Inmate medical care is one of the most important issues you will deal with as a top administrator. This is a complex policy arena with some very passionate stakeholders involved on all sides of this issue. California has been one of the highest profile states and is under “management” by a court master who reports to the judge regarding progress in court order compliance. This has created a lot of friction and litigation between the DOC and the court system. Everyone has an opinion on inmate medical care and many of those positions are uneducated. This is an area where the head administrator (you, hopefully) will be involved in personal testimony and often personal liability. Don’t take an upper level job until you understand the issues involved in inmate medical services. For this week, I want you to focus on a real and emerging ethical, legal and fiscal issue you would have to weigh in on as an administrator. It can’t get any more current or real than this. All systems screen for infectious disease so let’s not waste time there. Hepatitis C has come into focus in the last 10 years or so and it is an incredibly slowly progression disease. It may take 30 years to have a serious effect on the body which is perhaps why it was hard to recognize and isolate. We are also learning that a significant percent of the population have contracted this through medical transfusions as well as risky behaviors and until recently there was a high mortality rate associated with this disease. New screening tools can identify this disease even in the earliest stages. There are two extremely effective drugs out there from AbbVie (Vie Kira Pak, which is a cocktail of drugs) and Gilead Sciences (Harvoni). The retail cost is approximately $83K and $94K for a 12 week regimen of treatment. Here is the issue: do you prescribe these drugs to inmates? If you do, under what conditions? Let me explain some of the parameters of the issue for you to make sure you understand the nature of this debate. If you provide it to every inmate who tests positive for Hep C, you will go broke. The states do not have enough money to pay for this cure for everyone who tests positive. You may have someone who enters the system who tests positive and it is in the earliest stages and won’t require serious treatment for many, many years. During that time, he pay die from many other mortal conditions. He will probably be covered by federal or private insurance at a future time who can deliver the medication must more cost effectively. New drugs may arrive on the market. The copyright will be gone and generics may come into play. You start to see my point here. On the other hand, you may have someone on the precipice of death who needs it now and not later. Your agency has to make a decision as to when and if to prescribe and budget certainly is going to play a part in this. Some might argue you should stop testing for this so the decision isn’t there. That course of action has legal as well as ethical peril as well. All inmates who are identified with this disease will want treatment right now and not later. Additionally, it is infectious so failure to treat has risks there as well. No matter what your decision is with the exception of treating everyone, you will end up in court with a constitutional issue. How do you balance the issue of how much medical care one provides inmates. What would you do to resolve this issue? Please don’t focus on the fact that inmates are human beings and have a right to medical care. We already know that and every inmate does have access to medical care. The issue is that it does vary with jurisdiction. Why? Why do they have a right to medical care (which amendment is involved)? What is the difference between inadequate medical care and deliberate indifference? This one should really get you thinking about the reality of medical care in an institution. It is interesting to study this kind of a question from an academic perspective and I can assure you that it is stressful making decisions like this when the buck stops at your desk. I faced similar issues with HIV testing among several others.
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