A Times Editorial

Health care behind bars

Too many inmates in Florida prisons are dying because of inadequate medical care. It's no time to eliminate outside review of these cases.

© St. Petersburg Times, published October 3, 1999

And she is not alone.

According to a review of CMA reports, of the 463 deaths that occurred in Florida's prisons since January 1994, one in eight may have been preventable. This is a record more fitting to a war zone than a medical care system.

A series by Times staff writers Jo Becker and Adam Smith documents case after case of bollixed up medical and psychiatric care for inmates in 31 prisons around the state, often with deadly consequences. In Chavis' case, even the prison's own reviewers said that the lack of attention and treatment she received at the Florida Correctional Institution was "an egregious error," yet the doctor in charge was not fired.

Providing humane conditions of confinement is a primary duty of the Department of Corrections. But a stream of reports by the CMA indicate that the department may be too cost-conscious in providing care.

Prison doctors are paid far less than private-sector physicians, leading to questionable hires. Training and supervision of nurses seems to be lacking. Mental health professional positions have been cut systemwide even as the need for those services rises. And, due to the expense, the medical staff appears reluctant to hospitalize inmates even where it's obviously warranted.

Granted, the state prison population is a tough constituency for medical care. Many have been addicted to drugs or alcohol and probably had little medical care prior to entering prison. Even so, when the state holds a person captive, the state is responsible for his or her well-being, no matter what the cost.

The secrecy that shrouds a prison death only serves to compound adequacy of care issues. When a prisoner dies, the Department of Corrections does its own mortality review using prison doctors and administrators to evaluate the case. Then an insurance company contracted by the prison reviews the case again. But the findings of these investigations are not public records and typically aren't disclosed. Chavis' mother, Nadine Houston, tried for a year following her daughter's death to discover what happened to her. She was told by prison officials and the governor's office that "confidentiality issues" prevented her from getting all the details of her daughter's death.

The only review readily available to the public is that done by the CMA. And the CMA ensures objectivity by having private sector doctors conduct investigations, not internal prison staff. But the department doesn't like this added scrutiny. It is trying to defund the CMA, claiming its work is redundant and unnecessary. Yet the agency's oversight is the only way to hold the department accountable.

As the prison population continues to expand, as more inmates serve time well into old age, the burdens on our prison system to provide decent medical care will be even greater. Cutting corners will be an inclination that has to be discouraged. The only way to do that is for an outside agency to keep a vigilant watch.

© Copyright 1999 St. Petersburg Times. All rights reserved.