we need to reject wholesale demonization of every person who has a brush with the criminal law, persons who are released from prison should be given a second chance. and we need to enter into a new age of restoration and redemption. these are things that are listed in your conclusion, mr. jonas. and i think that those are very important ideals that we should seek to live up to. oftentimes it's we ourselves that are the perpetrators of overcriminalization. certainly, the legislators are responsible. and certainly judges and prosecutors who both are elected

are responsible for, you know, getting tough on crime and throwing the book at people and implementing the policies that we enshrine into law. but i will ask you both, you're both members of the bar. you're both attorneys. you're licensed to practice law. and you know that when a person suffers a a felony conviction even misdemeanor convictions in many states, they are barred from being able to be licensed to practice law. do you believe that those types of barriers which are collateral consequences, you believe that those should be removed from person's ability to practice law, to get a law license?

mr. heck? >> well, i think like in any other collateral sanction, i think they have to be looked at, the offense and the offender. and i think there are cases. we've seen it in ohio, where those impediments have been removed. and someone who is convicted, say, for example of involuntary manslaughter or murder have become lawyers. we've seen it with a lot lesser offenses. and yet at the same time we've seen some cases where someone who was convicted of a theft or a fraud was not given the license to practice law in ohio. so there has to be some type of parity also. there has to be some type of fairness and equity if we're going to have any collateral sanctions at all. >> so you would be against blanket bans on all who have been convicted being ineligible to receive a license to practice law? >> i would think blanket bans do

not serve any public purpose, blanket bans, correct. >> all right. i guess that means what i asked. >> i agree with you. >> okay. all right. thank you. >> and mr. jones? >> i would agree. unless you can show me that there is some public safety benefit that outweighs the individual right for a person to get a law license after they have gone to law school and passed the bar, unless you can show me some public safety benefit that outweighs that individual being able to practice law, i would certainly say you should not have that restriction, and you should not have any automatic mandatory bans. >> do you know of any initiatives by the aba or by any state bar association to address that particular issue, either one of you? >> no. i know the project of the collateral consequences of the conviction project did not entail that. it had to do with cataloging and just assembling and identifying all the collateral consequences, which was, again, a monumental

task. but as far as the particular issue that you're talking about, i do not know of any state or the american bartackling that yet. >> all right. thank you. how do collateral consequences disproportionately impact communities of color and the poor? >> i think that just like we see disproportionate as far as imprisonment is concerned, i think that goes along with that. because so many times the collateral sanctions are attached to a conviction. so i think that once you see the effect it has on the incarceration and imprisonment, you're going to see the thing on collateral sanctions. and i think collateral sanction especially as it relates to employment, as it relates to having an income and housing really has an affect in that regard. thank you. >> the answer is profoundly. there are studies that show that

african american men who never been -- have never had any trouble with the law at all are less likely to get a job than similarly situated white men with a felony conviction. there are studies that show that african american men are seven times more likely to be arrested for crimes, particularly drug possession crimes when the usage of drugs in those communities is the same. so the impact of these collateral consequences on african american individuals, their families, and society is profound. >> thank you. >> the gentleman's time is expired. the gentleman from tennessee, mr. cohen. >> thank you, mr. chair. these issues affect my constituents in a major way. second chance opportunities for employment is one of the things i hear most from constituents. somebody's had a conviction at some time in the past and they can't get a job. a continuing cycle. but more fundamental is the loss of the right to vote.

and i don't know if this has been addressed extensively by y'all. but do either of y'all know the history of that particular -- those laws? i was reading about civil death, and that seemed to take away your right to vote and everything else. and they described as barbarous barbarism condemned by justice and immorality, et cetera. we have these laws. does maryland have a law like that, mr. heck? >> maryland? >> i have to be honest with you. i'm not familiar with maryland law, sir. >> which state are you from? >> i'm from ohio. >> i'm sorry. i was thinking it was maryland. >> that's all right. >> they joined the big ten and i'm all confused. >> i appreciate that. >> ohio doesn't have such a law, does it? >> no. >> it's mostly southern states, right? >> that's my understanding. i have not done a study of that,

but that's my understanding. there is a history of what you say, disdisenfranchisement of the right to vote. it's so important. it trumps everything. when you take someone's right to vote away with the idea of never giving it back, i just think it should never be. >> mr. jones, are you familiar with any history on these laws? >> i have my own thoughts, but they would be conjecture, i don't know, but i tell you this. by the history of disenfranchisement, but by the time i get back to new york this afternoon i will know. >> i think the history goes back to jim crow, and i think it was kind of a southern thing really, if you look at the states that have those laws or had those laws, they're generally the same states that justice roberts said no longer have to have preclearance. because it's a wonderful world, according to justice roberts.

