PRISONS' HEALTH CARE COST SOARING

McCAIN -- Inside North Carolina's prisons, a little noticed problem keeps
getting bigger: Every year, the health-care bill for inmates goes up.

Fueled in part by rising prescription drug prices, the costs jumped by more
than a third -- about $35 million -- in the past four budget years.

The price tag is expected to keep rising during the next decade. Worried
state officials see no easy answers.

"We're trying to contain costs," said Joe Hamilton, director of management
services for the N.C. Division of Prisons. "But obviously they're going to
go up because health-care costs in general are going up in the community."

This budget year, inmate health care will cost the state an estimated $142
million. That's more than the budgets for either UNC Charlotte or the N.C.
Division of Public Health, which vaccinates children and investigates
disease outbreaks.

The money provides care for inmates such as Woodrow Williams, 82.

A convicted rapist serving a life sentence, he spends his days at McCain
Prison Hospital about 100 miles east of Charlotte, swallowing eight to 10
pills a day for his worsening back problems, breathing troubles and
arthritis aches.

"I think I'm taking more pills than I have to," he said one recent
afternoon, sitting on the side of his hospital bed. "But I trust (the
medical staff) knows what's best."

With the state housing more than 31,000 inmates in its 76 prisons, the
long-term outlook isn't good.

Prison populations are growing. Medical care generally is growing more
costly. And tougher N.C. sentencing laws mean more inmates such as Williams
will grow old behind bars.

As those trends converge, officials in the Carolinas and across the country
are finding it harder and harder to pick up the tab for health care that
state and federal courts say they are duty-bound to provide.

Few N.C. legislators want to take the politically unpopular step of raising
taxes to pay for it. They've ordered prison officials to gather information
this year about possibly privatizing such services. Prison officials say
they've already tried that on a smaller scale, only to find private firms
sometimes can't do it as cheaply as expected.

Some fear a major problem is brewing.

"I see a train wreck," said Sen. Frank Ballance, D-Warren. "You see a
problem without adequate funds to cover it."

No simple solution

It's not as if N.C. lawmakers and prison officials haven't been trying to
fix the problem.After inmate medical bills jumped by 20 percent in the
1998-99 budget year, lawmakers ordered the hiring of three cost containment
specialists, and prison officials embarked on a cost-cutting campaign.

They set up an inmate co-pay system similar to health maintenance
organizations, asking prisoners to pay $3 for routine medical visits.
They've set up an HMO-style review board in Raleigh that must approve every
request for specialized care.

They have also moved to create regional medical health-care centers at
select prisons, hoping to cut costs for medical supplies and for
transporting sick inmates.

Those measures helped. Inmate health-care spending increased by only 3
percent in the current budget year.

Still, problems persist.

The number of inmate medical visits and case reviews has nearly doubled
since 1999. The state's prison population is expected to grow by about
10,000 more inmates in the next decade, spurred in part by tough sentencing
laws passed in 1994.

Last month, N.C. Department of Correction officials told lawmakers they had
come up $7.2 million short in the inmate prescription drug budget. They won
permission to move money from unfilled salaries and other items.

Some wonder if private companies can take care of inmates more cheaply.
Legislators last year wrote a provision into the state's budget bill asking
prison officials to seek proposals from private companies that might want
to take over inmate health-care services.

Corrections officials are studying the proposals and will report their
findings to the General Assembly.

Prison officials say they've already tried privatizing health care on a
smaller scale in the late 1990s at prisons in the Eastern N.C. counties
Pasquotank and Hyde. They decided to end that experiment after failing to
reach a new contract deal in January with Tennessee-based Prison Health
Services.

The company wanted more than the state could afford, said Hamilton, of the
N.C. Division of Prisons. Other states trying the privatization route have
run into similar obstacles, he added.

N.C. Rep. Stan Bingham, R-Davidson, sits on a legislative panel that helps
oversee inmate health care. He said he isn't happy with the rising medical
bills, but prison officials seem to be doing all they can to contain costs.

"We're just going to have to accept the fact that, like everybody else's
health insurance, inmate health (costs) are going to rise," he said.
"There's not a simple solution."

'We're all humans'

The medical bills for a seriously ill inmate can pile up rapidly. Take
Henry Morris, a convicted drug trafficker from Durham whose room sits
around a corner and down a quiet hallway from Woodrow Williams' room at
McCain Prison Hospital.

Morris, 34, has aplastic anemia, a rare, sometimes fatal disorder that
occurs when a person's bone marrow fails to produce an adequate number of
blood cells. Since the disease makes him highly vulnerable to infection, he
wears a surgical mask over his mouth and nose.

His medicines cost the state roughly $2,400 a month -- or about $22 more
than the monthly pay for a rookie teacher in Charlotte-Mecklenburg Schools.

Inmates deserve care like anyone else, Morris said, sounding more
apologetic than defensive.

"We're all humans," he said. "I've seen people come up here real sick and
they're nursed back to health. The money the state gives us helps."

In the next decade, the number of prisoners 55 and older will comprise 20
percent of America's prison population. Elderly inmates cost more than
three times as much to incarcerate as younger prisoners, according to the
Justice Policy Institute, a think tank in Washington.

Many of the inmates haven't had regular health care until they come to
prison, said Dr. Paula Smith, director of health services for the
Department of Correction's prisons division.

Many suffer from problems related to drug and alcohol abuse. Complications
from high blood pressure, diabetes and heart disease are common. Even
20-year-olds are coming in with high blood pressure.

"When I was in private practice," Smith said, "that's something I never saw."

A fundamental obligation

North Carolina isn't the only state struggling to rein in spending on
corrections.

With the tepid economy crippling budgets, states such as Arkansas,
Connecticut, Utah and North Dakota have increased parole for nonviolent
prisoners or eased get-tough sentencing laws, according to the Justice
Policy Institute.

With North Carolina facing a nearly $1 billion budget shortfall this year,
the N.C. General Assembly is expected to talk about similar proposals
during its short session in May.

In South Carolina, prison officials are spending $58 million annually on
medical services, a figure that has increased by a total of about $8
million over the past three budget years. S.C. officials are looking for
ways to contain prescription drug costs and streamline medical services.

Sometimes cost-cutting isn't as simple as it appears. California went to an
inmate co-pay system as far back as 1994, but a January 2000 audit
concluded the program's cost exceeded the amount of money it brought in
from inmates.

States can only cut so much without risking lawsuits from inmates. Courts
consider it unconstitutionally cruel and unusual punishment to withhold
medical care from a sick prisoner.

The N.C. Supreme Court has said that when the state locks a person up, it
assumes a "fundamental and paramount obligation" to provide health care
because the individual can no longer seek it independently.

Prison officials say they have no choice but to manage the tricky balance
between legal duties and budget shortfalls.

"We're doing our best on a daily basis," Smith said. "We want to use the
taxpayers' dollars wisely and appropriately in our system."