Prisons

California’s hospitals, especially those located near prisons, provide inpatient acute and emergency health care services to inmates from California’s 33 state prisons. Correctional patients and recent parolees are comparatively more expensive and difficult to treat than other patients. Many have chronic conditions such as HIV, diabetes, obesity, heart disease, mental illness, smoking-related illnesses and consequences of drug abuse, alcoholism or violence.

Furthering impacting hospitals are the recent statutory changes proposed by the Governor to bring the 2009-10 and 2010-11 budgets into balance by reducing the state’s inmate and parolee populations potentially impacting hospitals and crowded emergency rooms.

POSITION: CHA supports a collaborative approach between California Department of Corrections and Rehabilitation (CDCR) and California Prison Health Care Services (CPHCS) and community hospitals to develop solutions to provided appropriate care to prisoners and parolees, reasonable payments to hospitals that cover the cost of care and long term stability between CDCR and hospitals.

ANALYSIS:

• Community hospitals cannot be expected to treat prisoner patients at a financial loss. Correctional patients are more expensive and difficult to treat than other patients and often present with complicated chronic conditions or in an emergent situation as a result of violence. CDCR must pay for the reasonable and allowable costs required by California law.
• Hospitals operating in areas where prisons are located in close proximity, or where prison health care facilities are currently planned, have been severely impacted due to the workforce drain and overall destabilization of the hospital health care system. When the U.S. District Court appointed the Receiver in October 2005 to bring CDCR’s health care system up to constitutional minimums, the district court judge issued an order directing the state to raise the salaries of doctors and nurses to help with recruitment and retention. Under the order, a prison physician’s pay was increased 10% and nurses received raises of 18%. Rural communities, in particular, face significant challenges in financing care and recruiting and maintaining health professionals to provide medical services. Moreover, there is a chronic shortage of registered nurses across the state, rural communities have less of a pipeline and smaller overall labor market. The substantially higher salaries being offered to physicians and nurses creates a significant staffing shortage for hospitals and puts hospitals in direct competition with correctional employers. The new 1734-bed prison health care facility approved for construction in Stockton, CA projects a workforce need of over 300 registered nurses and 400 psychiatric technicians.
• There are serious care coordination issues with respect to paroled inmates particularly those inmates eligible for early release and/or irrevocable parole. Hospitals are receiving little and in many instances, no notice regarding the discharge of an inmate from a correctional facility and the inmates are brought to the hospital emergency room by correctional and/or law enforcement personnel and dropped off. There is often no accompanying paperwork, hospital staff cannot make contact with prison physicians and in many cases, the hospital is not the appropriate service provider (i.e. the patient requires long term care, etc.). Further complicating an all ready precarious relationship, CDCR is implementing an early release program and placing certain parolees onto non-revocable parole (NRP). NRP parolees are not eligible for CDCR health care services.