it's just -- it's hard to fathom when you look at the history of discrimination in this country, and look at it in voting areas where we had preclearance. and those are the same states that put a scarlet letter on individuals, that says thou shalt not vote. voting, in my district -- we had an election in may, a primary election for county offices. very important. and about 10% of the people who were registered voted. so my theory is people who had convictions in the past were allowed to vote, by the simple act of voting they would show they were in the upper 10% of the citizenry. we do in tennessee have a law which i was happy to have sponsored and passed that allows you to get your right to vote restored without going to court and without having the d.a. come and bless you, et cetera.

but a guy in the house, kind of a neanderthal type character put an amendment on the bill which passed. it said if you were behind in your child support, you couldn't get your right to vote back. it's not something that is pretty clearly intended to have a disparate impact. >> there are two states i believe that this task force ought look at that allow individuals to vote while they are in prison. and i think that's maine and vermont. and you can conjecture and speculate as to why those two states allow that. but i do believe that maine and vermont, somebody can correct me if it's wrong, those two states allow you to vote while you're in prison. i think that everybody, that's right, that's right. >> vermont. which is the other state? >> maine. >> maine. but you have to be eating lobster or cheese at the same time. i yield the balance of my time. thank you.

>> thank you. we still have some time left. so i'll now recognize myself for five minutes. both mr. jones and mr. heck have said that we should repeal all mandatory collateral consequences that apply across the board. now, one part of federal law prohibits anyone who has been convicted of a misdemeanor crime of domestic violence from possessing a firearm. do you believe that congress should repeal this law? >> as far as my position is concerned, again, the aba has not taken a position on that. i think we have to look, again, at the individual involved in the individual crime. so, for example, we've had cases in domestic violence of something that is certainly on my radar screen personally and my office. and something just like child abuse that we take very seriously. and when we have a domestic violence case, i think we have

to look. is that person an owner of guns, or does that person use a gun? i think those distinctions have to be made. i think a broad -- simply a designation of someone who owns a gun should never be able to own a gun again i think has to be looked at very seriously as opposed to using a gun in domestic violence. and i have no problem with that person not being allowed to own a gun. >> so do you think the current law, which applies to besideses as well as felonies is a good law? >> depending on the circumstance. >> okay. >> again, depending on the circumstance. >> it shouldn't be across the board, mr. jones? >> i don't think it should be across the board. >> mr. jones? >> mandatory automatic across the board consequences ought be repealed, and we ought to be looking at individual tailoring, the denial of opportunities to

individual circumstances and individuals, individual people. there should not be across the board automatic mandatory. >> i'm kind of surprised. i think the nra would agree with both of you on this. let me ask you another question in time that i have left. when i first was elected to congress, my wife and i owned a two-family house that was across the street from an elementary school. and we lived in one-half of it, and i rented out the other half. say somebody came and applied, was a person who was a recognized minority, applied to live in the other half, and i found out before leasing it to them that they were registered sex offenders. could my denial of housing because they were registered sex offenders, not because they were persons of color or a protected

minority, be a defense in a fair housing complaint? >> not in ohio. because they would not be allowed to live there in ohio. you're saying you lived right across the street from a school, correct? >> i did. >> no. in ohio, and that's been going on, an increase in the number of feet, as well as the number of instances where a convicted sex offender may live. it started out within so many feet of a school, so many feet of a bus stop, so many feet of a day care, so many feet from where children will be. so that has become more broad. however, in the specific instance that you mentioned, no. because under ohio law, they would not be permitted to live there anyway. we've had cases like that. my office has on the civil side, which we also represent, have actually ordered people to move. and have got eviction notices for people and orders to have them move out because of close

proximity to schools. >> so if i was accused of denying housing under the state or federal fair housing law because i denied them the lease because i lived across the school in ohio, i could go to the district attorney and have him represent me against the fair housing complaint? >> well, under ohio law we cannot represent an individual interest. but i can assure you that we would stand right nokes you from the point that that convicted sexual offender should not live there. >> mr. jones? >> let me say two things about the sex offender issue. and if you look in our report, you will see that not only prosecuting attorneys who work in this area, but also individuals who are responsible for administering stayed sex offender registries say the same thing, two points. the first is that anyone is more

