The nation’s incarcerated population is aging rapidly, with nearly four times as many inmates 55 or over as there were at the start of this century. That’s led to increased rates of diabetes and heart disease, among other problems. Younger offenders have high rates of addiction. Prisoners make up one percent of the population, yet they account for 35 percent of the nation’s total cases of hepatitis C, Governing reports. “They are the most expensive segment of the population,” says Marc Stern, a public health professor at the University of Washington, “and they are the sickest.” Inmates are unlikely to receive adequate medical attention. A majority of states have contracted out prison health care to private companies. Vendors have been sued hundreds of times. Some cases are frivolous, but some have led to multimillion-dollar judgments and court orders to change practices.
Horror stories of needless deaths abound. From Arizona to Florida, prisoners with cancer have been treated with nothing more than Tylenol. A Columbia University study found that 97 percent of inmates with hepatitis C do not receive the expensive medication they need. Inmates must complain of the same symptoms multiple times before they even get to see a doctor, sometimes waiting weeks. A default attitude among guards is that inmates are lying about being sick, says Susan Lawrence, a physician and attorney who has worked in prisons. States often pay private companies on a per-inmate, per-day basis. Providers low-ball one another to get business, leaving less money available for care. There are three major private players — Corizon Health, Centurion Managed Care and Wexford Health Sources. States unhappy with their services don’t have many places to turn. “It’s like a game of musical chairs, but there are only three chairs,” says David Fathi of the American Civil Liberties Union National Prison Project.