If Phillip Tharrington hadn't been caught attempting to rob a Rockville store in 2005, he might never have gotten treatment for an HIV infection he had ignored for years.
The 47-year-old said he was persuaded to get care after being sent to the Maryland Correctional Institution in Hagerstown, where officials have been striving to identify and treat the disproportionate number of prisoners who arrive with chronic conditions such as HIV and hepatitis-C infections and diabetes.
State data suggest there are now more healthy prisoners like Tharrington among the 26,000 incarcerated in Maryland facilities — and that's good public policy, officials say. More diseases are being controlled and fewer costly hospital trips are needed, making the system more efficient. And when offenders return to their communities, they're healthier and less likely to infect others.
"We knew we needed to have a better model," said Dr. Sharon Baucom, medical director of the state Department of Public Safety and Correctional Services. "Now we're running an HMO behind bars. And we're seeing better outcomes."
Even so, not everyone agrees that enough prisoners are getting sufficient care, despite a constitutional mandate. More troubling for cities such as Baltimore, the public health benefit may be fleeting, experts say. Few prisoners are linked to continuing health care when they are freed, and they again become sick.
Those inside and outside the long-troubled state system agreed that changes were needed for the 22,000 prisoners and about 4,000 more awaiting trials each year. A lawsuit by the American Civil Liberties Union in the 1970s sparked intervention by the U.S. Justice Department at the state-controlled Baltimore jail facilities and brought extra scrutiny to overall management. A 2002 report highlighted 107 issues, including 45 related to health, which officials say are finally near resolution.
Serious changes began in 2005 when state officials dumped the much-criticized health care contractor. The contract was split into five parts, and funding was increased by about 60 percent to more than $150 million a year to keep pace with growing health care and drug costs.
Two years later, Maryland followed other states in focusing on early care of chronic conditions, much like federal health care reform aims to do. State corrections officials now point to decreases in the total days inmates spend in the hospital to just above accepted national rates for a prison population. The total number of trips to the emergency room is better than the national standard.
More inmates have their diabetes under control, and the number voluntarily tested for HIV in fiscal year 2010 was more than double the number in fiscal year 2007. The number with undetectable amounts of active virus in their blood — who, like Tharrington, are less likely to transmit HIV to others — has been rising.
Baucom said corrections staff members are aggressively looking for those who need care and explaining why they need to stay on their medications — Tharrington said he was given "an education in the immune system." Top doctors at University of Maryland Medical Center and Johns Hopkins Hospital also have been enlisted to treat patients via weekly teleconferences.
Baucom also acknowledges challenges. For example, HIV testing is voluntary in Maryland and some inmates refuse. A hepatitis-C treatment protocol is offered in state prisons but is so lengthy it's not accessible to those incarcerated for less than two years.
Recent arrestees also are frequently belligerent, high or drunk and can't identify their conditions or medications, Baucom said. About 75,000 people a year go through the Baltimore jail and central booking facilities, which are controlled by the state. County jails remain under the control of local governments.
A medical assessment is required within 24 hours of being booked and follow-up is required within seven days. But that didn't happen for Gerald Washington, according to Crystal Edwards, an attorney for Washington's mother, who filed a multimillion-dollar wrongful death lawsuit in December, alleging Washington was denied asthma medication.
"I understand he asked for his inhaler repeatedly and nothing was done," said Edwards.
State officials declined to comment on the case but said exams are now tracked electronically, and the contractor can be penalized for failures. That has improved record-keeping, but not always medication distribution, said Elizabeth Alexander, former director of the ACLU National Prison Project, which filed the original lawsuit in Baltimore.
