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									The Prison-Industrial Complex

      Social Policy and
   Correctional Health Care
        Martin Donohoe
• “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
         US 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)
   – 2.3 million behind bars (jail + prison)
      • 1.52 million in jail; 0.79 million in prison
      • Includes 250,000 women, 93,000 youths
      • 1.6 million prisoners in China
       US Incarceration Rates
• 6-fold increase in # of people behind bars
  from 1972-2000
   – And rising
• # of women behind bars up 750% from
• 3100 local jails, 1200 state and federal
  prisons in U.S.
       US Incarceration Rates
• 10 million Americans put behind bars each
• 3-fold increase in # of people behind bars
  from 1987-2007
   – Crime rate down 25% compared with
• # of women behind bars up 750% from
US Incarceration Rates and Costs
• US incarceration rate highest in world
  –Russia close second
  –6X > Britain, Canada, France
• Costs: $30,000/yr for prison spot;
  $70,000/yr for jail spot
   Race and Detention Rates
• African-Americans: 1815/100,000
  –More black men behind bars than in
• Latino-Americans: 609/100,000
• Caucasian-Americans: 235/100,000
• Asian-Americans: 99/100,000
 Immigration Detention Centers
• Run by Immigration and Customs
  Enforcement, a branch of DHS
  – Haphazard network of governmentally- and
    privately-run jails
• Increasing numbers of detainees (“War on
  – Fastest-growing form of detention in U.S.
  – Lucrative business
  Immigration Detention Centers /
• Abuses common, including over 100
  deaths since late 2003
• Guantanamo, overseas black-ops sites
  (extraordinary rendition)
  – 92% were never involved with al-Qaeda (per
    government data)
 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
   Reasons for Overcrowding
• “War on Drugs”
• Mandatory Minimums
• Repeat Offender laws
  – 13 states have “three strikes laws”
• Truth in Sentencing regulations
• Decreased judicial independence
             Corporate Crime:
             Silent but Deadly
• $200 billion/yr. (vs. $4 billion for burglary and
• 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
            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
           Corporate Crime
• “Corporation: An ingenious device for
  obtaining individual profit without individual
                               Ambrose Bierce
• “A criminal is a person with predatory
  instincts who has not sufficient capital to
  form a corporation.”
                                  Howard Scott
 The Prison-Industrial Complex
• Private prisons currently hold
  16% of federal and 7% of state
  –Only UK has higher proportion of
   private prisoners than US
• 18 corporations guard 10,000
  prisoners in 27 states
 Private prison boom over past 15
• Reasons:
  – Prevailing political philosophy which
    disparages the effectiveness of (and even
    need for) government social programs
  – Often-illusory promises of free-market
        –Despite evidence to contrary (e.g.,
          Medicare/Medicaid, water privatization,
  – Increasing demand from ICE and USMS
 The Prison-Industrial Complex
• Leading trade group:
  – American Correctional Association
• For-profit companies involved:
  – Corrections Corporation of America
    • Controls 2/3 of private U.S. prisons
  – GEO Group (formerly Wackenhut)
    • Together these two companies control 75% of
      market, with over $2.9 billion revenue in 2010
 The Prison-Industrial Complex
• For-profit companies involved:
  – Correctional Medical Services
  – Others (Westinghouse, AT&T, Sprint, MCI,
    Smith Barney, American Express, Merrill
    Lynch, Shearson-Lehman, Allstate, GE,
    Wells Fargo [7% owned by Warren Buffet’s
    Berkshire Hathaway])
Corrections Corporation of America
• Largest for-profit prison corporation
• Largest detainer of undocumented immigrants
  – Facilitated by Arizona’s SB1070 and similar laws in
    UT, IN, GA, AL, and SC
• Earns between$90 and $200 per prisoner per
• Accused of paying lower salaries and providing
  less training than state-run prisons
 The Prison-Industrial Complex
• Aggressive marketing to state and local
  – Promise jobs, new income
• Rural areas targeted
  – Face declines in farming, manufacturing,
    logging, and mining
• Companies offered tax breaks, subsidies,
  and infrastructure assistance
  The Prison-Industrial Complex:
   2001 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
   The Prison-Industrial Complex:
     Politically 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 Delay’s (R-TX)
    Foundation for Kids
      • Delay’s brother Randy lobbied TX
        Bureau of Prisons on behalf of GEO
   The Prison-Industrial Complex:
     Politically Well-Connected
• Spent over $20 million lobbying legislators
  and DHS between 2003 and 2010
• $3.3 million donated in 44 states between
  2000 and 2004
   – 2/3 to candidates, 1/3 to parties (2/3 of
     this to Republicans
   – More given to states with tougher
     sentencing laws
 The Prison-Industrial Complex:
• 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
              Jails for Jesus:
          Faith-Based Initiatives
•   Increasing presence
•   Politically powerful
•   Most evangelical Christian
•   Supported financially by George W Bush’s
    Faith-Based Initiatives Program
    – e.g., Prison Fellowship Ministries – founded
      by Watergate felon Charles Colson in 1976
            Jails for Jesus:
        Faith-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
            Jails for Jesus:
        Faith-Based Initiatives
• Some programs “cure” sex offenders
  through prayer and Bible study
  – Rather than evidence-based programs
    employing aversion therapy and normative
• Highly recidivist and dangerous criminals
  may be released back into society armed
  with little more than polemics about sin
    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
  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%,
  – 28% of jails detoxify arrestees
          Inmate Deaths
• 141 per 100,000 deaths in custody in
• 89% - medical conditions
  –8% - suicide or homicide
  –3% - alcohol/drug intoxication or
    accidental injury
            Inmate Deaths
• Blacks prisoners have ½ mortality of Black
  non-prisoners (fewer alcohol- and drug-
  related deaths, lethal accidents, and
  chronic diseases; guaranteed health care)
• White prisoners have 12% higher mortality
  than White non-prisoners (higher death
  rates from infections, including HIV and
            Inmate Deaths
• Very few prisons have hospice programs

