Report: Prison health care system needs more accountability

A new report concludes health care services provided to the roughly 9,000 adult inmates in Minnesota prisons should be better coordinated and accountable.

Perhaps because of snow-slopped roads, the official release today of the report from Minnesota Legislative Auditor Jim Nobles drew only a sparse crowd. Only three of the 12 lawmakers who typically review legislative-auditor reports attended the hearing.

Nobles said he understands that the topic of prison health lacks a natural constituency.

"The Legislature deals with many issues, where if you talk about them, many people show up because it affects their lives," Nobles said. "The people who are most directly affected by these services can't show up. They're incarcerated."

Minnesota continues to have one of the lowest inmate mortality rates in the nation, but recent high-profile deaths in state prisons helped prompt Nobles' office to conduct the inquiry. It examined how the Department of Corrections cares for the medical, dental, and mental health needs of offenders.

At $68 million in fiscal year 2013, health services amount to a fifth of the state's total prison costs.

Nobles said it was important for his office to examine whether the state is fulfilling a constitutional requirement to deliver adequate health care to inmates, who typically are sicker than the average population. Nearly a third of inmates in Minnesota's aging prison population have chronic ailments, including heart disease and diabetes.

The auditor's report found that despite those challenges, Minnesota has yet to develop a consistent way to manage people with chronic conditions.

Joel Alter, who led the report, says offenders with mental illnesses spent more time in segregated cells than other inmates.

"This raises questions about whether some inmates are being disciplined who instead should be getting into treatment for their mental illness," he said.

Alter said research shows isolating people with mental illness can make their conditions worse.

Corrections officials say they don't segregate offenders who aren't responsible for their behavior. They agreed with many of the auditor's findings, and said they already comply with some of his recommendations.

Corrections Commissioner Tom Roy emphasized what he found to be the most telling discovery in the 109-page document.

"The highlight of the report is that Minnesota has the lowest mortality rate of the 49 correctional systems reporting," Roy said. "If you or I were going to consider placement of a loved one in a treatment facility or a hospital, mortality rate would certainly be the gold standard, because that reflects quality of care."

He noted that from 2001 to 2010, Minnesota reported 127 prison deaths. Wisconsin, which has a prison population that is more than twice the size of Minnesota's, had more than triple the number of deaths, according to figures from the Bureau of Justice Statistics.

"I'm not here today to throw Wisconsin under the bus," Roy said. "But we believe these statistics — while they might not be perfect and might not stand up to the scrutiny of the auditor — they indicate that we in fact have a very efficient medical health care system, that we save lives regularly."

The legislative auditor's office, however, cautions against reading too much into a state's mortality rate. Other factors, such as the age of inmates or the prevalence of life sentences, can also play into the percentage of dying inmates.

But the legislative auditor agrees that the issue of prison deaths — along with what led to them — are worth examining. The report found that while inmates received appropriate care in many cases, it identified what it called "service delivery problems" that may have contributed to the deaths.

Nobles said his office came to this conclusion by poring over so-called "mortality reviews" — documents that are off-limits to the public and the media. He recommends that the Legislature consider classifying them as public.

"We think more should be revealed," he said. "We could certainly still protect privacy and individual identities. We think there is an issue of transparency and accountability, that more information is not made available."

Corrections officials have balked at the suggestion, saying mortality reviews will be more candid and thorough if they're confidential.

Another recommendation would create a state ombudsman for corrections.

That would be a relatively low-cost way to provide a voice to inmates with grievances, state Sen. Mary Kiffmeyer said.

"You need somebody in your corner. If you're appealing to the very same people that are running the entity, it's really hard," said Kiffmeyer, R-Big Lake. "If all they're being told is, 'You go hire your own attorney,' while the agency has attorneys, it seems like a very unfair situation and it puts them in a difficult spot."

But Roy, the corrections commissioner, said he's not ready to commit to an ombudsman. He said Minnesota offenders already have a significant voice, and Roy said he personally reads every letter addressed to him.