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 Correctional System in the United States of American

 

Unseen, Uncounted, Uninsured, and Uncounted Hepatitis C Infected

Ex-Offenders Creates a Public Health Crisis in America

Annually, 6.5 million women are at risk physical and health care risk because their partner(s) have a history of incarceration.  .

  • Within the first 72 hours of release many ex-offender will use injectable drugs
  • Within 6 days ex-offenders will have unprotected sex with 1-3 partners
  • An average of 30% of ex-offenders will infect their primary sexual partner(s) with HV and/or HCV
  • In California 850,000 children under the age of 14 have at least one parent in the correctional system

The Unseen, Uncounted, and Unplanned population has the potential to tip our fragile health care system to an unstable and barely thriving entity as the annual cost to care for HCV patients is increasing 25% - 35% annually.  For patients who are uninsured or lack adequate medical insurance; or fear of losing their job when they seek medical care. They may delay seeking medical care when thee individuals health has declined to such an extent that whey they finally receive medical assistance, it will be costly, complex, and the expected length of stays may be extended. Discharges will be difficult because so many organ systems have declined over time because of a preventable illness.

In 2008, 7.3 million adults were in the U.S. correctional system (federal and state prisons, community jails, parole, and probation) which is the combined populations of cities of Chicago, Dallas, San Diego, and Philadelphia together. The Bureau of Justice Statistics in June 2000 reported 31.4% (2.3 million) adults in the correctional system had hepatitis C infected which is equal to the population of Houston, Texas.  Assuming 30% of the 2.3 million HCV infected inmates/ex-offender infect 1-3 partners – an additional 6.9 million newly infected HCV individuals – or another 1-3 cities the size of Houston will require complex health care

HCV is a chronic blood born virus that requires high utilization of complex medical care.  HCV is the leading cause of liver disease, liver cancer, and liver transplants.  Over the next ten to twenty years, more people of color, women, uninsured, and those with a history of incarceration and substance will require liver transplants.  How will we as a society decide who is worthy of receiving a liver transplant? As a society will we decide a married soccer mom living in the suburbs with three school age children is more worthy than a single uninsured mom living in East Oakland or South Central Los Angeles?

HCV is a chronic blood born virus that requires high utilization of complex medical care.  HCV is the leading cause of liver disease, liver cancer, and liver transplants.  Over the next ten to twenty years, more people of color, women, uninsured, and those with a history of incarceration and substance will require liver transplants.  How will we as a society decide who is worthy of receiving a liver transplant? As a society will we decide a married soccer mom living in the suburbs with three school age children is more worthy than a single uninsured mom living in East Oakland or South Central Los Angeles?

A Closer Look at HCV Infection in the Correctional System

In 2008, 7.3 million adults were in the U.S. correctional system (federal and state prisons, community jails, parole, and probation) which is the combined populations of cities of Chicago, Dallas, San Diego, and Philadelphia together. The Bureau of Justice Statistics in June 2000 reported 31.4% (2.3 million) adults in the correctional system had hepatitis C infected which is equal to the population of Houston, Texas.  Assuming 30% of the 2.3 million HCV infected inmates/ex-offender infect 1-3 partners - 2.3 million - 6.9 million new HCV infected individuals – or another 1-3 cities the size of Houston will require complex health care

The disproportionate number of young Hispanic and African Americans incarcerated males, 1 in 11 African American males and 1 in 27 Hispanic males ages 18-25 this combined with 82% of all new HIV infections are among African American and Hispanic young women ages 13-24 and lack health care. This will adversely impact communities of color in the future.

