DOH Oversight of Correctional Health Care
In early 2004, the NYS Assembly Standing Committees on Health and Corrections held public hearings to address the health care offered in NYS prisons. The following are excerpts from testimony by Lambert N. King, M.D., Ph.D.
In his testimony to this committee, NYS Department of Corrections (DOCS) Commissioner Glenn Gourd testified: "I don't know of any other state health department responsible for prison medical care." Commissioner Gourd is apparently unaware that in California, where the prison system houses over 160,000 inmates in about 70 facilities, the California Department of Health Services has statutory and enforcement responsibility for specific standards, inspection and licensure of a range of hospital and correctional medical treatment facilities within the California prison system. Moreover, there are numerous major jail health care systems, including those in New York City and San Francisco, where the local city health departments are directly responsible for the oversight and quality of delivery of correctional health care services. Thus, such arrangements certainly do not lack precedent or prior experience.
But even if there were no such precedents, anyone familiar with the remarkable history of the NYS DOH knows that it has usually led the nation in unique health care and policy reforms. Two excellent examples are the creation and development of the AIDS Institute and the promulgation of standards for limitations on working hours and strengthened supervision of resident physicians in teaching hospitals. We should expect and must accept nothing less than similarly stellar leadership from the NYS DOH with respect to the vital responsibility of health care for the 65,000 men and women confined on any given day in New York's prisons.
Incarcerated persons are completely dependent upon DOCS for medical, mental health and oral health services. It is this total dependency, coupled with a long history of egregiously deficient health services and conditions in U. S. prisons, which converged to firmly establish that systematically inadequate health services in correctional institutions violate the Eighth Amendment prohibition against cruel and unusual punishment. 50 years ago, there was no firm legal basis to conclude that delivery of adequate health service was central to the mission of prisons and jails. Today, however, there can remain no doubt that our Constitution mandates provision of an adequate health services program to be a sine qua non [absolute prerequisite] with respect to the very existence of jail and prisons.
In fact, multiple studies and publications have demonstrated that our major jail and prison systems are among our nation's largest institutional care providers for persons with serious mental illnesses, HIV and Hepatitis C infection, and the multiple sequelae [consequences] of cigarette smoking. Yet DOH continues to assert that DOCS is not "principally engaged in the provision of services by or under the direction of a physician." By doing so, DOH reminds us that denial isn't just a river in Egypt.
DOH surveillance of DOCS health services is not fundamentally a question of whether the current quality of DOCS health care is excellent, mediocre or awful. Article 28 [the public health law mandating DOH surveillance of hospitals and other health care facilities] exists because we all know that the quality of care in our hospitals can vary widely from place-to-place and from time-to-time. Not even our most prestigious health care institutions in New York State would assert, as does DOCS, that they should be exempt from DOH oversight under Article 28 because their quality of care is better than ever and, thereby, the checks and balances in place for all other major health care providers do not apply.
It is irresponsible to continue to isolate correctional health care, including the DOCS program, from our entire health care system. Every day, many men and women leave our prisons and return to communities throughout the State. For those with serious health problems, we must have solid transitional medical care plans, continuity of care, and cost-effective use of the health care resources the State has already invested to care for them in prison. Left to its own devices, DOCS cannot and will not do this. DOH must not only accept its obligations to monitor and improve the quality of New York's prison health care system, it must embrace this extraordinary opportunity that exists to benefit the health of all of our citizens.
This article was provided by AIDS Community Research Initiative of America. It is a part of the publication ACRIA Update. Visit ACRIA's website to find out more about their activities, publications and services.