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Health Care in Louisiana Prisons: An Overview


Health Care in Louisiana Prisons: An Overview Raman Singh, M.D. Medical/Mental Health Director Louisiana Department of Public Safety and Corrections – PowerPoint PPT presentation

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Title: Health Care in Louisiana Prisons: An Overview

Health Care in Louisiana Prisons An Overview
  • Raman Singh, M.D.
  • Medical/Mental Health Director
  • Louisiana Department of Public Safety and

Overview Louisiana Corrections Health Care
  • Our great nation also has the highest
    incarceration rate in the world and many of the
    incarcerated individuals are a product of
    broken families, broken educational system,
    unhealthy job market , lack of access to adequate
    health care, etc.
  • Over the years, Correctional leaders have come to
    realize that the traditional lock and feed"
    model is only adding fuel to the fire and now
    there is a strong wave of re entry efforts to
    tackle the core issues of the criminal justice
  • The focus has shifted from minimum to get by
    to finding and implementing best practices to
    build and run an efficient correctional health
    care system.

It is often said that the measure of a
civilization is how it treats its weakest
members, the last, the least, the littlest.
A Right to Medical Mental Health Care for the
  • Landmark Case of Estelle v. Gamble
  • Right of access to health care
  • Right to care that is ordered
  • Right to a professional medical judgment
  • Those that are incarcerated do not have the
  • ability to drive to the nearest emergency
  • room or call for assistance for a serious medical
  • need. He or she relies on prison officials in
  • instances.

Overview Louisiana Corrections Health Care
  • Staggering numbers of individuals are
    incarcerated who have serious mental health
    conditions, multiple risk factors for heart
    conditions, cancers and infectious diseases who
    lacked access to health care before their
    incarceration. The number of elderly offenders is
    growing at an alarming rate, further burdening
    already strained state budgets.
  • At the same time, the health care field is
    advancing at a very fast pace. New technological
    inventions are happening every day which are
    changing the landscape dramatically for good but
    also raising the price tag.
  • The Congressional Budget Office has found that
    "about half of all growth in health care spending
    in the past several decades was associated with
    changes in medical care made possible by advances
    in technology."

Snapshot of Louisiana
  • According to the Federal Bureau of Justice
    Statistics, Louisiana has the highest offender
    death rates in the country. It is because we
    have the highest number of HIV people, sit in
    the cancer belt, and have one of the worst
    obesity problems leading to a higher number of
    heart disease.
  • In 2007, 65 of adults in Louisiana were
    overweight or obese.

Snapshot of Louisiana Most Common Causes of
DeathRate per 100,000 populationReference
CDC, Louisiana Burden of Chronic Disease, 2008
HIV in Louisiana
  • In the most recent CDC HIV Surveillance Report
    (Vol. 22), Louisiana ranked 4th highest in
    estimated state AIDS case rates (20.0 per
    100,000) and 11th in the number of estimated AIDS
    cases in 2010.
  • In 2009, Louisiana ranked 5th highest in
    estimated state AIDS case rates (19.4 per
    100,000) and 12th in the number of estimated AIDS
  • In the CDC HIV Surveillance Report (Vol. 22), the
    Baton Rouge metropolitan area ranked 1st in
    estimated AIDS case rates (33.7 per 100,000) and
    the New Orleans metropolitan area ranked 5th in
    estimated AIDS case rates (26.2 per 100,000) in
    2010 among the large metropolitan areas in the