likely to be abused in that manner by someone within the four walls of their home than they are by someone who is either delivering their mail or cutting their grass. you're much more likely to be molested or abused in some way by someone who is under your roof. and secondly, the overwhelming majority of arrests in these types of cases are by first offenders. the number of people who are sexual predators, who are serial offenders is very small. it's not -- so that these prosecutors and these people who run these central registries, what they say is that the residency restrictions that we place on these folks are wrongheaded and don't make sense and are actually counterproductive because you're more likely to have a problem with uncle sam than you are with the guy who is delivering your mail. >> well, my time is expired.

i want to thank all of the witnesses for your testimony and good answer to questions. thank the members for participating. does anybody wish to put printed material into the record? gentleman from alabama. mic, please. >> i'm sorry. i asked permission to submit testimony in the record from mr. jesse wiel on behalf of jesse's fellowship which is an independent prison fellowship ministry which offers his perspective of reentering society after he served a sentence for criminal offense. >> without. >> thank you. >> the gentleman from virginia, mr. scott. >> thank you. accept testimony from the robert f. kennedy center for justice and human rights, bernard kerik, anthony pleasant and reports from the sentencing project

state level estimates of felony disenfranchisement in the united states 2010, and from a report from the sentencing project, a lifetime of punishment, the impact of felony drug ban on welfare benefits, all be placed on the record. >> without objection. >> and if there is no further business to come before the task force, without objection, the task force stands adjourned. >> thank you. tonight on c-span3, washington journal's interview with michigan state university president. it's part of our special series on universities in the big ten conference. and that will be followed by events featuring conservative political figures and journalists. we'll bring you a discussion on the future of the republican party. and then selections from this year's western conservative summit in colorado.

plus ben carson speaking earlier this year at the national press club. you can see all that starting at 8:00 p.m. eastern here on c-span3. also tonight our campaign 2014 coverage continues with a series of debates on our companion network c-span live at 7:00 eastern. see a massachusetts governors debate between republican charlie baker and democrat martha coakley. and then live at eighting, new hampshire senator jeanne shaheen debates scott brown as part of her bid for reelection. here is a look at some of the ads running in that race. >> i'm jeanne shaheen and i approve this message. >> scott brown says i'm pro-choice. >> scott brown sponsored a bill so employers could deny women insurance coverage for birth control. >> i can't believe scott brown supports limiting access to birth control. >> and brown pushed for a law to force women considering abortion

to look at color photographs of developing fetuses. no wonder anti-choice groups in massachusetts endorsed scott brown. >> i don't trust scott brown. >> you may have seen that senator shaheen is running an ad calling into question my support for women's health care. i want you to know the facts. i'm pro-choice. i support continued funding for planned parenthood, and i believe women should have access to contraception. after six years of voting with president obama, senator shaheen has resorted to a smear campaign. to distract voters from her record. senator shaheen knows better, and the people of new hampshire deserve better. i'm scott brown and i approved this message. >> i'm jeanne shaheen and i approve this message. >> the big oil companies are the most profitable on the planet. but scott brown voted to give them more than 20th billion in taxpayer subsidies. >> this guy is not for us. >> i don't trust scott brown for a minute. >> big oil give scott brown thousands of dollars within days of his votes. >> scott brown doesn't care about new hampshire.

>> and now big oil is spending millions to get him back to washington. >> scott brown is in it for scott brown. nobody else. and not new hampshire, no way. >> hey. i know what you are thinking. another ad. hear me out. senator jeanne shaheen says she puts you first, but she votes with obama 99% of the time. 99%. that's for more spending, more debt. obamacare? come on. we have to put up with obama for two more years. but we can fire shaheen now. let's fire jeanne shaheen. okay. here's your video. >> the new hampshire senate race is listed as democrat in recent polling. you can see tonight's debate starting at 8:00 eastern. and finally nikki haley debates a field including independents tom irvin, tom french and morgan

reeves. that debate airs at 9:00 eastern on c-span. here are a few of the comments we received on our ebola coverage. >> why can't we all get behind the president and what he wants to do for the good of the people, and that's this ebola thing, which as i told greta this morning, i think it's overhyped by the media, and i've timed the time they have given. 10 to 12 minutes every morning when it first came out. and they're still talking about it. there are other things that are important to talk about too. but they don't do it. >> i would like to see c-span do a question about is this ebola virus the proof that we need a national one payer health care system. we just saw what happened in

