The Real Cost of Prisons Weblog

Taxpayers pay an average of about $32,000 per year to house a state prison inmate, including an average of almost $4,500 in health care costs. The average inmate health care cost has not increased significantly in the last four years, despite an overall rise in prison population, statistics show. Where costs have increased significantly is among prisoners requiring intensive, long-term medical care.

At Laurel Highlands Prison in southwestern Pennsylvania's Somerset County, which houses the state's oldest and sickest inmates, the population increased 15 percent between 2003-04 and 2007-08 - but the average medical costs nearly doubled from $8,704 to $15,346 per inmate. The estimated rate of confirmed HIV and AIDS patients in Pennsylvania prisons was more than 2 1/2 times higher than the general population in 2005, according to Prison Health Services. The monthly treatment costs ranged from $1,200 to $2,500 per inmate.

In 2007, cancer, coronary artery disease and end-stage liver disease primarily due to infectious hepatitis were responsible for almost 70 percent of inmate deaths. HIV ranked sixth, between suicide and gastrointestinal bleeding.

The cost of treating chronic illnesses among prisoners varies, state prison officials said.

Kidney disease has experienced "modest" cost increases in large part due to new medication for management of dialysis patients, Roberts said.

Diabetes and hypertension management costs have been flat or decreased due to wider availability of generic drugs, and a once daily dosing regimen, which improved patient compliance with medications. Hospitalization rates for cardiac and diabetic patients also remained stable, Prison Health Services spokesman Ronald Roberts said.

HIV and AIDS management has experienced a nearly 50 percent increase in medication costs.

The need to add a fourth HIV drug to the previous three-drug therapy is responsible for most of the "significant" cost increases with HIV treatment, Roberts said. New costly lab testing is often required as resistant strains of HIV virus continue to increase among prison populations.

Cancer-related costs alone have risen "substantially" - 16 percent annually - according to Prison Health Services. Prostate cancer is the most common diagnosis among male prisoners.

The state Department of Corrections' tumor registry has listed more than 600 patients since 1994 with either a diagnosis or history of cancer.

The vast majority of those patients are diagnosed while incarcerated, said Susan McNaughton, spokeswoman for the Pennsylvania Department of Corrections.

State prisoners can be monitored and treated for chronic diseases at in-house prison medical units using video teleconferencing for pre- and post-operative consultations.

Prisoners requiring more intensive care can be transferred to a state prison with a specialized medical unit. These units save taxpayer money because they can provide medical care cheaper than hospitals, and save costs related to transportation and security.

Prisoners with unstable health are treated in outside hospitals, said Dr. Nicholas Scharff, assistant medical director of the bureau of health care services. For extraordinary cancer care, such as bone marrow transplants or leukemia induction, prisoners are treated at a state-contracted, outside medical center.

Cancer care is overseen by a staff oncologist who develops individual treatment plans and oversees treatment, which has resulted in earlier diagnosis, saving money through less invasive and prolonged treatment.

Installing a chemotherapy suite at Graterford has provided greater uniform care under National Comprehensive Cancer Network standards. Financially, it also has provided an "enormous" cost savings since chemotherapy is among the more expensive and lucrative medical specialties, McNaughton said.

But she added that a "significant" number of cancers, such as acute leukemia, still require outside hospital treatment.

"We are obligated to provide inmates with medical care and we provide the same care that someone in the community would get," McNaughton said.

Cancer, coronary artery disease and end-stage liver disease are responsible for most inmate deaths in state prisons.

Specialized medical units within the Pennsylvania State Prison system

Laurel Highlands: long-term nursing, assisted care and personal care units, dialysis units

Graterford: chemotherapy suite

Forest: hepatitis C treatment

Somerset: elective day surgery program (elective procedures include port removal, ACL repair, cataract surgery, biopsies, colonoscopy and hernia repair)

Smithfield: diagnostic medical imaging program

A healthy cost for Pennsylvania

Monthly cost for health care services per state inmate in 2003-04: $127.77

Monthly cost for health care services per state inmate in 2007-08: $166.86

For the 2007 calendar year, 8,805 dialysis treatments were provided to state prisoners.

Source: Prison Healthcare Services, Pennsylvania Department of Correction

March 22, 2009
http://www.phillyburbs.com/news/news_details/article/262/2009/march/22/how-pa-handles-prison-medical-care.htm