated individuals are
a product of; broken families, broken educational
system, unhealthy job market , lack of access to
adequate health care, etc.
• Over the years, Correctional leaders have come to
realize that the traditional “lock and feed" model is only
adding fuel to the fire and now there is a strong wave of
re entry efforts to tackle the core issues of the criminal
justice system.
• The focus has shifted from “ minimum to get by” to “
finding and implementing best practices to build and run
an efficient correctional health care system”.
It is often said that the
measure of a civilization
is how it treats it’s
weakest members, the
last, the least, the littlest.
A Right to Medical & Mental
Health Care for the Incarcerated
Landmark Case of Estelle v. Gamble
1) Right of access to health care
2) Right to care that is ordered
3) Right to a professional medical judgment
Those that are incarcerated do not have the
ability to drive to the nearest emergency
room or call for assistance for a serious medical
need. He or she relies on prison officials in those
instances.
Overview Louisiana Corrections
Health Care
Staggering numbers of individuals are incarcerated who have; serious
mental health conditions, multiple risk factors for heart conditions,
cancers and infectious diseases who lacked access to health care
before their incarceration. The number of elderly offenders is
growing at an alarming rate, further burdening already strained state
budgets.
At the same time, the health care field is advancing at a very fast pace.
New technological inventions are happening every day which are
changing the landscape dramatically for good but also raising the
price tag.
The Congressional Budget Office has found that "about half of all
growth in health care spending in the past several decades was
associated with changes in medical care made possible by
advances in technology."
Snapshot of Louisiana
• According to the Federal Bureau of Justice &
Statistics, Louisiana has the highest offender
death rates in the country. It is because we have
the highest number of HIV + people, sit in the
cancer belt, and have one of the worst obesity
problems leading to a higher number of heart
disease.
• In 2007, 65% of adults in Louisiana were
overweight or obese.
Snapshot of Louisiana
Most Common Causes
of Death
Rate per 100,000 population
Reference: CDC, Louisiana: Burden of Chronic Disease, 2008
Respiratory
Disease
44.5
43.2
57.6
46.6
Stroke
LA
US
209.3
183.8
All Cancers
255.7
Heart Disease
211.1
0
50
100
150
200
250
300
HIV in Louisiana
• In the most recent CDC HIV Surveillance Report (Vol.
22), Louisiana ranked 4th highest in estimated state
AIDS case rates (20.0 per 100,000) and 11th in the
number of estimated AIDS cases in 2010.
• In 2009, Louisiana ranked 5th highest in estimated
state AIDS case rates (19.4 per 100,000) and 12th in the
number of estimated AIDS cases.
• In the CDC HIV Surveillance Report (Vol. 22), the Baton
Rouge metropolitan area ranked 1st in estimated
AIDS case rates (33.7 per 100,000) and the New
Orleans metropolitan area ranked 5th in estimated
AIDS case rates (26.2 per 100,000) in 2010 among the
large metropolitan areas in the nation.
Current Chronic Illnesses Diagnosed
in Louisiana DOC Facilities
Chronic Disease
2009
2012
%
Population
Increase in
diagnosis
Hypertension
4,346
5,436
29.6%
population
25%
Diabetes
1,178
1,301
7.1%
population
9%
Cancer
193
216
1.2%
population
9%
Heart Disease
271
308
1.7%
population
11%
Pulmonary Disease
890
1,221
6.6%
population
26%
HIV
542
549
3%
population
1.2%
Hepatitis C
2,270
2,017
11%
population
11%
DECREASE
Health Care Work load
Comparison 2008 - 2012
• Due to the aging population, offender’s health care needs are
increasing which is also being seen in the communities (similar
increase is being reported in the medical journals as age is the main
driving factor).
• Examples of the impact are;
– For offenders housed at the two Male LOC 1 facilities (LSP & Hunt) are
listed:
•
•
•
•
High Blood Pressure
Diabetes
Cancer
COPD/Asthma
33% 
25% 
34% 
55% 
• The elderly offender population (> 50 yrs) has increased 26%
increase since 2008 and it is a known fact that this sub group’s
health care needs are very high.
• On site medical encounters have increased by 45% since 2008.
Mental Health
•
28% of DOC Offender Population with Mental Health
Issues
•
13% are on Psychotropic medications.
•
There were 53,822 psychotropic prescriptions written
in FY 11/12.
•
During FY 11/12 there were 456 Mental Health
Observations, 2,097 Standard Watches and 178
Extreme Watches for DOC offenders.
•
During FY 11/12 there were 18 suicide attempts and 7
were significant injuries.
•
71% diagnosed with substance abuse addiction or
dependence.
DOC Facilities Only
On Site Care
60000
50000
40000
30000
20000
10000
0
Population
2008 20,263
2012 18,083
52977
41525
27187
20751
28302
25461
FY 12
2227 3344
Sick Call
On Site
Emergency
FY 08
Infirmary
Admits
Inpatient Days
Parish Prisons and Health Care
• From December 2011 to March 2012, parish
facilities transferred 193 (15% of all transfers)
offender to HRDC for medical or mental health
issues, 49 (25%) of these transfers were a direct
admit to the infirmary because of their medical
needs.
LSU Services
Off Site Care
15360
15354
15340
15320
15300
15300
FY 09
FY 12
15280
15260
# Offender Days in Public/Private
Hospital
Scheduled Medical Trips
1500
1201
1326 1257
FY 08
998
1000
799
FY 09
FY 10
500
FY 11
FY 12
0
Cost Containment
• Telemedicine encounters have increased by 82% since 2009.
– 2009
589 encounters
– 2012
3,337 encounters
– This has helped us to contain the off site medical visits despite a higher
number of sick offender.
• Psychotropic medication costs have decreased by 53% even
though cost of medications has increases, the Department has
implemented a more efficient ordering process.
• FY2008 DOC paid 1,059,595 for medical invoices and in FY 2010
paid only $346,652.00, a 67% decrease in expenses.
• Expansion of Inpatient beds - The medical complex at EHCC was
expanded to increase the number of skilled nursing beds available
throughout the Department.
• Opening Elderly assistance dorms – for housing increased number
of elderly and disabled offenders requiring assistance with activities
of daily living.
• Collaboration with other agencies
Long-term Goals
• Health Care
– Re entry
– HIV Discharge Planning
– Mental Health
– Substance Abuse (Steve Hoyle S.A. Program)
Long-term Goals
• Deliver more Definitive On-site
Care
• Expansion of Substance Abuse /
Mental Health Courts
• Expansion of Medical Releases
Medical Releases from DOC
Currently Active
Compassionate Releases
Approved / Released
Currently Active
Medical Parole Releases
Released during year
4
2006
2007
2008
2009
2010
2011
2012
Total
0
1
4
5
10
9
5
34
22
2006
2007
2008
2009
2010
2011
2012
Total
1
0
0
4
5
14
10
34
Challenges in Correctional Health
Care
•
As many of our states face one of the worst fiscal crises,
appropriate health care has to be delivered in a cost efficient
manner.
• These are interesting times. There are many major reforms in
corrections and our nation is witnessing the most significant change
in the health care industry.
• Correctional health care sits in this unique cusp, promoting these
new ideas of managed care and tying them to continuity of care and
having a positive impact on re entry efforts.
• In addition, there are significant developments with the Affordable
Care Act, Prison Rape Elimination Act, Gender Identity Disorder,
Mentally ill in segregation, effective substance abuse treatment, and
aftercare planning (getting releasing offenders their social security
benefits, VA benefits etc.) .