The total correctional population is currently about 1.9 million.  At least 70% of these individuals will return to society.  In the year 2000, The Bureau of Justice Statistics stated that there was an average of 31.4% of all inmates having Hepatitis C.  Annually, that is approximately, 600,000 former inmates, who have HCV returning to their communities. They will infect 1-3 individuals at some point in their lifetime generating and an additional number of newly HCV infected individuals seeking complex medical care, bombarding emergency departments, requiring high utilized medical services,  and  long term care  that has the potential to cripple the already struggling Public Health care system

Annually, up to 6,500,000 women are at risk of being infected with HCV and/or HIV within 6 days from ex-offenders.  Women of color are most adversely impacted; the majority of these women are single mothers with young children, and as they struggle to cope with HCV. The lives of their children and communities are also impacted because of the increase in demand for social services. Women are dying of ESLD. This has increased from 11.4 per 100,000 in 1999 to 12.9 per 100,000 in 2003 from a California study.

The inmate populations are high-risk individuals who continue to use drugs, share needles and have unprotected sex while still incarcerated. Examples of this movement of diseases from the correctional system to the local community and then to the communities that these inmate return to can be seen with these mortality charts.

Mortality Rates within a Correctional System within California

 

To the local community where a prison is located

Fremont County, Colorado

Or Del Norte County, California—Both Fremont and Del Norte Counties have the Correctional facility as the primary employer within the county

To the community that former inmates return to

Japan Town, San Francisco, California

The above mortality tables indicate the flow of infectious disease from within our correctional system to the communities that the inmates return to.  A system that believes that the “Security of the Facility is Paramount”; this shows that this concept is failing.  While the security can be interpreted in many ways, once the inmate is released back into the local community, by providing sub-optimal medical treatment for diseases-their action puts the local community at risk for these diseases.  “The Security of the Facility”  is not only protecting the local community from inmates while they are incarcerated but also providing Workers’ Compensation for those who work within the facility but the communities tht  inmates return to.  By only offering sub-optimal medical care, theses facilities become in essence, incubators for infectious diseases.

The economic, social, and medical toll  of HCV on any County is demonstrated by the liver disease mortality rate in Alameda County’s jail (1.4 million Alameda County population)  of 10  is equal to New York City’s Riker’s Island  (8.3 million population) and greater than Los Angeles County  (10 million population) at 6  liver cancer deaths.

 

 Annually, the mortality rates in county jails are increasing.  The majority of county jail deaths occur within the first 30 days of incarceration

 

Distribution of Deaths, by Time Served (days) Since Admission and Cause of Death 2000-2007 per 100,000 inmates

Time served

Heart Disease

 

AIDS

 

Cancer

 

Liver Disease

 

All other illnesses

 

Drug

/Alcohol Intoxication

 

 

7 or less days

32

%

7

%

4

%

24

%

31

%

74

%

 

8-30 days

21

 

20

 

12

 

18

 

22

 

7

 

 

31-60 days

13

 

13

 

14

 

16

 

12

 

3

 

 

61-120 days

13

 

23

 

18

 

18

 

14

 

5

 

 

121-180 days

8

 

16

 

16

 

9

 

8

 

3

 

 

More than 180 days

13

 

21

 

36

 

16

 

13

 

8

 

 

Source: Bureau of Justice Statistics, Mortality in Local Jails, 2000-2007 NCJ 222988, 07-07-2010

Annually, the mortality rates in the majority of county jails are increasing. The crimes committed by older inmates are petty. It appears that one of reasons individuals with chronic illnesses commit a petty crime is to return to jail to die for safety and medical care. 24% die in jails within less than 7 days and the majority die within 120 days from a chronic disease (long-term illness) – which means that the county jails have become a substitute for access to medical care and treatment.  Local jails do not have medical facilities to manage, treat or provide surgery for sick and dying inmates; therefore, the County must seek medical care from public and private medical facilities which is very costly and utilizing limited hospital beds within the county. This overflow from the jails to the local hospitals will impact the hospital beds that would have been available for full paying patients via insurance.  This Surge is beginning to impact the quality of care at the local medical centers that are already experiencing a bed shortage.

