Captive patient: Medical care in California’s prisons and jails

Each year, millions of Californians must decide how they will obtain and pay for their medical care. While many of them have a choice as to where and how they get that care, another large population within the state has virtually no say the quality of medical care available to them.

Currently, California’s state prisons are home to more than 183,000 incarcerated persons. Their medical care is entrusted to the California Department of Corrections and Rehabilitation (CDCR). Those inmates are spread out across 35 different penal facilities, where the availability, quality and cost of medical care appears to vary greatly. For example, the total cost of nonlabor-related medical care, which is adjusted by a cost-of-living adjustment (COLA) factor, is just $52 per inmate per month at Calipatria State Prison. At the California Men’s Colony, a state prison located in San Luis Obispo County, that cost is $217 per inmate, per month. At the R.J. Donovan Correctional Facility in San Diego, the cost is as much as $789 per inmate, per month.

California’s prison system has a fraught history when it comes to providing adequate care to its wards. Medical care for inmates in California's state prisons was placed into receivership in 2006 after a federal court ruled that conditions in the state’s prisons were unconstitutional. A decade later, many of the state’s prisons remain under that receivership as the CDCR and the California Prison Health Care Receivership Corporation continues to try and raise the level of medical care for inmates to proper constitutional standards, collecting a massive trove of data on each prison's performance along the way.

My fellowship project will use this data to explore the various factors that determine the quality of medical care California’s inmates are getting, and whether that care is enough to meet the needs of the state’s prisoner population. Using the available data as a starting point, I believe we can find out whether the state is living up its promise to improve medical care for its inmates and if those improvements reach across all of the state’s prison facilities. Furthermore, I plan to answer the question of whether the documented improvements translate to real-world results for inmates through interviews with prisoner rights advocates groups, health care experts, and current and former inmates themselves.

California’s prisons aren’t the only facilities in the state struggling with providing medical care to inmates. Unlike prisons, medical care at each of the state’s 123 county jails isn’t managed by a single entity, and the quality and availability of care can vary based on the size, staffing, and budgetary restrictions. Many county jails claim efforts to realign the state prison population have strained their ability to provide medical care to inmates. Under Assembly Bill 109, passed in 2011, non-violent, non-serious, and non-sex offenders, who once may have been housed in state prisons, are now serving their sentences in county jails. While realignment helped lower inmate populations in the state’s overcrowded prisons, it saddled county jails with more inmates serving longer sentences than they’d housed previously, challenging them to provide long-term medical care to inmates who suffer from chronic conditions with the limited resources at their disposal. As part of my proposed project, I plan to compare the data points collected from the state prisons with data from the state’s county jails, and explore what impact, if any, prison realignment has had on the medical care in the state’s many county jails, and what that impact means for the lives and health of inmates.

When it is completed, I believe this project will provide a window into how effectively our state and its counties are providing critical medical care to an overlooked and marginalized community whose health care is out of their hands and at the mercy of mercurial political, social, and economic forces beyond their control. 

[Photo by Vince via Flickr.]