Loyola Law Professor Releases Report on State of Healthcare Services in Louisiana Prisons
NOTE: The House Health and Welfare Committee invited the authors to present the report on Wednesday, May 19, at 9 a.m. The hearing can be live streamed at legis.la.gov
(New Orleans – May 17, 2021) – Leading researchers today released a pivotal report assessing the adequacy of healthcare services in state-managed prison facilities in Louisiana, a poverty-ridden state with the highest incarceration rate in the nation. The state Department of Public Safety and Corrections is required to provide adequate healthcare to more than 16,000 incarcerated people in Louisiana, a poverty-ridden state that has the highest incarceration rate in the nation.
The report identifies numerous challenges in terms of healthcare access, delivery, and administration for healthcare delivery in Louisiana’s eight state prisons, within the context of significant healthcare needs of the incarcerated population.
“This report dives into an important issue impacting people across Louisiana: access to healthcare,” said La. State Representative Mandie Landry, D-Dist. 91. “As legislators, it is essential for us to bring people together so that we can solve the complex problems we face. All of my constituents deserve equal representation, no matter where they are living.”
Three leading researchers co-authored the report: Loyola University New Orleans Law Professor Andrea Armstrong, one of the nation’s leading experts on prison and jail conditions, community health expert Dr. Ashley Wennerstrom of LSU Health Sciences Center, and Bruce Reilly of Voice of the Experienced (VOTE), a scholar with personal incarceration experience and expertise in advocacy and community organizing.
“This report implicates the constitutional rights of incarcerated people to adequate medical and mental health care consistent with health care available in communities across Louisiana,” said Armstrong, whose work is supported by a generous three-year grant from the Robert Wood Johnson Foundation.
“The challenges identified in this report could create liability for the state for providing substandard healthcare, particularly when these challenges lead to preventable deaths.”
For the systemic analysis, Representative Landry secured documents in January from the Louisiana Department of Public Health and Department of Safety and Corrections, including: internal and external audits, information about available services provided to incarcerated people, listings of all personnel, policies, and contracts for health care services in the eight state-managed prisons.
The authors also conducted interviews with external healthcare providers who work with incarcerated populations. Over the course of six months, they quickly surfaced critical challenges tied to access, delivery and administration of healthcare within the state prison system.
“Research shows that incarcerated people have higher rates of many illnesses than the general population, and that is certainly true in our state, which, unfortunately ranks poorly in numerous health and social indicators,” Dr. Wennerstrom said.
“Our work underscores the urgent need to improve healthcare quality and access for arguably one of the most vulnerable populations in Louisiana.”
The need is great. According to the report, nationwide, incarcerated people are generally sicker than the general population, with roughly three to four times the rate of hypertension, diabetes, and serious mental illness. These patterns hold true in Louisiana, with a significant number of people in Louisiana prisons having health conditions that require continuous care and oversight. The report details specific findings at individual facilities.
• At the Louisiana State Penitentiary, prison doctors ordered specialty consultations 8,375 times over 12 months, but only completed 50% within that same time period, for example.
• More than 50% of incarcerated men at a state prison in Allen, La., have been diagnosed with hypertension.
• More than 50% of incarcerated women at the Louisiana Correctional Institute for Women have a prescription for a mental health condition, and there are approximately 30 pregnancies in a given year.
On aggregate, roughly 6,000 people incarcerated in Louisiana in FY 2020 had hypertension, over 400 had heart disease, about 1,200 had been diagnosed with diabetes, roughly 1,600 had COPD, and about 300 had cancer. In terms of communicable disease, over 400 people were living with HIV, and about 1,500 were living with Hepatitis C. Other conditions included serious mental illness, end stage renal disease (requiring dialysis), and pregnancy/childbirth.
In FY 2020, the proportion of people on medication at any given facility ranged from 58% to 95%. Similarly, the proportion of people with a substance use disorder ranged from 56% to 98% across prisons. LSU Health Sciences Center - New Orleans estimates that 40% of incarcerated individuals have experienced mental illness and 20% of incarcerated people have been diagnosed with a serious mental illness (SMI).5 Of those with SMI diagnoses, 41% suffer from schizophrenia.
The authors identified potential barriers to access to mental and physical care for incarcerated residents including: a lack of preventative care, costs and processes of accessing care, and potential disciplinary charges. In terms of healthcare delivery, researchers identified specific challenges for incarcerated patients in segregation receiving chronic, specialty, and behavioral health care. Within healthcare administration, they found challenges including: license status for healthcare providers, vacancies, and paper medical records.
Moreover, the prison system has recently faced increased healthcare expenses, the authors said. The Louisiana Department of Safety and Corrections had a fiscal year budget of $81 million in healthcare expenses in FY 2019; in FY 2020, expenses for professional services increased to approximately $96.3 million.
The authors recommend a high-level authoritative coordinating committee appointed by the governor to: develop and monitor standardized healthcare policies, develop and monitor healthcare staffing plans, review and monitor the impact of medical co-pays, and assess the feasibility of partnerships with community-based providers to help provide adequate healthcare delivery to incarcerated residents.
According to the report, the committee should include a mix of representatives from across the prison system: administrative leaders from the Louisiana Department of Public Health and Department of Public Safety and Corrections, external medical and behavioral healthcare providers, experts in public health and incarceration, and currently and formerly incarcerated patients.
“Year in and year out, we hear stories about the struggles our people face in getting basic health care in prison, where there are no second opinions,” Reilly said. “Many of the problems identified here are the same ones people have faced for decades, and now is the time for us to address them. Just because the task seems hard is not a reason to ignore it.”