California hospitals are nervously bracing for a court-ordered inmate reduction program that will grant early release to thousands of inmates no longer deemed a threat to society, in part because they are old and medically fragile.
Many of these inmates will need immediate care at hospitals, dialysis units, and behavioral facilities, and their first stop in freedom may be the emergency room.
Just last week, says David Green, CEO of 165-bed El Centro Regional Medical Center, he received notice that "a prisoner with several end-stage diseases" at Centinela State Prison, about 10 miles to the west, was being paroled, to an address that was the same as his hospital's.
"I talked with the Imperial County Health Director and said 'This is nice to know!' I was told they can't find any other place to put this person so they'll have to deposit them on my front door.
"This puts the pressure on us to make our social services departments figure out what to do with these patients," Green says. "I'm stuck having to put them in an inpatient bed while we try to figure out what to do."
With 170,000 inmates, California's prison system is the largest in the U.S. and is dangerously overcapacity by about 190%. In February, a federal court demanded that the state reduce that population by 45,000, to 130,000, after finding that the correctional system could not provide adequate medical and mental health care to such a large number of prisoners.
Although the state has appealed that ruling, Gov. Arnold Schwarzenegger on Friday announced a more modest plan in an effort to appease that will reduce the inmate population by 18,212, in part with transfers to other state prisons and private facilities, commuted sentences, and early release of old and sick inmates.
Whatever number is ultimately granted early release, it will be on top of approximately 10,000 inmates who are already released each month statewide after they have served their sentences. However, the routine release of inmates is in general a healthier population than those who would be granted early release on the basis of senior age or illness.
"Every hospital in California is worried, especially those that are close to these state prisons," says Lynne Ashbeck, regional vice president of the Hospital Council of Northern and Central California.
"It's a distasteful situation for everybody," says Elizabeth Howard of the California State Association of Counties, which worries about the impact on hospitals, drug, and alcohol services, and mental health units owned and operated by county jurisdictions. "When appropriate places can't be found, it's been our experience that they have been released from prison, right into hospitals in certain areas."
The system has been ordered into federal receivership because of concerns over delays and quality of care within the correctional system over the last decade.
Gordon Hinkle, spokesman for the state Department of Corrections, says not all of the 18,000 to 45,000 inmates that will be released from the prison system to reduce overcrowding are sick or old. In fact, he says, the number is more like 6,000, and includes some inmates who would be released to home arrest.
"There's a lot of fear out there of what's going to happen," he says, "but if you see the total package, which is posted on our Web site, it's not a major component of the proposal."
Hospital officials throughout the state say that they have six major concerns about the impact of early release of older, sicker inmates:
- Delays in getting inmates qualified for Medi-Cal or Medicare may take as long as 18 months. "And to the extent that it takes a year or 18 months, that's debt on your books, " says Kelly Brooks, of the State Association of Counties.
- Medi-Cal and Medicare reimburse hospitals for far less than their costs, which translates into another unfunded mandate.
- Many inmates will not qualify for either program, resulting in a demand for uncompensated care from local healthcare networks.
- Many inmates are likely to continue to have behavioral, drug or alcohol treatment needs after their release.
- Hospital officials worry quietly that when these inmates are released, they will be in need of much deferred care that wasn't or couldn't be provided during incarceration. Medical problems that might have been more cheaply and more easily managed may have been allowed to get out of control.
- California is one of only two states in the country where all inmates are released on condition of parole, and that release is to the area where they committed the crime, unless that region lacks the ability to provide a certain type of care the patient needs. In that case, they would be paroled near that health service they need.
Hospitals in counties with numerous prisons, including Kern, Kings, and Imperial, worry that they may receive more former inmate patients as a result.
"There's no one who wants to step up and pay for this population," says Brooks of the County Supervisors Association. "That's what it comes down to."
Hospital officials are also irritated because of a bill attached to the current budget that capped reimbursement to hospitals for treating prison inmates during their incarceration, a cap that shortchanges hospitals and doctors relative to the cost of providing that care. Not only are health providers not being reimbursed fairly for taking care of inmates while they are incarcerated, but providers will have to absorb the unfair burden after they are released, they say.
For David Green of El Centro Regional, it isn't just Centinela State Prison, population 4,556, that he's worried about. Imperial County also is home to Calipatria State Prison, which incarcerates 4,268 felons.
“Maybe this is hearsay, but I heard at a recent supervisors' meeting they would be paroling 2,500 into Imperial County, and many of them will be paroled right here."