texas with this capitalistic health care system, and now it's going to cost us millions and millions to clean that mess up. >> regarding ebola and hospitals not being ready, you had a guest on, oh, gosh, it could have been eight, nine years ago, and i forget the author's name. she wrote a book called "pandemic." and she went into how our hospitals weren't prepared. it was under the bush administration. there was readiness for nothing. we had a shortage of doctors and nurses. i wonder how that fares today. her book "pandemic" said it all. we were not ready then. and we're not ready now. you should have her back on again. >> and continue to let us know what you think about the programs that you're watching. call us at 202-626-3400. e-mail us at comments@c-span.org. or you can send us a tweet at c-span #comments.

join the c-span conversation. like us on facebook. follow us on twitter. >> next, a look at the challenges of delivering adequate health care to the prison population. former inmates and prison officials took part in this discussion hosted by the alliance for health reform. this is an hour and 45 minutes. attention, please. i don't want to interrupt your lunch munching, but i'd like to get us started. we have a lot of ground to cover and some great people to hear from. my name is ed howard. i'm with the alliance for health reform, and i want to welcome you to this program on behalf of senator rockefeller, senator

blunt, our board of directors. the program concerns the health of people in prisons and other correctional facilities and the health care they need and the health care they receive, which may be the same and may not be the same. if you're concerned about getting proper care to those who need it, then how those behind bars have access to care should be important to you. and if you care about state budgets, you need to care about prison health. states spent about $8 billion on correctional health care in 2011, which was about $1 in six of their entire correctional budget. that level of spending shouldn't be surprising. this is not a healthy population.

it includes a lot of folks with chronic conditions, with mental illness, with addiction disorders, and it's getting older as the population ages. so it's not surprising that states are trying a whole range of different strategies to get a handle on correctional health spending. everything from contracting with third parties to deliver the care to having more services delivered on site, to taking advantage of new health coverage opportunities for inmates. so today we're going to take a look at how well those strategies and some others are working and what kinds of policy changes might be helpful to improve both the quality and the value of the care that this population receives. and as we examine these issues, we're pleased to have as a partner in today's program.

the santine corporation, which contracts to provide medicaid coverage in a dozen states, operates a number of related services. and later in the program, you're going to hear from dr. asher tierney, who is a physician from a tennessee joint venture that provides correctional health care and in which santine is a partner. let me do a little housekeeping before we get started. if you want to tweet, that's how you do it, the #prisonhealth. if you need wi-fi in order to tweet or do anything else, the credentials are on the screen. feel free to make use of them. there's a bunch of good material in the packets you received when you came in, including biographical information. about all of the folks on our speaker list.

and there's a one-page materials list that actually lists everything that you have copies of and additional material that you can go to for further edification. all of that is on our website, allhealth.org. particularly that one pager you should try online because you can click on those things and you don't have to worry about copying a long url. there's going to be a video recording available of this briefing in a couple of days on our website followed by a transcript a day or two after that. and you can follow along with the slides that the speakers will be using today on that website. if you're watching on c-span, you can find all these materials and the slides on our website. you can follow along if that is what you would like to do.

word about questions at the appropriate time, you can ask a question three ways. there's a green card you can fill out and hold up. there are microphones at either side of the room you can use to ask in your own voice. and you can tweet us a question using the hash tag, and we'll monitor and get that up to the dais. the only other thing i would ask is as we go forward, that you fill out the blue evaluation form that's in your packet so we can improve these programs as we go along and cover subjects and have speakers that would be of the most interest to you. so let's get to the program. our format is a little different than usual. there are going to be two panels, not just one. you'll have a chance to ask questions after each one. first we're going to get an overview of the issue and then

turn to a view of these issues from some people who understand them from first-hand experience. and then a second panel will address concerns about health care and the correctional system from the standpoint of some folks who are charged with delivering that care. so starting with our first panel. i'll introduce them all to keep the continuity of the conversation going. we're going to start with steve rosenberg, who's the president and founder of community oriented correctional health services. is there a pronounceable acronym? >> cochs. >> cochs. all right. those of you who have been going to richmond to watch the redskins begin tryouts understand that coaches are important. steve's been working to assure health care access to vulnerable populations for more than 40 years and provides technical assistance to correctional

