The Prison-Industrial Complex

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The Prison-Industrial Complex

• Social Policy and Correctional Health Care
• Martin Donohoe

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• The mood and temper of the public in regard to
  the treatment of crime and criminals is one of
  the most unfailing tests of any country. A calm,
  dispassionate recognition of the rights of the
  accused and even of the convicted criminal, ...
  and the treatment of crime and the criminal
  mark and measure the stored-up strength of a
  nation, and are the sign and proof of the living
  virtue within it.
• Winston Churchill

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LockdownUS Incarceration Rates

• World prison population 8.75 million
• US 6.5 million under correctional supervision
  (behind bars, on parole, or on probation) - 1/31
  adults (vs. 1/77 in 1982)
• 2 million behind bars (jail prison)
• 1.25 million in jail 0.75 million in prison
• Includes 180,000 women

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LockdownUS Incarceration Rates

• 6-fold increase in of people behind bars from
  1972-2000
• And rising
• of women behind bars up 750 from 1980
• 3100 local jails, 1200 state and federal prisons
  in U.S.

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LockdownUS Incarceration Rates and Costs

• US incarceration rate highest in world
• Russia close second
• 6X gt Britain, Canada, France
• Costs 30,000/yr for prison spot 70,000/yr for
  jail spot

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Race and Detention Rates

• African-Americans 1815/100,000
• More black men behind bars than in college
• Latino-Americans 609/100,000
• Caucasian-Americans 235/100,000
• Asian-Americans 99/100,000

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Jail and Prison Overcrowding

• 22 states and federal prison system at 100
  capacity in 2000
• 1/11 prisoners serving life sentence
• ¼ of these without possibility of parole

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Reasons for Overcrowding

• War on Drugs
• Mandatory Minimums
• Repeat Offender laws
• 13 states have three strikes laws
• Truth in Sentencing regulations
• Decreased judicial independence

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Corporate CrimeSilent but Deadly

• 200 billion/yr. (vs. 4 billion for burglary and
  robbery)
• Fines for corporate environmental and social
  abuses minimal/cost of doing business
• Some corporations linked to human rights abuses
  in US and abroad
• Most lobby Congress to weaken environmental and
  occupational health and safety laws

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Corporate Crime

• The only social responsibility of business is
  to increase its profits.
• Milton Friedman
• Corporations have no moral conscience. They
  are designed by law, to be concerned only for
  their stockholders, and not, say, what are
  sometimes called their stakeholders, like the
  community or the work force
• Noam Chomsky

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Corporate Crime

• Corporation An ingenious device for obtaining
  individual profit without individual
  responsibility.
• Ambrose Bierce
• A criminal is a person with predatory instincts
  who has not sufficient capital to form a
  corporation.
• Howard Scott

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The Prison-Industrial Complex

• Private prisons currently hold just under 10 of
  US prisoners
• Only UK has higher proportion of private
  prisoners than US
• 18 corporations guard 10,000 prisoners in 27
  states

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Private prison boom over past 15 years

• Reasons
• Prevailing political philosophy which disparages
  the effectiveness of (and even need for)
  government social programs
• Often-illusory promises of free-market
  effectiveness
• Despite evidence to contrary (e.g.,
  Medicare/Medicaid, water privatization, etc.)
• Increasing demand from ICE and USMS

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The Prison-Industrial Complex

• Leading trade group
• American Correctional Association
• For-profit companies involved
• Corrections Corporation of America
• GEO Group (formerly Wackenhut)
• Together these two companies control 75 of
  market
• Correctional Medical Services
• Others (Westinghouse, ATT, Sprint, MCI, Smith
  Barney, American Express, Merrill Lynch,
  Shearson-Lehman, Allstate, and GE)

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The Prison-Industrial Complex

• Aggressive marketing to state and local
  governments
• Promise jobs, new income
• Rural areas targeted
• Face declines in farming, manufacturing, logging,
  and mining
• Companies offered tax breaks, subsidies, and
  infrastructure assistance

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The Prison-Industrial Complex2001 Bureau of
Justice Study

• Average savings to community 1
• Does not take into account
• Hidden monetary subsidies
• Private prisons selecting least costly inmates
• c.f., cherry picking by health insurers
• Private prisons attract large national chain
  stores like Wal-Mart, which
• leads to demise of local businesses
• Shifts locally-generated tax revenues to distant
  corporate coffers

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The Prison-Industrial ComplexPolitically
Well-Connected

• Private prison industry donated 1.2 million to
  830 candidates in 2000 elections
• 100,000 from CCA to indicted former House
  Speaker Tom Delays (R-TX) Foundation for Kids
• Delays brother Randy lobbied TX Bureau of
  Prisons on behalf of GEO

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The Prison-Industrial ComplexPolitically
Well-Connected

• 3.3 million donated in 44 states between 200 and
  2004
• 2/3 to candidates, 1/3 to parties (2/3 of this to
  Republicans
• More given to states with tougher sentencing laws

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The Prison-Industrial ComplexAbuses

• Some paid for non-existent prisoners, due to
  inmate census guarantees
• 2009 Two judges in PA convicted of jailing 2000
  children in exchange for bribes from private
  prison companies

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Jails for JesusFaith-Based Initiatives

• Increasing presence
• Politically powerful
• Most evangelical Christian
• Supported financially by George W Bushs
  Faith-Based Initiatives Program
• e.g., Prison Fellowship Ministries founded by
  Watergate felon Charles Colson in 1976

