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
Lockdown:
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
Lockdown:
US Incarceration Rates
• 6-fold increase in # of people behind bars
from 1972-2000
– And rising
• # of women behind bars up 750% from
1980
• 3100 local jails, 1200 state and federal
prisons in U.S.
Lockdown:
US Incarceration Rates
• 10 million Americans put behind bars each
year
• 3-fold increase in # of people behind bars
from 1987-2007
– Crime rate down 25% compared with
1988
• # of women behind bars up 750% from
1980
Lockdown:
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
college
• 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
Immigration”)
– Fastest-growing form of detention in U.S.
– Lucrative business
Immigration Detention Centers /
Guantanamo
• 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
parole
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
robbery)
• 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
responsibility.”
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
prisoners
–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
years
• Reasons:
– Prevailing political philosophy which
disparages the effectiveness of (and even
need for) government social programs
– Often-illusory promises of free-market
effectiveness
–Despite evidence to contrary (e.g.,
Medicare/Medicaid, water privatization,
etc.)
– 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
night
• Accused of paying lower salaries and providing
less training than state-run prisons
The Prison-Industrial Complex
• Aggressive marketing to state and local
governments
– 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:
Abuses
• 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
homosexuals
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
counseling
• 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
population
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%,
respectively
– 28% of jails detoxify arrestees
Inmate Deaths
• 141 per 100,000 deaths in custody in
2007
• 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 drugrelated 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
hepatitis)
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
entities
• 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
(largest/cheapest)
– 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
cut
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
prospects
• 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
ex-offender
• High rates of criminal recidivism
Summary
• 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
Summary
• 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
Summary
• Convicts released without necessary skills
to maintain abstinence and with few job
skills
• Poor financial and employment prospects
of released criminals make return to crime
an attractive or desperate survival option
Summary
• 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
improvement
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
penalty
• Improve provider education re criminal
justice system
• Run for office
Health Professionals and
Criminality
• 2002: AAMC standard application includes
questions about felony convictions
• 2008: Questions about military discharge
history and misdemeanor convictions
added
Health Professionals and
Criminality
• Medical schools make final judgments
– Previous offences one of the most robust
predictors of future offenses
• Including cheating
– 2009: BU med student accused of
stalking/murder
Conclusion
• Hold government accountable for
creating fair system that
combines reasonable punishment
with restitution and smooth reentry 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
criminals.”
Fyodor Dostoevsky
Reference
• 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
http://www.medscape.com/viewarticle/520
251
Contact Information
Public Health and Social Justice
Website
http://www.phsj.org
martindonohoe@phsj.org