Thursday, January 11, 2007

My Big Fat Hissy-Fit

[Note: I sat on this post for a day to cool down and think about it. The title has been changed three times and I also removed a few triple exclamation marks. I've downgraded my rant from a Category IV to a Category II.]

I am about to have a screaming banchee hissy-fit. Consider yourself warned. I've been blogging for almost nine months now and so far have never gone on a full-fledged, died-in-the-wool rant. I am about to make up for lost time.

The topic is an article on CNN that was just posted an hour ago. It's a story about a New England Journal of Medicine paper regarding mortality rates of prisoners who have just been released. I haven't seen the full article yet, but as reported it involved "26,270 men and 3,967 women released from Washington state prisons from mid-1999 through 2003". It doesn't say how the causes of death were confirmed, but the study found that newly released offenders were 3.5 times more likely to die within two weeks of release than an age, race and sex-based comparison group. The most common cause of death was overdose followed by cardiac disease, homicide and suicide.

To all of this I say: "No kidding! How much money did you spend figuring this out?" We knew twenty years ago that incarceration had some protective effect. In 1987 the Johns Hopkins School of Public Health looked at mortality rates among Maryland prisoners and found that age-matched prisoners actually lived longer than men out in free society. The CNN article also noted that the increase in post-release death rates were replicated in studies done in Europe and Australia.

What am I ranting about? It's this except here:

Other experts said the results don't surprise them, because inmates have far more physical and mental health problems than other citizens, (and) often get inadequate treatment behind bars...
There ya go. It's obvious, isn't it? If they're locked up then by definition they are getting inadequate care. It's axiomatic. It's also a knee-jerk stereotype.

Excuse me? Didn't you just say that they die after they get out? Who do you think has been keeping them alive all those months? Are you about to suggest that every patient who dies after discharge from a hospital was obviously neglected while they were inpatient? What planet are you on?

The thing they aren't mentioning is that they have no way of knowing how long the offenders would have lived had they not been incarcerated. These people live dangerous, high risk lifestyles. They annoy other criminals and get murdered. They kill themselves. While they are incarcerated we generally manage to keep all of that from happening. I don't like reading about my patients in the newspaper when they turn up dead after release, but it happens. I really don't like it when people suggest it's because I didn't do a good enough job while they were inside.

The only useful thing about this article that I liked was the conclusion:

Rather than saddling emergency rooms (and taxpayers) with the cost of providing post-release health care, we need to find a model of continuing care for ex-offenders.

Amen. And when we get that accomplished we will have a model for the rest of free society. Ya gotta start somewhere.

Thanks. I feel better.

Addendum: The print version of this story that came out later that day did not include that aggravating phrase. Instead, it concluded this:
Cause (of death) often is overdose of narcotics after forced clean years, study finds
In other words, they lose their tolerance for drugs when they're locked up and so they are more likely to die of accidental overdose when they relapse after release.