A Closer Look at the HCV Infection as the disease moves into our Communities

·         The liver disease mortality rate in county jails demonstrates the  level of HCV  in communities of color, as the majority of inmates are  Hispanic, Native American, and African Americans

·         In 2009 African Americans were less than 8% of San Francisco’s population and wrer 34.6% of new HCV infections. The majority of HCV infected African Americans were under the age of 35

·         1 in 50 Hispanics are HCV infected.  HCV is the 7th leading cause of death amongst Hispanics ages 25-44 and the 3rd leading cause of Hispanic deaths ages 45-66.  Alameda County’s Hispanic population has increased from 19% in 2000 to 22% in 2008. Hispanics are the fastest growing population in the county

·         In 2007, Native American/Alaska Natives were twice as likely to develop hepatitis C as whites   Alaska Natives  - median age of infection for IDUs was 22 – the estimated length of seeking  HCV treatment (females 11 years and males 16 years)  and 53% were ages 20-39)

·         A recent study of Native American HCV infected women  in Arizona  reported  they are dying in  their late thirties to mid-forties

·         The average age of a parolee/probationer is 38.  Assuming the median age of HCV infection is 22,  he/she is 16+ years into the disease which means  he/she will  within the 4-8 years require complex medical care

·         South Central Los Angeles is one to the most difficult places in the country to receive and give medical care. South Central Los  Angeles has 0.73 hospital beds per 1,000 residents

·         Los Angeles has an average of 1.23 hospital beds per 1,000 residents compared to 4.3 hospital beds per 1,000 residents nationally. 

·         Approximately, 14% of the nation’s uninsured live in California and 1 in 3 visits to Los Angeles emergency rooms are uninsured

·         From 1995-2004, there was a 376%  increase in HCV related  deaths of individuals  ages of 35-54 

·         End Stage Liver Disease (ESLD) is the second leading cause of death in the California prison system  (average age of death <55).  In the Texas prison system  41% of Hispanic male inmates died of HCV related deaths - average age 48-54

Communities around the United States are facing bankruptcy.  Funding that they that thought would be coming to them either from the Federal or State Level are rapidly being cut.  Many say that the local community is better able to determine what services are needed. However, many these services are a national concern, such as public health.  A virus does not know nor recognize any sort of boundary or jurisdiction; they can move freely throughout society.  Hepatitis C is one such virus. 

The 2005 End Stage Liver Disease (ESLD): Morbidity, Mortality, and Transplantation study of California 1999-2003 confirms why Native American’s refer to HCV as the new “Trail of Tears,” they represent less than 1% of the country’s population. The deaths by ESLD in 1999 for Native Americans was 28.3 per 100,000 and increased to 35.8  per 100,000 in 2003  Yet Natives receive the least hospitalizations of any ethnic group in the state.  Hispanics are the fastest growing population in the country and so are their rates of HCV infection – 24.8 per 100,000 in 1999 to 29.9 per 100,000 in 2003.

Nationwide there were 17,000 individuals on the organ transplant waiting list and approximately 3,500 liver transplants occur each year. As the chart below demonstrates the current a racial disparity on liver transplants including hard working insured people of color who have insured often wait longer and often die before receiving organ transplants than whites.

California  1999-2003    End Stage Liver Disease Deaths and Death Rates 

 

1999

2000

2002

2003

 

Deaths

Deaths

Deaths

Deaths

 

 

 

 

 

CALIFORNIA TOTAL

    5,574

   6,310

 6,737

  6,808

 

 

 

 

 

Race- Ethnicity

 

 

 

 

    African American/Black

       378

      392

    451

     437

   American Indian/Alaska Native

         55

        74

      67

       90

   Asian/Pacific Islander

       525

      613

    629

     653

   Hispanic/Latino

    1,383

   1,707

 1,856

  1,986

sub-total for non-white

    2,341

   2,786

 3,003

  3,166

   White

    3,226

   3,515

 3,724

  3,618

 

 

 

 

 

Gender

 

 

 

 

   Female

    1,879

   2,114

 2,338

  2,317

   Male

    3,785

   4,196

 4,399

  4,491

 

The costs of doing nothing, by delaying treatment can actually increase the total costs to everyone.

