Going To Prison For Healthcare

I’m sure you’ve heard of Americans who need health care but don’t have insurance or aren’t qualified for whatever programs are offered by the government going to Canada or some other country to take advantage of their universal health care programs.  Or maybe somebody who has joined the military to get benefits.

But what about the person who robbed a bank – with the full intention of getting caught and going to prison so he could have healthcare.

Not my favorite way to get health care benefits. Not a very sure way to get health care benefits.  They even admit this in the article.  “It all depends on the judge.” I have heard of a lot of people trying to get into prison for many different reasons. Some just to get minimal room and board facilities.  The veterans looking for space in a domiciliary used to call it “Three Hots and a Cot.” 

In one of the California correctional facilities where I once served time – I mean, “worked” — they had a specialized  training  program for Activities of Daily Living (ADL).  No matter how much the institution applied this program to make transition to the outside world easier, anyone dismissed would be back within two weeks maximum. 

They used to say that this program had replaced the long-closed state mental hospitals, by taking care of people who simply cannot survive outside of an institution.  I remember, for example, one very impaired gentleman who was found on a bus 150 miles away in 48 hours, heading toward the Mexican border.  He was speaking incoherently and had not removed an identity bracelet which told the reader what prison he had just left. The fellow who robbed a bank to go to prison for healthcare is certainly not chronically impaired. Rather, he is someone who made a poorly-considered decision, but had some real illnesses and wanted treatment.  

Yes, it is true that there is a law that mandates medical care for those in prison.  Did this fellow know the difference between petty larceny and felony theft?  He didn’t think of that? Actually, this may have at least slightly harmed my view of prisoners as people who know more about law–and more about police procedures than anyone I have known. Ah, how they loved to watch and to criticize “Cops” on television. One thing that nobody seems to know much about is this ideal of “health benefits.” It is not just who pays how much for what, but—-here is my shockerooney–if the “what” works. There are far too many variables here. I remember seeing at least one long-term outcome study showing that, for example, with type II diabetes, there may not be all that much difference between people who are treated over a long period of time, and those who are not. There are people like one of my uncles, who has bottles full of pills for diabetes sitting unopened in his medicine cabinet, and doesn’t think sweets can really hurt you.  He certainly seemed not too long ago to have a personality not too different from what I remember him as having as a child. He certainly seemed to function well in his retirement activities. I have a specific memory of a specific conversation with one of the custodial personnel ( a term the guards prefer to be called)  at a California State Penitentiary where I once worked.  The “custodian” was watching while I assessed an inmate, finished my assessment, and dismissed this man to the custody of another guard for return to his cell. It would be an understatement to say that the custodial staff was hostile not only to the inmates, but to the medical staff, and seemed to relish every passive-aggressive behavior they could imagine.  After this assessment visit, the guard who had been present with me in the room was openly hostile and  angry at me.  I did not take this as a good sign —  anger breeds more anger, especially in a setting like prison, so I simply asked him why he was so angry. He told me that his son had what they seemed to think was ADD.  And he told me that he paid plenty out of his salary for healthcare benefits.  But he could not get a psychiatrist as smart as me, who would spend as much time, and actually care about his son.  Instead, the state provided some worthless example of humanity with a psychiatrist – me — taking a lot of time trying to help a “piece of @!$#”  prisoner, and it was painful for him to watch. The injustice of the so-called justice system.

I did not have a good explanation for him, and he wasn’t inclined to engage me in conversation.  He simply wanted me and the prisoners to feel his wrath.

This was not an isolated experience.  This was the rule – not the exception – when dealing with the custodial staff. The accused bank robber in “USA Today” has a “potentially life-threatening” growth on his chest.  From that non-specific description, I have no idea what the problem really is and how life-threatening it could be.  As for the slipped discs and even the pain radiating down into the leg, I am a (very) old neurosurgical resident who has actually assisted in operating this sort of thing.

One of the reasons I changed specialties was that I eventually discovered that surgery could make at least some patients worse, maybe as many as it made better.  I would meet a post-operative patient in the supermarket, and ask how they were doing.  It was easy to observe – and they were not bashful about telling me – the unvarnished truth.  The pain and limited mobility – It just didn’t sound like a successful operation. But by every medical standard, it was considered a rousing success.

What about the quality of jail medicine?  Not just jail medicine, but any of the programs that are supposed to serve the indigent. Or the programs of the academic institutions, or anything?

Doctors are not saints – I’ve not yet met the equivalent of Mother Teresa.  Physicians are more often over-worked and stressed-out (or burned-out) humans who are victims of the system in which they work.  They might be victims as much as the convicts they serve in prison, or the enlisted personnel they serve in the military – I’ve worked in both systems – or even the restrictions of private insurance companies and HMOs. I think it may be important to check some research, some outcome studies, before getting a job you don’t like just because you want “healthcare benefits.” It is even more important to check outcome studies before robbing a bank.