Current Chronic Illnesses Diagnosed in Louisiana
DOC Facilities
Chronic Disease 2009 2012 Population Increase in diagnosis
Hypertension 4,346 5,436 29.6 population 25
Diabetes 1,178 1,301 7.1 population 9
Cancer 193 216 1.2 population 9
Heart Disease 271 308 1.7 population 11
Pulmonary Disease 890 1,221 6.6 population 26
HIV 542 549 3 population 1.2
Hepatitis C 2,270 2,017 11 population 11 DECREASE
Health Care Work loadComparison 2008 - 2012
  • Due to the aging population, offenders health
    care needs are increasing which is also being
    seen in the communities (similar increase is
    being reported in the medical journals as age is
    the main driving factor).
  • Examples of the impact are
  • For offenders housed at the two Male LOC 1
    facilities (LSP Hunt) are listed
  • High Blood Pressure 33 ?
  • Diabetes 25 ?
  • Cancer 34 ?
  • COPD/Asthma 55 ?
  • The elderly offender population (gt 50 yrs) has
    increased 26 increase since 2008 and it is a
    known fact that this sub groups health care
    needs are very high.
  • On site medical encounters have increased by 45
    since 2008.

Mental Health
  • 28 of DOC Offender Population with Mental Health
  • 13 are on Psychotropic medications.
  • There were 53,822 psychotropic prescriptions
    written in FY 11/12.
  • During FY 11/12 there were 456 Mental Health
    Observations, 2,097 Standard Watches and 178
    Extreme Watches for DOC offenders.
  • During FY 11/12 there were 18 suicide attempts
    and 7 were significant injuries.
  • 71 diagnosed with substance abuse addiction or
  • Elayn Hunt Correctional Center has an inpatient
    Mental Health housing unit were the Level of Care
    1 offenders stay. Currently there are 96
    severally mentally ill. This unit has nursing
    and social workers on site 24 hours a day.

  • Population
  • 20,263
  • 2012 18,083

DOC Facilities Only
Parish Prisons and Health Care
  • From December 2011 to March 2012, parish
    facilities transferred 193 (15 of all transfers)
    offender to HRDC for medical or mental health
    issues, 49 (25) of these transfers were a direct
    admit to the infirmary because of their medical

LSU Services
(No Transcript)
Cost Containment
  • Telemedicine encounters have increased by 82
    since 2009.
  • 2009 589 encounters
  • 2012 3,337 encounters
  • This has helped us to contain the off site
    medical visits despite a higher number of sick
  • Psychotropic medication costs have decreased by
    53 even though cost of medications has
    increases, the Department has implemented a more
    efficient ordering process.
  • FY2008 DOC paid 1,059,595 for medical invoices
    and in FY 2010 paid only 346,652.00, a 67
    decrease in expenses.
  • Expansion of Inpatient beds - The medical complex
    at EHCC was expanded to increase the number of
    skilled nursing beds available throughout the
  • Opening Elderly assistance dorms for housing
    increased number of elderly and disabled
    offenders requiring assistance with activities of
    daily living.
  • Collaboration with other agencies

Long-term Goals
  • Health Care
  • Re entry
  • HIV Discharge Planning
  • Mental Health
  • Substance Abuse (Steve Hoyle S.A. Program)

Long-term Goals
  • Deliver more Definitive On-site Care
  • Expansion of Substance Abuse / Mental Health
  • Expansion of Medical Releases

Medical Releases from DOC

Currently Active Compassionate Releases 4
  2006 2007 2008 2009 2010 2011 2012 Total
Approved / Released 0 1 4 5 10 9 5 34
Currently Active Medical Parole Releases 22
  2006 2007 2008 2009 2010 2011 2012 Total
Released during year 1 0 0 4 5 14 10 34
Challenges in Correctional Health Care
  • As many of our states face one of the worst
    fiscal crises, appropriate health care has to be
    delivered in a cost efficient manner.
  • These are interesting times. There are many major
    reforms in corrections and our nation is
    witnessing the most significant change in the
    health care industry.
  • Correctional health care sits in this unique
    cusp, promoting these new ideas of managed care
    and tying them to continuity of care and having a
    positive impact on re entry efforts.
  • In addition, there are significant developments
    with the Affordable Care Act, Prison Rape
    Elimination Act, Gender Identity Disorder,
    Mentally ill in segregation, effective substance
    abuse treatment, and aftercare planning (getting
    releasing offenders their social security
    benefits, VA benefits etc.) .