Health Care in Louisiana Prisons:

An Overview

Raman Singh, M.D.Medical/Mental Health DirectorLouisiana Department of Public

Safety and Corrections

• 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”.

Overview Louisiana Corrections Health Care

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. Gamble1) Right of access to health care2) Right to care that is ordered3) Right to a professional medical judgment

Those that are incarcerated do not have theability to drive to the nearest emergencyroom or call for assistance for a serious medicalneed. He or she relies on prison officials in thoseinstances.

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."

Overview Louisiana Corrections Health Care

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 DeathRate per 100,000 population

Reference: CDC, Louisiana: Burden of Chronic Disease, 2008

211.1

183.8

46.6

43.2

255.7

209.3

57.6

44.5

0 50 100 150 200 250 300

Heart Disease

All Cancers

Stroke

RespiratoryDisease

LA

US

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 loadComparison 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 33% • Diabetes 25% • Cancer 34% • COPD/Asthma 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.

• Elayn Hunt Correctional Center has an inpatient Mental Health housing unit were the Level of Care 1 offenders stay. Currently there are 96 severally mentally ill. This unit has nursing and social workers on site 24 hours a day.

On Site Care

27187

2227

28302

41525

3344

52977

2075125461

0100002000030000400005000060000

Sick Call On SiteEmergency

InfirmaryAdmits

Inpatient Days

FY 08

FY 12

Population 2008 20,2632012 18,083

DOC Facilities Only

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

15354

15300

15260

15280

15300

15320

15340

15360

Scheduled Medical Trips

FY 09

FY 12

# Offender Days in Public/Private Hospital

12011326 1257

998799

0

500

1000

1500

FY 08

FY 09

FY 10

FY 11

FY 12

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

Currently Active Compassionate Releases 4

  2006 2007 2008 2009 2010 2011 2012 Total

Approved / Released 0 1 4 5 10 9 5 34

Currently Active Medical Parole Releases 22

  2006 2007 2008 2009 2010 2011 2012 Total

Released during year 1 0 0 4 5 14 10 34

Medical Releases from DOC

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.) .