Lock fewer people up to improve Illinois inmate healthcare

The barbaric state of medical care in state prisons was documented recently by a team of doctors acting as court-appointed experts, and the team’s blistering 405-page report leaves the state with but two choices: either spend more money on medical care of 49,000 inmates or deliver better medical care to a much smaller prison population.The government’s first option — spending its way out of the prison medical crisis by deepening the budgetary crisis — isn’t really an option at all given the condition of the state’s finances. Faced with this stark reality, whether one aspires to be lenient or tough on crime no longer matters much. Deincarceration has become a fiscal inevitability.The physicians’ report demonstrates that prison medical resources have been stretched beyond the breaking point. Not only are facilities dramatically understaffed, but many of the existing staff are incompetent and underqualified. These deficiencies result in unspeakable suffering and wasted lives.For some, it might be tempting to think that the state could cut medical costs without reducing the prison population. That will not work. Hiring qualified staff with the competence to provide adequate care — the very thing that the report finds lacking — takes money.Nor can the state refuse to take care of the people it locks up. As the Supreme Court has held, the cruel and unusual punishments clause of the Eighth Amendment requires prisons to provide adequate medical care. Incarceration prevents people from accessing their own doctors, and the government cannot — legally or morally — lock people up and leave them to waste away without the care necessary to prevent avoidable death and extreme physical suffering. A state that tries to do so will pay for it later in legal judgments.The only solution, then, is for the government to accept fewer patients — in other words, to lock up fewer people. Gov. Rauner could accomplish this by commuting the sentences of most aging prisoners (following a risk assessment) and low-level drug offenders. Nationwide, approximately 16 percent of prisoners have a drug crime as their offense of conviction. Another 16 percent of American prisoners are 50 or older. These older prisoners are unlikely to recidivate, and their release would have the greatest fiscal impact because they require more complex and expensive medical care.

The Governor aspires to reduce the prison population by 25 percent over the next decade, but that modest goal would provide too little too late. Over the next 10 years, the costs of incarceration will continue to skyrocket and the death toll from incompetent medical care will continue to mount. The state lacks the money to spend its way out of this crisis, and the only solution is prompt action to downsize the prison system.

David M. Shapiro is a clinical assistant professor of law and attorney for the Roderick and Solange MacArthur Justice Center at Northwestern University School of Law, Chicago.