systems toward that end. debra rowe is the executive director of returning citizens united here in d.c. with 20-plus years experience supporting and advocating for those re-entering from incarceration. she holds a master's degree in human services and spent several years incarcerated herself some years ago. finally, we'll hear from jacqueline craig-bey, who's a supervisor at a domestic violence safe house here in town and an advocate for inmates and former inmates among other vulnerable groups. she's the first parallel hired by the university of d.c. law school. and before she, quote, turned her life around, unquote, as she phrases it, she spent more than 20 years in prison herself. so we're really looking forward to hearing from you folks, and we'll turn first to steve rosenberg. >> well, thanks, ed. thank you, all. welcome for joining us.

i'm really appreciative to have the opportunity to talk about this relationship between public health and public safety because they're so closely tied. as ed mentioned, i'm president of cochs. we're nationally based, fill tlopcally funded nonprofit. our goal is to break down the barriers and build connectivity between our public health and public safety systems. before proceeding, i just want to make a quick distinction between jails and prisons to make sure everybody understands what we're talking about. jails are county or city-based places where folks are held prior to trial or for being sentenced to a misdemeanor usually less than one year. prisons are operated by state or federal governments, and folks go there for a longer sentence. with the data you have in front of you, shows the point in time snapshot of who's in jail and who's in prison, but i'd like to turn your attention to the data below that, which is that more than 11 million folks annually circulate through our nation's jails. those folks are there for a very

brief time, and 4% of them, only 4% of them end up in state prison. 96% are released directly from jail back into the community. so when we look who's cycling in and out of jails, what we see are these are our nation's most marginalized folks. they're largely young, largely nonwhite, largely poor, and suffering from diseases way in proportion to it the rest of the population. let me just give you some data you can see that. these are the rates of hepatitis for justice-involved individuals compared to nonjustice-involved individuals. and you can see as we get older down the age spectrum, the gap widens largely. this is the data on hiv compared to justice-involved individuals compared to nonjustice-involved individuals. this is the data on substance use disorder. there was a recent study that was completed.

it's known as the adam study, which looked at the incidence of substance abuse disorders. and what it found, between 60 and 80% had an illegal drug in their body at the time of arrest. so we obviously can see that much of our criminal justice system is inherently a public health challenge. folks have substance use disorder. it's that disorder that's having them end up in the correctional system. similarly, folks with serious mental illness -- look at that data. national population compared to local population. and for women in particular, this is a much greater challenge. more than 30% of women who have incarceration or justice-involved experience have a serious mental illness. obviously what we're depicting to you is this is a challenging population. but what i want to show you are their insurance status.

prior to january 1st, 2014, 90% of individuals leaving jail were uninsured. so we make this investment in stabilizing their health care because we are required to under the supreme court's ruling which said that public jurisdictions have a responsibility under the eighth amendment to not be deliberately indifferent to the citizens that are under their charge. so we make this investment in stabilizing them and then the minute they leave the street, typically we lose that investment. but it's the bottom point i think should be of more concern to all of us. a study showed that of individuals incarcerated who had a chronic disease, 80% of them did not receive treatment for that chronic disease in the year prior to their arrest. so if you have an untreated behavioral health disorder, i just showed you the data on substance use disorder and mental illness, you're not

receiving treatment for that disorder in the community. the likelihood of your ending up exposed to the criminal justice system becomes fairly high. so what do we know about what happens when we treat the underlying substance use disorder? washington state in 2003 ran a natural science experiment. their data system allows them to organize the jail booking data, medicaid claims data, and mental health utilization data. the state provided $30 million of general funds to its five largest counties for them to go ahead and treat as they saw fit individuals with substance use disorder. and the results were startling. notice this is not completion of substance abuse treatment. this is exposure to substance abuse treatment. the first thing you want to notice is the arrest rate went down by 33%. simply by exposing folks to substance use disorder treatment, the arrest rate went down by a third. for every dollar that the state spent on treating folks with substance use disorder, it saved

a hard $1.16 in criminal justice costs. if the cost of victims of crime are included, the savings was $2.87 for every dollar saved. that's on the justice side. now let's look on the health care side. as you've seen, folks with justice experience have very high morbidity. prior to 2003, their health care costs were increasing at a rate of 5.5% annually. once they were exposed to substance use disorder treatment, all of the sudden their costs dropped to 2.2% annually. here in d.c., folks are always talking about bending the cost curve. what you have in front of you is a perfect example of a cost curve that was bent simply by providing access to substance use disorder treatment. >> bent out of shape. >> it bent out of shape. that's right. bent way out of shape. i think so where that leaves us are recommendations for you as policymakers in going forward.