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Jails for JesusFaith-Based Initiatives

• Offer perks in exchange for participation in
  prayer groups and courses
• Perks better cell location, job training and
  post-release job placement
• Courses Creationism, Intelligent Design,
  Conversion Therapy for homosexuals

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Jails for JesusFaith-Based Initiatives

• Some programs cure sex offenders through prayer
  and Bible study
• Rather than evidence-based programs employing
  aversion therapy and normative counseling
• Highly recidivist and dangerous criminals may be
  released back into society armed with little more
  than polemics about sin

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Health Issues of Prisoners

• At least 1/3 of state and ¼ of federal inmates
  have a physical impairment or mental condition
• Mental illness
• Dental caries and periodontal disease
• Infectious diseases HIV, Hep B and C, STDs
  (including HPV?cervical CA)
• Usual chronic illnesses seen in aging population

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Crime and Substance Abuse

• 52 of state and 34 of federal inmates under
  influence of alcohol or other drugs at time of
  offenses
• Rates of alcohol and opiate dependency among
  arrestees at least 12 and 4, respectively
• 28 of jails detoxify arrestees

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Inmate Deaths

• 12,129 inmates died in custody between 2001 and
  2004
• 89 - medical conditions
• 8 - suicide or homicide
• 3 - alcohol/drug intoxication or accidental
  injury

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Prison Health Care

• Estelle v. Gamble (US Supreme Court, 1976)
  affirms inmates constitutional right to medical
  care (based on 8th Amendment prohibiting cruel
  and unusual punishment)
• Amnesty International and AMA have commented upon
  poor overall quality of care

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Prison Health Care

• 60 provided by government entities
• 40 (in 34 states) provided by private
  corporations
• Private care often substandard

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Prison Health Care

• Some doctors unable to practice elsewhere have
  limited licenses to work in prisons
• Some government and private institutions require
  co-pays
• Discourages needed care increases costs

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Examples of Substandard Prison Health Care

• Correctional Medical Systems (largest/cheapest)
• Numerous lawsuits/investigations for poor care,
  negligence, patient dumping opaque accounting of
  taxpayer dollars
• Prison Health Services
• Cited by NY state for negligence/deaths subject
  of gt1000 lawsuits

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Examples of Substandard Prison Health Care

• Californias state prison health care system
  placed into receivership
• 1 unnecessary death/day
• 5 co-pays limit access

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Rehabilitation and Release

• 600,000 prisoners released each year
• 4-fold increase over 1980
• High risk of death in first few weeks after
  release, mostly due to homicide, suicide, and
  drug overdose

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Rehabilitation and Release

• 1990s funding for rehab dramatically cut
• Newly released and paroled convicts face
  restricted access to federally-subsidized
  housing, welfare, and health care

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Ex-offenders have poor job prospects

• Little education and job skills training occur
  behind bars
• GED programs reduce recidivism, decrease costs
• Limited resumés, background checks
• 60 of employers would not knowingly hire an
  ex-offender
• High rates of criminal recidivism

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Summary

• US worlds wealthiest nation
• Incarcerates greater percentage of its citizens
  than any other country
• Criminal justice system marred by racism
• Prisoner health care substandard
• Until recently, US executed juveniles and
  mentally handicapped

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Summary

• US continues to execute adults
• Drug users confined with more hardened criminals
  in overcrowded institutions
• Creates ideal conditions for nurturing and
  mentoring of more dangerous criminals
• Punishment prioritized over rehabilitation

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Summary

• Convicts released without necessary skills to
  maintain abstinence and with few job skills
• Poor financial and employment prospects of
  released criminals make return to crime an
  attractive or desperate survival option

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Summary

• US criminal justice system marked by injustices,
  fails to lower crime and increase public safety
• Significant portions of system turned over to
  enterprises that value profit over human dignity,
  development and community improvement

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Role of Health Professionals in Creating a Fair
Criminal Justice System

• Address social ills that foster substance abuse
  and other crimes
• Especially rising gap between rich and poor,
  haves and have nots
• Increase focus on magnitude and consequences of
  corporate crime

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Role of Health Professionals in Creating a Fair
Criminal Justice System

• Speak out against injustice, racism, death
  penalty
• Improve provider education re criminal justice
  system
• Run for office

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Health Professionals and Criminality

• 2002 AAMC standard application includes
  questions about felony convictions
• 2008 Questions about military discharge history
  and misdemeanor convictions added

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Health Professionals and Criminality

• Medical schools make final judgments
• Previous offences one of the most robust
  predictors of future offenses
• Including cheating
• 2009 BU med student accused of stalking/murder

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Conclusion

• Hold government accountable for creating fair
  system that combines reasonable punishment with
  restitution and smooth re-entry of rehabilitated
  criminals into society

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Prison Health Care

• A society should be judged not by how it treats
  its outstanding citizens but by how it treats its
  criminals.
• Fyodor Dostoevsky

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Reference

• Donohoe MT. Incarceration Nation Health and
  Welfare in the Prison System in the United
  States. Medscape Ob/Gyn and Womens Health
  200611(1) posted 1/20/06. Available at
  http//www.medscape.com/viewarticle/520251

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Contact Information

• Public Health and Social Justice Website
• http//www.phsj.org
• martindonohoe_at_phsj.org