Prisoners are persons whom most of us would rather not think about. Banished from everyday sight, they exist in a shadow world that only dimly enters our awareness. They are members of a "total institution" that controls their daily existence in a way that few of us can imagine. "[P]rison is a complex of physical arrangements and of measures, all wholly governmental, all wholly performed by agents of government, which determine the total existence of certain human beings (except perhaps in the realm of the spirit, and inevitably there as well) from sundown to sundown, sleeping, walking, speaking, silent, working, playing, viewing, eating, voiding, reading, alone, with others. . . ." It is thus easy to think of prisoners as members of a separate netherworld, driven by its own demands, ordered by its own customs, ruled by those whose claim to power rests on raw necessity. -- Justice William Brennan, dissenting in O’Lone v. Estate of Shabazz, 482 U.S. 342, 354-55 (1987).

Sunday, August 12, 2007

CEO Survival Guide (Hint: Don't Get Sick)

Just ran across an article in Conde Nast Portfolio - C.E.O. Survival Guide: Pre-Prison Prep -

I pretty much agree with all 10 points.

In particular, one I haven't talked about is #4: Don't Get Sick. They are being kind when they say: "Prison medical staffs may not be up to the standard you have come to expect."

Medical care is actually rather scary, especially if you have a chronic condition you are used to treating on the outside. For example, if you are diabetic you can no longer give yourself insulin shots. I knew a couple guys that would go in first thing in the morning and once in the afternoon to get their shots. They were constantly battling the doctor as to the appropriate dosage. I saw one guy go into diabetic shock in the dining hall. I don't mean to be rude but he looked like a cockroach on its back in the throes of death. It was quite scary. Fortunately, the staff attended to him pretty quickly and he recovered ok, but everyone pretty much lost their appetite for what remained of their lunch.

One of my roommates had so many chronic medical problems (he really had no business in a workcamp), he was sent 3 times (!) during my brief stay to the local emergency room due to seizure-like symptoms. He was always returned within a few days because the prison doctor, not the hospital doctor, has final say about his fitness to return and it is expensive for BOP to pay for his medical care in the hospital. The third time they dropped him down half a flight of stairs (we were on the 3rd floor) and, when he returned, he could barely get out of bed due to soreness in neck and back. Were it not so serious, it would have been comical.

I had a routine initial dental appointment and physical exam. That was fortunately the extent of my personal experience with medical care in prison. The dentist and physician's assistant that I saw were fine although I was not being treated for any specific medical condition. I am not qualified to evaluate the competence of any of the medical staff but I do know that the medical director and chief physician had very low reputations among the inmates. (Having a low reputation among inmates is not necessarily a bad thing, but....)

Finally, if I haven't depressed you enough, one inmate died last fall. He was in his 50s, playing soccer, and had a heart attack. One of the other inmates was a physician himself and was present to treat him. However, the CO prevented him from doing so. As a matter of rule, the CO was apparently right..... BOP regulations prohibit inmates from providing medical care to other inmates. However, the medical office was probably half a mile away and the inmate died on the soccer field. I was not there (it was before my time) but the story was well known in the camp.


Anonymous said...

What is the point of having an inmate in camp that is costing taxpayers so much....might as well cut his sentence or give him home confinement on his own dollar.....BOP policies really intrigue me. This guy you mention who went 3-4 times for short hopital stays, probably cost a lot. Now think of it this way out of 750 inmates the elderly inmates have chronic issues...what's the point...

Bill Bailey said...

BOP probably gets perhaps more grief than they deserve on this matter.

BOP did not send this guy to prison -- some judge did (and I am quite sure that BOP wonders sometimes what the hell the judge was thinking when they sent some of these guys to prison and I am sure judges are thinking what the hell Congress was thinking when it drafted some of these sentencing guidelines that basically tied judge's hands).

It is BOP's job to manage his incarceration, which includes responsibility for his healthcare. I don't envy their job. They have limited resources and there is not exactly a large consituency advocating an increase in the budget for prisoner health care "benefits."

How many doctors do you know that dream of working for a prison? It is not hard to imagine that BOP gets the "bottom of the barrel" when it comes to qualified healthcare professionals.

This particular guy is due to be released in Nov or Jan (I can't remember which), which is not that far away from BOP's perspective. They don't want to invest a lot in his healthcare when he will not be their problem shortly. If it was up to them, they would send him home NOW just to be relieved of the problem. (I am sure they pray that he dies in the hospital and not in the prison... less paperwork if he dies on someone else's watch!)

I don't believe it is up to BOP to give this guy home confinement... that would require a modification of the judgement and commitment document (i.e. the sentence). The best BOP can do is send him to a medical facility but given the relative brief time he has remaining and the limited beds available in such facilities, I am sure they are reluctant to transfer him. On the other hand, he could very well die in Pensacola. He is already the same age (47) that his father was when he died.

Judges can take into account health issues when they determine the sentence, but this particular guy was a poor hispanic inmate who basically became the "fall guy" as best as I could tell in a bank fraud case. I don't know how good his attorney was in raising the health issues to the judge.

He had a remarkably good attitude and a lot of support and sympathy from other inmates but it was a very sad situation.

Anonymous said...

Great Post Bill, you bring a GREAT point with your commentary, The sentencing guidelines are really messed up, some of the statues are not for certain scenarios, extreme and excessive punishment. Congress needs to do a better job...hopefully the elections will bring some change.

Anonymous said...

Not allowing the former doctor to "treat" the prisoner who had a heart attack sounds dramatic but it really isn't. If you have a heart attack the only "treatmen" that the doc could have done was CPR. Anyone in the field who has to get CPR done to them is a dead man without a defibrillator. The statistics for successful CPR out of the hospital are dismal.

A lot of docs in the BOP are public health physicians, which is a uniform service that believe it or not attracts a lot of doctors. The pay is similar to the military not including bonuses and the retirement is not too bad either. No billing, no malpractice premiums, housing, food, medical and dental are covered. You can also transfer to the indian health service and the US Coast Guard.

Granted the USPSH docs I worked with aren't as good as my private practice partners but there are still some good docs and PA's there.