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Diseases Can't Be Locked In

June 01, 2004

Over recent months, legislators in Sacramento have taken Californians to some pretty grim places in hearings on the state's 32 prisons. No corridor of the $6-billion correctional system is likely to be darker than the one lawmakers plan to explore today.

A joint Senate-Assembly committee will examine profound problems in the prisons' healthcare delivery system, including the tuberculosis and hepatitis C that inmates may carry back to their communities.

Although taxpayers pay nearly $1 billion a year to provide medical care to the state's 162,533 inmates, up from $600 million just three years ago, the extra money hasn't always bought better health.

Consider the arrival of an inmate with infectious tuberculosis in December at Solano State Prison in Vacaville, west of Sacramento. Although Shasta County jail officials had accurately diagnosed and medicated him after he was arrested, he arrived at Vacaville with no TB medications, no TB culture results and no medical records, and infected up to 10 people, according to the California Conference of Local Health Officers, which monitors public health threats.

That does not mean TB runs rampant in the prisons, but it underscores the need to revive the prisons' own Public Health Service, a 40-person unit that had been tracking and treating infectious diseases until it was disbanded in October because of budget cuts.

The prisons also need to grapple better with an epidemic of hepatitis C, which is spread mostly through dirty drug needles and sexual contact. As of two years ago, top prison officials say, the disease had infected an incredible 1 in 3 state prison inmates.

Currently, there is too little testing for and treatment of hepatitis C, and county health officials accuse prisons of fobbing off sick parolees on county health systems.

Poor management goes beyond tracking and treating disease. State prison auditors have described a pattern of overpayment for medical services inside and outside prisons. In the last two years, only a quarter of prison contracts with medical providers were competitively bid, according to a report in April.

A related failure is the lack of a bulk purchasing system to drive down inmate prescription drug costs. California taxpayers pay 66% more to buy medications for inmates than the federal Department of Veterans Affairs does for drugs for former military personnel.

The Schwarzenegger administration has produced some good longer-term ideas. These include possibly turning over prison healthcare to the University of California or a managed-care provider.

First, however, legislators, prison officials and the administration should rein in uncontrolled costs, as well as find money to shore up detection and treatment in prisons. Diseases brought into prison or contracted there should be dealt with there.

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