ABSTRACT

MSPH-12-0002.0 This case looks at the challenges that confront public health professionals who work in a corrections environment. In 2006, medical care for prisoners in California was put under a court-appointed Receiver to fix a broken system. By 2011, much progress had been made in updating technology, hiring competent medical personnel and rationalizing medical costs. But one group of inmates consistently ran up high bills—the elderly ailing, often in no condition to pose a threat to public safety. In 2010, the legislature had enacted a new “medical parole” program, which built on an existing—but rarely used—compassionate release provision  to reduce the burden on the state of caring for dying inmates. In late 2011, the Receiver’s Office unit in charge of identifying candidates for medical parole had to decide on the case of Carl Wade, an inmate at the California Medical Facility.

This case will help students understand the tension that arises between conflicting societal priorities—and how public health officials can be caught in the middle. US society believes crime should be punished; but also provides inmates with constitutionally mandated healthcare. The result: high costs for older, ailing inmates--including those who are comatose, demented or severely debilitated. The doctors who care for these patients determine when an inmate becomes a candidate for release under medical parole into a community-based nursing facility—but they elect not to know the inmate’s criminal history. Students can debate whether this is appropriate; how public health, which focuses on nurture, can cooperate with corrections, which focuses on punishment; and what it means to provide responsible medical care in a highly political environment. It also raises for discussion the role of an outside authority (the Receiver’s Office) in reforming government-provided healthcare.

This case can be used in a course or class about public health policy, corrections and health care, or strategic management.