You probably don't need a lot of incentive to avoid going to prison, what with the shankings, the anal rape, the race riots, the crowding, the racist gangs you'll have to join for protection, and the general tendency of our society to treat prison as a legalized form of torture. But believe it or not, prison may actually worse than these facts have led you to believe.

Let's say you're a doctor. Doctors are respectable and highly educated, right? Yes, but like any other profession there is a bottom of the barrel, people who went to barely-accredited medical schools and barely graduated. The kind who are routinely disciplined by state medical boards and repeatedly sued with good cause for medical malpractice. The Doctor Nick Rivieras of the world, if you will. What does a doctor do in that situation? Where do you work after you are suspended for fondling an anaesthetized patient? After too many patients end up dying from ridiculous mistakes?

Well, you go to work in a prison.

There was a brief spike in interest a few years ago, prompted by heavy coverage in the New York Times and budget/overcrowding crisis in the California Dept. of Corrections (where an inmate dies "every six or seven days" from inadequate care), in the sorry excuse for healthcare that inmates receive. In addition to being denied (expensive) medications and other forms of treatment due to shortages of funding and serious understaffing, inmates are routinely treated by physicians who see prisons as the employer of last resort. The reasons are not mysterious. Would you want to be a prison doctor? I certainly wouldn't. I'd take that low-paying, dangerous job only if normal society wouldn't take me. Then again, people will take unpleasant work if compensated accordingly – note how inner-city hospitals are rarely short on staff because of the extra incentives they provide.

Unfortunately prison health care, like so many other aspects of our correctional system, has been farmed out in the misguided belief that money is saved. Prison Health Services, Inc., the "profiteer of human misery of the week," controls an overwhelming amount of this corner of the market in human suffering. It also provides yet another example of why privatization of public services rarely makes sense. PHS sure is cheap, which saves the states some badly needed cash, right? Well, yes, they save money up front. But gosh are those wrongful death lawsuits expensive to settle. Like all other profiteers on the government tit, PHS gets paid a lump sum and then maximizes profits by cutting every cost known to man. By hiring Dr. Nick Riviera. By refusing to provide prescription drugs. By having one doctor for 7,000 inmates. State and local governments are quickly learning that withholding insulin from diabetics is a risky cost-control measure. When they die, well, it isn't real cheap to make that problem disappear.

So, in addition to all of the other horrendous aspects of being in prison, remember that five years for stealing a car can easily turn into a death sentence if you have medical problems. Aside from the human rights issues involved (and recognizing that most people have limited sympathy for convicted criminals) you can sit back and enjoy yet another example of how privatization does little more than move costs from one pile to another, usually increasing them in the process.


  • One of my students who provides me with lots of wagonhalt-type stories once told me that his brother "shot a crackhead trying to break into his house the other day" and was arrested, but "it's cool, 'cause he's diabetic, and they never give him his insulin, so he goes into a diabetic coma and they have to send him to a hospital and drop the charges."


    That was only the first two wagonhalts of that particular situation, but there were quite a few more when the kid and his other brother tried to get the wife and kids out of the house before the crackhead's friends came for revenge. MY JOB IS AWESOME.

  • Combine that with the aging prison population and you have an even bigger mess.

    @Peggy – Um, I will never complain about my job again.

  • I know quite a few people involved in government contracting on the local, state, and federal level, and from personal experience I can tell you that not one of them does what they do because they love doing it. They do it because some government agency with orders to outsource was waving around a big blank check, and they wanted a piece of it. Every single one of them operates on exactly the principle you describe: they are handed a lump sum, so the less of it they spend doing the job, the more they get to keep. Further, most of them say that they are subject to minimal oversight, and it is usually very difficult for an agency to stop doing business with them, for any reason.

    "True believer" free-market types love to go on about how the private sector does everything better – competition in the market means that the best firms will succeed while others will fail, etc. But this example – government contracting, specifically prison medicine – is a great demonstration of how spurious that argument is. If you're asking who will turn a greater profit, the free market is the place to be. But if you're actually interested in making sure a certain good or service is provided competently, the profit motive gets in the way.

  • The name 'Department of Corrections' is oxymoronic to the extreme, as there's nothing now nor has there ever been anything remotely rehabilitative about prison. It should surprise no one that recidivism is on the rise and that a country frightened by its own shadow thinks that locking people up for awhile will solve this problem.

  • @Sir: "correction" also means "punishment used to train"; I don't know that the word is intended to imply rehabilitation at all. Prison isn't the solution to anything, but the rehabilitation programs I've seen haven't done much for recidivism either. Neither address the causes of most criminal behavior.

    But even the folks who support inhumane treatment of prisoners have to realize that it's not the deterrent they think. Just as with health, prevention is the cure.

  • Prisons are not rife with anal rape, stabbings, and the rest. I work in a prison (as a librarian), and it's not anything close to what movies and television suggests. There is rape, stabbing, drug-use, theft, beatings, neglect, and all the rest, but the day-to-day workings can best be summed up in one word: boring.

    Really, the most dangerous part of my day is the commute to and from the prison. That's where I'm taking my life in my hands.

    And there are two types of doctors working at the prison: ones that care and ones that can't be employed elsewhere. The same can be said of the dentists, nurses, psychiatrists, and other medical professionals I work with. Some try to get the care to the inmates, do a good job, but get stifled by the drudgery of the system, the (financial) bankruptcy of the system, and the inmates themselves. I really don't want to hate them, but some days there isn't a more appropriate emotional response.

    The other type of professionals working in the prison system are those who can't get employed elsewhere. Some have medical licenses that are under probation, can't get licensed or insured unless through an employer like the state, and have backgrounds that can be best described as "colorful".

    Prison is a lot like most state jobs. It won't attract the best and brightest, though some become that while there. It isn't the first choice of many people. It's not fun. It's not that hard to work there. The pay isn't great. The benefits are pretty good. Retirement system is very good. And state workers are very good at putting their employer down. We bitch, but we know we have it good. Probably 10% less good if the latest budget proposals hit, but still above average.

  • Very well said, ladiesbane.
    Scary thing is, the prison industry is becoming the most profitable in the U.S. As it grows, it will need more and more inmates to provide ultra- cheap labor for manufacturing and service jobs. Hence, the motive for rehabilitation is shrinking rapidly.

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