The table below demonstrates the cost of providing health care for 150 uninsured HCV infected patients End Stage Liver Disease - $11.97 million and a minimum of 2,790 hospital days

 The Unseen, Uncounted, Uninsured, and Uncounted HCV population will impact every area of health care and will overflow into our communities.  By having additional people utilizing our healthcare system, this will restrict those needing health services within the community.  Once this group of HCV infected people begin to require major medical services,  they will force out others seeking medical care.

·   EMTALA/Emergency Department – Emergency departments are the most critical path to the nations’ heath care delivery system.  EMTALA guaranteed access point for a who need care regardless of ability to pay

o   One of the most common HCV related emergency medical care is  hepatic encephalopathy  - 81.2%  are admitted through the emergency department

o     Nationally over 500,000 times a year, or once every minute, ambulances carry sick patients are turned away from full emergency rooms and sent to others often farther away.  

·      Bed Management – “a bed is a bed is a bed” as public hospitals beds are filled with uninsured HCV infected patients who require complex care.  Uninsured patients will seek treatment at HMOs and PPS thereby reducing the  number of available beds for insured/membership patients seeks care

·         Difficult Discharges

·         Readmission

·         Continuum of Care

·         Premature Deaths - The death of women of color in their prime years (economic and parenting) will result in generations of young children of color growing up without the stability of mothers, grandmothers, aunts, sisters to guide and protect them

·         Reduction in the Tax Base  - Premature deaths weakens  communities tax bases and reduces its ability to finance public expenditures, including those aimed at accumulating human capital, such as education and health services, family time, parenting per HCV related premature deaths

HOW WE CAN SAVE MONEY AND CREATE JOBS

Reducing the recidivism rate is the number priority that we have. Getting medical access for returning inmates is a must.  Counselors, peer counselors who have lived within the community and know exactly how to talk and relate to these ex-offenders are necessary

As the table below illustrates, with our preparation and utilization of our program, this is what we can accomplish, and the potential savings that we can offer you and your community.  By effectively allocating your expenses differently, a community can save money and jobs. 

 

Number of Inmate

 

Number of inmates

Total savings by providing

 

not returning to jail

Savings to Jail

Additional individuals that can be treated

treatment-50% clear virus

1%

177

$4,512,641

291

$21,305,141

2%

353

$9,025,282

582

$42,610,281

3%

530

$13,537,923

873

$63,915,422

4%

706

$18,050,564

1165

$85,220,563

5%

883

$22,563,205

1456

$106,525,704

 By reducing the recidivism rate, those individuals may also contribute to the local tax base.  As demonstrated by this table:

Total earnings of cleared inmates-

 

average age 35 ($25K/yr)

$37,500,000

Possible Taxes generated 30%

$11,250,000

 

Table 9. Percent of the total jail population, percent of jail inmate deaths, and average annual mortality rate per 100,000 jail inmates by selected inmate characteristics, 2000–2007

Characteristic

 

Percent of deaths in jails

 

Average annual mortality rate

 

Total

100

%

145

Sex

 

 

 

 

 

Male

88

%

146

 

Female

12

 

136

Race/Hispanic origin

 

 

 

 

 

White, non-Hispanic

52

%

172

 

Black, non-Hispanic

34

 

123

 

Hispanic

12

 

111

 

Other/multiple race/a

2

 

184

Age

 

 

 

 

 

Under 18

1

%

49

 

18-24

10

 

52

 

25-34

20

 

88

 

35-44

29

 

163

 

45-54

27

 

383

 

55 or older

14

 

892

 

 

 

60% recidivism

 

 

 

 

Sourcebook of Criminal Justice Statistics Online

 

