Subject: Advocates pushing Review of Prison Health System
Date: Fri, 11 Apr 2003 13:07:52 EDT

Advocates pushing review of prison health system
By ALICIA CHANG
The Associated Press
ALBANY -- There are competing views about how best to deliver health care
services inside New York's sprawling prison system to inmates suffering from
potentially fatal chronic diseases. Corrections officials maintain that what
they are doing works, and point to the dramatic decline of AIDS-related
deaths and tuberculosis outbreaks in prisons in the past decade. However,
prison reform advocates contend that the prison system exists in a vacuum
with little oversight. The result, they say, is that inmates receive
inconsistent care depending on where they are locked up. "The picture is a
very uneven one," Robert Gangi, executive director of the Correctional
Association of New York, said of the state's prisons. "There's been
significant improvements over the last decade but very serious problems
remain," Gangi said. One issue is that the state Department of Correctional
Services maintains virtual control over every aspect of prison life,
including the delivery of medical care to inmates. For years, advocates and
some Democratic state lawmakers have unsuccessfully pushed for the state
Health Department to extend its control to prison infirmaries so that they
are subject to the same quality control standards as civilian health
facilities. Currently, the state Commission of Corrections, a watchdog group
over state prisons and local jails, is charged with establishing minimum
health care standards. But advocates want more, favoring an agency that
focuses solely on medical care delivery to oversee inmates' health. New York
corrections officials dispute claims that inmates receive substandard medical
care. "They receive care that is at least as good as what people receive on
the outside," corrections spokesman James Flateau said. He said every inmate
upon entering prison is screened for TB and hepatitis C and can voluntarily
request to be tested for HIV, the virus that causes AIDS. Roughly 67,000
inmates are spread out in 70 prisons across the state and some 29,000 inmates
are released to the community each year. Critics say health safeguards need
to be in place so that sick inmates don't pose a public health hazard when
they are released. About 15 percent of inmates are infected with hepatitis C,
a viral disease that attacks the liver and about 9 percent are positive for
HIV, according to prison officials. Since Gov. George Pataki took office in
1995, the state's spending on medical care for prisoners increased more than
50 percent, from $149 million to $229 million in the current year's budget,
Flateau said. The federal Centers for Disease Control and Prevention estimate
that of the more than 4 million Americans with chronic hepatitis C
infections, 39 percent once were in prison. Health experts say the disease is
commonly spread among inmates through intravenous drug use, unprotected sex
and sharing of items like razors. About 1 percent of inmates with hepatitis C
infections in New York are receiving treatment, advocates and prison
officials say. Advocates believe that number should be higher, but
corrections officials insist that all those who qualify for treatment receive
it. Unlike hepatitis A and B, there is no vaccine against hepatitis C.
Treatment involves a combination of the drugs interferon and ribavirin, which
can cost up to $25,000 annually to administer. Some inmates are temporarily
ineligible for treatment because of past drug use or preexisting medical
conditions. In other cases, CDC guidelines advise that the year-long
anti-viral treatment regimen should not be started if there is less than a
year remaining on an inmates' sentence. Originally published Monday, March
24, 2003