Prison HMOs
The Basics

In order to understand the prison HMO (Health Maintenance Organization) or a hybrid HMO healthcare provider, one must first have a working knowledge and understanding of the HMO as it exists in general society. Armed with that knowledge as a foundation, and the "outside" HMO as a template, only then can one understand the tricks and traps of the Prison HMO, and how it utilizes those tricks and traps to their advantage---and the inmate patient's disadvantage.

The HMO In Society

Managed health care in the United States has grown by leaps and bounds. According to a 1996 Consumer Report article, How Good Is Your Health Plan (August 1996, p. 29), half of all Americans at that time who had health insurance received their benefits through some form of HMO. That number has since increased.

Problems arise because of the incongruous elements of an HMO. HMOs are neither 100% "health care provider" nor are they 100% an "insurer". They are a business, and just as with any business, they're in business to make a profit. Statutes governing HMO operations vary from state to state. Realize also, that state statutes that deal with deceptive and unfair trade practices may apply to an HMO case; and while medical malpractice and negligence laws are usually pertinent; the laws that govern how insurance companies do business may equally be applicable.

The HMO Behind Bars

The HMO behind bars (the Prison HMO) takes advantage of the public's ill will toward offenders to justify giving poor healthcare while at the same time making a profit. Patient inmates die as a result of negligence, indifference, malpractice, inadequate training, non-qualified and non-licensed personnel and cost cutting. Encounters with an HMO behind bars can become a death sentence, even for offenders whose cases have not yet gone to trial (those in jails or detention centers) or who have been convicted of relatively minor crimes. Many are people with curable conditions.

In the free world, a sick person has choices - even you as an HMO patient have choices. You can switch doctors or health plans if you're not satisfied. Clearly in a prison setting that is not the case.


Prison Healthcare - On the Inside

Patients in prison are summarily ignored. It can take anywhere from 3 days to 3 months or longer to been seen by a prison doctor. Medical emergencies aren't; unless you're in the process of dying-whether by heart attack or end-stage liver disease.

Inmate patients state their concerns to doctors and prison medical personnel only to be met with apathy and non-treatment by the doctors and nursing staff. Inmate requests for detailed information about their condition(s) or medications are met with disdain and disgust, and are denied the information. If a doctor doesn't like the questions or inferences of questionable treatment and healthcare, that doctor and nursing staff can (will) retaliate against that patient and will utilize a variety of ways to do so especially if that inmate has no outside support --- from family or friends.

Inmate patients can request tests for specific conditions and be denied those tests. They can be forced to succumb to other medical tests for conditions they do not have. If they refuse the unnecessary tests, they may be "written up" for refusing treatment, and subsequently not treated for any current or future conditions.

Inmate patients are lied to about their health conditions. Inmate patients can be dying of cancer and told they have the flu. Inmate patients can have bleeding ulcers and be treated with antacids. Inmate patients can be told that their blood work and enzyme levels are 'normal' when in fact they are in end-stage liver disease, and eligible for medical parole. Inmate patients may have brain tumors and be treated for migraines. The result? Permanently disability or death.

It is this defiance by the Prison HMO, or other healthcare providers and your State Department of Corrections that ensure that the medical provider company nets a profit at the end of each fiscal year. As a result of not providing adequate treatment to your prison population, it saves your State millions of dollars.

Inmate patients not only have limited access to accurate and factual information from both the medical provider and the prison itself; but are subject to retaliation techniques if they (a) are aggressive in obtaining needed healthcare and/or (b) have no outside support from family and/or friends. Additionally, they do not have timely access to attorneys; and are continually denied their right to informed consent.

Prison HMOs
They Do Affect (Effect) You

The HMO out in society just like the Prison HMO, is a business that makes money, lots of money. And just as with the Prison HMO so it is with the HMO in society-the more money for the HMOs, the less for patient healthcare.

If you are one of the ill-informed and hold the belief that "you don't care about whether or not inmates receive adequate healthcare" think again. If you are one of the millions in this country that cannot afford healthcare yourself, or for your children, and you are of the belief, that these to HMO systems-the HMOs in society and the Prison HMO are unrelated and don't concern you, think again. Your tax dollars are paying for both. If unconvinced perhaps numbers will drive the point home to you:

  • Nearly 600,000 inmates are released each year, many of them riddled with disease.
  • According to the most recent Bureau of Justice Statistics, 24,000 inmates nationwide were HIV positive (in 1996). A more recent study by the National Commission on Correctional Healthcare (NCCHC) put the number with HIV as high as 47,000; 10 times higher than the rate in the general population. That number has gone up.
  • TB, which is a lung disease, spreads rapidly through the air in enclosed spaces, infects 1 in 4 people in some prisons, compared to less than 1 in 10,000 in the general population.
  • Hepatitis C, often a lethal liver disease, spread by blood exchange, infects approximately 41% of the inmates just in California prisons alone; compared to less than 2% of the population at large.

What Can You Do?

Whether an inmate or a member of free society, if you suspect negligence, medical malpractice or neglect, have suffered a personal injury by a work related accident, vehicle accident, are having difficulty getting approval from your healthcare provider for specific tests, surgeries or procedures, or a death has occurred in or as a result from:

  • A State Department of Corrections
  • Jail or Detention Center
  • A Prison Healthcare Provider
  • A hospital
  • Nursing Home / Elder Abuse
  • Physician or Nursing Staff

Contact our Consulting Services and utilize our free Attorney Referral Service.

Copyright © 2008 Karen L. Russo - The Wrongful Death Institute & Forensic Science Associates. All Rights Reserved. These articles or pages may not be copied, transmitted, forwarded, reposted, or republished, in whole or in part, electronically or in any other format, without express written permission. This is not a solicitation for legal business. The Institute is not engaged in the practice of law. Mere contact through this website does not constitute a contract for representation. Wrongful Death Institute pages are designed and maintained by Four Boys Inc.