Since I moved to California last year, Californiaâ€™s Prison Realignment policy has been getting deserved attention. It’s no secret that prisons are the site of an acute concentration of medical and social service problems. But where did that concentration come from?
In my first post I thought I’d take a moment to enumerate some of the features of prisons and of prisoner populations that make that concentration so intractable, especially here in California:
- Prisons are rural and isolated, and this impedes the swift delivery of medical services.
- Prisoners are frequently transferred from other prisons, which complicates record-keeping â€“ an essential feature of medical care.
- The architectural features of prisons themselves often either exacerbate or precipitate medical problems.
- Prisoners are drawn from groups where problems typically concentrate before they arrive in prison.
- Some prisoners refuse urgent medical care.
- Medical personnel donâ€™t make much money. One would be mistaken in thinking that the high wages that prison officers enjoy carries over to medical personnel in prisons. Consequently, medical units are understaffed and, at times, the staff itself is incompetent.
Many people wonder why a sweeping policy to re-structure prisons based on overcrowding is so centrally preoccupied with the delivery of medical service specifically. The two seem related, but by no means synonymous. The answer is that the problems found in prison medical units are typically amplified by prison overcrowding, and that the medical units are the first to show indicia of deterioration.
The way problems become magnified by overcrowding in medical units is different to the way that problems are magnified in the regular prison wings. One might be able to double stack a bed in a prison cell, but the same canâ€™t be done with a clinic bed. Medical attention requires much more prison officer manpower per inmate than is necessary for prisoners held in other parts of the facility; even simple tasks like transporting inmates from the medical unit to other facilities is vastly more difficult when the medical unit is overcrowded. The result, as was so poignantly highlighted in the Brown v. Plata decision, is an increased reliance on Secure Housing Units in instances for which the SHU was not envisioned.
Hence, the problems that accompany prison overcrowding obey a multiplicative rather than a linear function. Looking through the list, one could easily find a recipe for bleakness. Sure, it is bleak. But many of them are also eminently soluble (Number 2 in particular). Thereâ€™s nothing inevitable and intractable about the way these problems are concentrated. Itâ€™s often a good idea to remind oneself that it wasnâ€™t always like this. We got here as a result of a series of very conscious decisions. Itâ€™s generally understood that getting out of the problem of mass incarceration is going to be much more difficult than getting into it, but itâ€™s entirely possible. Weâ€™ve just got to work for it. Hard.