i really want to give you four things to consider. one is, these are folks who are not mothers with kids with ear aches who are going to bang on the door of the welfare system say, give me a medicaid card. a study in 2009 in massachusetts showed while there are only 3% of individuals in the state uninsured, 22% of individuals showing up at publicly funded substance abuse treatment programs whose demographic parallel is exactly that of justice-involved individuals, largely male, largely poor, those folks had an uninsurance rate of 22%. so the very first thing i want to make sure you all understand is that targeted outreach for enrollment will be necessary. this is going to be a complex and difficult population to enroll. and that the use of the medicaid administrative claiming program by public safety entities can facilitate their enrollment. most folks within the public safety world know nothing about the medicaid administrative

claiming program, and that is a great opportunity for use for states and localities to bring in resources to enable them to enroll this challenging population, and as you just saw, enrolling this population will save everyone funds. the second is that we need to understand the relationship between substance use disorders and the criminal justice system and how health care providers both in the corrections and in the community can work together to increase public safety. that's the second take home. the third take home is wanting to talk a little bit about how it's important that we understand that we have an our books going back to the medicaid program this thing called the imd exclusion, or that is people who are patients in an institution of mental disease cannot receive medicaid. the purpose of that goes back to the desire when medicaid was started to not have the state hospitals suddenly become financed by the federal government. well, our science and vocabulary

have advanced since then. we now understand things like traumatic brain injury. tbi, criminogenic behavior. i want to urge you to give very careful consideration as policymakers to make sure that statutory folks that are 50 years old that may not be relevant in today's world, that we don't fail to meet this juncture of public health and public safety because we're trapped in old statutory and regulatory language and we figure out how to change that world. erica good did an article on this in "the new york times" three weeks ago, in order to really facilitate the opportunities. and i guess my last recommendation would be to make sure that we pay attention to how we build bridges. we have these two separate silos. we have a criminal justice silo over here. we have a community health silo over there. these silos have not been very good at talking with one another, at informing one another.

i guess the third would be that here in d.c. on a policy level, that we do everything that we can to bridge those gaps and to make sure that folks understand that public health and public safety are incredibly intertwined. with that, ed, i'll go to the folks to your right. >> terrific. thanks very much, steve. could i just ask you one question? >> sure. >> you were talking about new terms. i'll tell you one new term i would appreciate your defining. that is criminogenic. >> sure. what we now know is we now have identified the causes of behavior that result in people behaving in a criminal justice manner, people becoming justice involved. those come under the general heading of criminogenic. that means the characteristics that have way more to do with mental health, housing, hey have to do with lifestyle, anger management. they have to do with peer relationships, that there's this whole bevy that we know now how to treat. the challenge has been the regulatory framework in a post-affordable care act world

that limits our treatment. i want to make it clear that this is a bipartisan issue. governor perry, governor deal of georgia, they've been going out and also promoting treatment of criminogenic behavior rather than incarceration. what changes is states who have enrolled in the affordable care act, the ability to really scale this at a level that a state governor cannot necessarily do. >> excellent. thanks very much. we'll turn next to debra rowe. from returning citizens united. >> thank you, ed. all right. good afternoon. during my incarceration at the reformatory in the late 1980s, i witnessed the disheartening maltreatment of women who were ill and readied in my dorm. for example, the women who were sick were kept at the very end of the dorm. this was during the time when hiv and a.i.d.s. became

prevalent in communities, and several of the women that i am referencing had hiv infections. during that period, i met my colleague here, jacqueline. you see, we along with a few other sisters were the voice for those women. we raised cane and forced correctional officers to get off of their behinds and get them to the infirmary when needed. and we bathed and fed them ourselves. upon release, i was offered a job by the d.c. department of corrections health administration to educate my inmate and re-entry peers about hiv disease. while studying for my job, i read a report from the centers for disease control that stated that 16% of those entering d.c. jail had hiv infection. and i wondered, how did they know that? i began my personal inquiry because i knew that hiv testing was not being offered at that time. i'm going to venture out and say that they were blind testing these inmates, and after advocating for testing in the