 

 

 

 

 

 

 

 

 

 

 

Returned to prison with

 

 

Time after release

Rearrested

 

Reconvicted

 

new prison sentence

 

 

 

 

 

 

 

 

 

 

6 months

29.9

%

10.6

%

5

%

 

1 year

44.1

 

21.5

 

10.4

%

 

2 years

59.2

 

36.4

 

18.8

%

 

3 years

67.5

 

46.9

 

25.4

%

 

 

 

 

60% recidivism

 

 

 

 

Sourcebook of Criminal Justice Statistics Online

 

 

 

 

 

Returned to prison with

 

 

Time after release

Rearrested

 

Reconvicted

 

new prison sentence

 

 

 

 

 

 

 

 

 

 

6 months

29.9

%

10.6

%

5

%

 

1 year

44.1

 

21.5

 

10.4

%

 

2 years

59.2

 

36.4

 

18.8

%

 

3 years

67.5

 

46.9

 

25.4

%

 

                       

 

 

Percent of inmates who reported a medical problem, gender and age

 

 

 

 

 

Percent

 

 

 

All inmates

 

36.9

%

Gender

 

 

 

 

 

 

Male

 

 

34.8

%

 

Female

 

 

52.6

 

Age

 

 

 

 

 

 

24 or younger

 

 

25

%

 

25-34

 

 

33.7

 

 

35-44

 

 

43.3

 

 

45 or older

 

 

60.5

 

 Estimated number of inmates held in custody in state or federal prisons or in local jails June 30, 2009

Year

Total

2,096,300

 

 

 

 

 

18-19

68,200

3.30%

 

20-24

318,800

15.20%

 

25-29

360,800

17.20%

 

30-34

326,400

15.60%

 

35-39

308,100

14.70%

 

40-44

278,600

13.30%

The

45-49

203,900

9.70%

Expense

50-54

111,800

5.30%

Years

55-59

58,000

2.80%

 

60-64

25,200

1.20%

 

65 or older

21,000

1.00%

 

Total

2,080,800

99.30%

 

 

 

 

 

 

Cost for Treating 1 inmate with HCV no positive results

Direct Cost

Indirect

Esophageal Varices

$61,960

Cost of Officers

 

Days in Hospital

$67,091

Security

 

Transjugular Shunt

$43,209

Transport

 

Surgical Shunts

$53,994

 

 

Interferon Treatment

$15,000

 

 

Total Cost for one inmate

$241,254

 

 

 

 

 

 

Comparison for 100 inmates with 50% clearing HCV virus

Not treating anyone

No Results for 50

Results for 50

Indirect Costs

$24,125,400.00

$12,062,700.00

$775,000.00

1:12

 

 

 

 

 

 

 

 

Mortality rate per 100,000 local jail inmates

 

 

 

 

 

Cause of death

 

Total/a

15-24

25-34

35-44

45-54

55-64

All causes

 

145

53

90

165

379

731

Illness/b

 

52

4

17

58

185

422

 

Heart disease

32

3

10

34

115

292

 

AIDS

8

1

5

13

21

19

 

Cancer

5

0

1

3

17

66

 

Liver diseases

4

0

0

5

22

24

 

Cerebrovascular diseases

3

0

1

4

10

21

Suicide

 

43

32

42

50

55

70

Drug/alcohol intoxication

 

10

5

10

12

21

13

Accidental

 

4

2

3

5

10

13

Homicide

 

3

3

2

3

6

9

Other/unknown

 

8

3

4

9

20

45

                 

Homeless in year before arrest

 

 

 

 

 

 

Yes

49

%

48.8

%

 

No

35

 

34.6

 

Employed in month before offense

 

 

 

 

 

 

Yes

35

%

33.5

%

 

No

41

 

43.6

 

 

 

 


 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

As Americans, we can do better.  We need to strive for excellence and a better way of life for our children!!!!
 

 

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