Inmates’ Medical Tab Nears $1 Billion

As medical bills for the state prison system approach $1 billion a year, lawmakers Tuesday called into question the use of tax dollars for procedures such as a male inmate’s breast reduction surgery and skin treatments at a Beverly Hills dermatologist.

Paying millions to shuttle prisoners to hospitals hundreds of miles from where they are locked up also faced criticism.

With inmate healthcare spending nearly double what it was in 1999, lawmakers are demanding immediate changes to bring costs into line.

“Even if it weren’t a tight budget year, this would be something that is absolutely unacceptable,” said Assemblywoman Wilma Chan (D-Alameda).

The attacks on prison spending came at a joint legislative hearing and followed a state audit released in April. The audit revealed that prison officials seek competitive bids for less than a quarter of the contracts they enter into with hospitals, and may be routinely paying claims for services never provided.

The state prison system runs 32 facilities with 160,000 inmates, and healthcare accounts for a significant chunk of its $6-billion annual budget.

Prison officials challenged some of the accusations made by lawmakers, but acknowledged that reforms were needed. “We are using the recommendations contained in the Bureau of State Audit report as a blueprint for change,” said Jeanne Woodford, director of the Department of Corrections.

Those recommendations include imposing rules to ensure that contracts are negotiated competitively and imposing uniform treatment standards spelling out what is appropriate and when.

But Woodford warned that the department must abide by a number of court judgments requiring it to provide medical care that may seem excessive.

“We are under court mandates affecting our services,” she said.

In many cases, officials say, they are unable to attract trained doctors and nurses to work in the prisons and are left no choice but to enter into costly contracts with distant hospitals.

Prison officials also pointed out that the system must tend to thousands of patients requiring special care, including those with AIDS and other diseases, elderly inmates, prisoners in need of transplants, and paraplegics and quadriplegics.

Lawmakers, however, say the department can do better.

“We need to protect the constitutional rights of the prisoners, but excuse me, as a taxpayer I have constitutional rights too, and these guys are getting care that I don’t even get,” said Assemblywoman Rebecca Cohn (D-Saratoga).

Some legislators pointed out that at the same time prisons are entering into contracts with private healthcare providers with no discernible cost controls, many prisoners are unable to get the most basic treatment.

Sen. Jackie Speier (D-Hillsborough) said she was frustrated to learn -- through a tip to the Legislature’s government oversight hotline -- that just last Thursday a prison inmate had received breast reduction surgery at the same time the department has had to eliminate efforts to curb tuberculosis.

“I understand lots of inmates at this particular prison have undergone this procedure,” Speier said. Prison officials say they do not authorize any surgery unless it is absolutely necessary; any treatment that is out of the ordinary must be approved by a team of physicians and headquarters.

“Certainly our policy is not to perform cosmetic surgery,” said Renee Kanan, who oversees healthcare services for the department. “But there may be some mitigating factors in this particular case.”

Speier shot back: “I can’t imagine the necessity for breast reduction surgery in a male inmate.”

Cohn demanded that the department tally up the cost for acne and other treatments provided to inmates by a Beverly Hills dermatologist.

The department did not have the figures at the hearing, but Kanan said there are instances where such treatments are medically necessary.

“There are severe cases of acne that are disfiguring,” Kanan said. “There would be some circumstances where it would be appropriate medical treatment.”

Lawmakers also called on the department to find ways to provide care for inmates closer to the prisons. Sen. Gloria Romero (D-Los Angeles) estimates that the state is wasting millions of dollars by contracting with hospitals hundreds of miles away instead of taking advantage of facilities nearby or providing adequate care in their own clinics.

In fiscal 2002-03, for example, the state spent more than $8.7 million transporting inmates to and from hospitals.

Prison officials said they are working on ways to contain those and other costs -- but cautioned lawmakers to be patient.

Woodford said the administration is talking to University of California officials about a plan “to partner with them to create a healthcare system that is more accountable and cost effective.”

Assemblyman Todd Spitzer (R-Orange), however, said the auditor’s report came out two months ago, and the state Corrections Department should have a clear plan for moving forward by now.

“This is what people hate about government.”