• Some have compassionate release
  programs, to allow death outside of prison
  before completion of sentence
        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
       Prison Health Care
• 60% provided by government
• 40% (in 34 states) provided by
  private corporations
• Private care often substandard
        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
 Examples of Substandard Prison
          Health Care
• Correctional Medical Systems
  – 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 >1000 lawsuits; under investigation
    in VT
 Examples of Substandard Prison
          Health Care
• California’s state prison health
  care system placed into
  receivership through 2012
   –1 unnecessary death/day
   –$5 co-pays limit access
   Rehabilitation and Release
• 600,000 prisoners released each year
   – 4-fold increase over 1980
   – 97% of all prisoners eventually return to
     the community
   – 1990s: funding for rehab dramatically
   Rehabilitation and Release
• Newly released and paroled convicts face
  restricted access to federally-subsidized
  housing, welfare, and health care
• ½ of state correctional facilities provide
  only a 1-2 week supply of medication
• Wait times for Medicare, Medicaid, and
  Social Security benefits up to 3 months
    Rehabilitation and Release
• Drug felons in 18 states permanently
  banned from receiving welfare
• High risk of death in first few weeks after
  release, mostly due to homicide, suicide,
  and drug overdose
      Ex-offenders have poor job
• Little education and job skills training occur
  behind bars
   – GED programs reduce recidivism, decrease costs
• Most prisoners released with $50 to $100 “gate
  money” and a bus ticket
• Limited resumés, background checks
• 60% of employers would not knowingly hire an
• High rates of criminal recidivism
• US world’s 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
• 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
• Convicts released without necessary skills
  to maintain abstinence and with few job
• Poor financial and employment prospects
  of released criminals make return to crime
  an attractive or desperate survival option
• 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
    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
    Role of Health Professionals in
Creating a Fair Criminal Justice System
• Speak out against injustice, racism, death
• Improve provider education re criminal
  justice system
• Run for office
    Health Professionals and
• 2002: AAMC standard application includes
  questions about felony convictions

• 2008: Questions about military discharge
  history and misdemeanor convictions
    Health Professionals and
• Medical schools make final judgments
  – Previous offences one of the most robust
    predictors of future offenses
    • Including cheating
  – 2009: BU med student accused of
• Hold government accountable for
  creating fair system that
  combines reasonable punishment
  with restitution and smooth re-
  entry of rehabilitated criminals
  into society
       Prison Health Care
• “A society should be judged not
  by how it treats its outstanding
  citizens but by how it treats its
                  Fyodor Dostoevsky
• Donohoe MT. Incarceration Nation: Health
  and Welfare in the Prison System in the
  United States. Medscape Ob/Gyn and
  Women’s Health 2006;11(1): posted
  1/20/06. Available at
     Contact Information
Public Health and Social Justice

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