jail, the correctional medical staff was frantic that they didn't have the resources for the testing, which confirmed my suspicion about the blind test. i see the same parallel with hepatitis c and that many, many women, some of whom have served ten years or more, or less, who have had blood draws have contracted hep c infections and were unaware of their status until they came home and visited a free community physician's office and learned of their results from a laboratory result there. one inmate who has served 15 years in prison went from lewisberg to cumberland, then to petersburg and then to petersburg camp and had blood draws upon entry to each of those institutions. yet he did not learn of his hep c diagnosis until he was tested at a community clinic upon his release. according to the center for

disease control, the prevalence of hep c infection in prison inmates is substantially higher than that of the u.s. general population. among prison inmates, 16% to 41% have ever been infected with hep c and 12% to 35% are chronically infected compared to 1.5% in uninstitutionalized u.s. population. it's primarily associated with a history of injection drug use. cdc recommends that correctional facilities ask inmates questions about their risk factors for hc infection during their entry medical evaluations. inmates reporting risk factors should be tested, and those who test positive should receive further medical evaluation to determine if they have chronic infection and/or liver disease. although it's not exclusively considered a sexually

transmitted disease, the hep c virus has the potential to be spread through sexual contact. it shouldn't matter that they are incarcerated. they have the right to know. all of this is happening in the private prisons. in closing, the inmates have reported that their health services are limited, and they're being charged. they have to pay $5 to sign up for a sick call and medications, and you can pay and sign up to see a dentist, for example, and may not see him until the following year. one inmate told me a few days ago that he had an abscess that swelled up to the size of a baseball. after three weeks before he was treated. i'm passionately concerned about those who are 55 and older in the system. this concludes my story, and i'm happy to answer any questions.

and i do concur with all of steven rosenberg's recommendations. thank you. >> thank you very much, debra. and of course, for those of you who haven't been reading health policy stories for the last year or so, hep c at $1,000 a pill has a cure. prison systems and other correctional facilities right now are having to figure out how to deal with the kinds of percentages and the numbers of inmates and residents that debra was talking about. so public health meets -- >> public safety. >> correctional policy. you bet. now we'll turn to jacqueline craig-bey. jacqueline, thank you so much for being here. >> thank you for having me. excuse me. my name is jacqueline craig-bey. i am a former inmate.

i have several stories from when i was incarcerated as it relates to the medical facility, medical in prison. while i was there, i broke my leg, and it took them approximately a week before they got me to the hospital. i was taken to the infirmary there in the jail, and they put a makeshift cast on. i mean, it was just put on with no padding, no anything. i don't even know if the lady had a license to put this thing on me. when i finally got to the hospital a week later, the doctors over there laughed about it and called one another and come and see this funny thing that was on my foot.

the medical facility just isn't a place where inmates should be. nobody there is actually looking to take care of an inmate. it's just a job to them. they're just there for the paycheck. when i was pregnant, i had a child while i was incarcerated. and after i had my child, you know, women here know that you have to have a six-week checkup after having a child. well, i saw the doctor in the hallway. he just touched my stomach and said, oh, you're fine, and that was my six-week checkup. and these are the type of things that go on in the prison and are not talked about. nobody talks about the people who have hiv, and they're afraid for other people to know that they have hiv, so they don't go to the medical facility to get their medications. they don't want people to know their status.

so these are people who are sitting there with this disease and not being treated. they don't have the staff to talk to these women and men, to let them know it's okay to come to the infirmary or some kind of way to give them this medicine without everybody knowing what the medicine is. because when you go to the line, everybody knows what everybody's taking. so some people don't want to take their medication. and that's a problem. that's a big problem. there should be some kind of way where women or men can get their medication without the world knowing what you're taking. also, i've seen people pass -- die in prison for things that could have been prevented. women were coming down with

cancer in connecticut, and it was just crazy. it was so many women at one time coming up with these cancer diagnoses.

>> is what go e glows on with an inmate. they consider us on the forgotten. as long as nobody cares about it. so we have to care for one another. so i would call attorneys and people that i knew in the district and have them fly to connecticut to help one of the sisters or brothers that needed some help because, otherwise, we'll sit there and languish in prison with no help at all. and it's just a really sad thing for us to languish away like that. and that's all i have to say today. >> that's quiet a lot to have to say. thank you, jacqueline. let me just say to both of

you, you've described some conditions that would result in the issuance of arrest warrants if they occurred in some other situations. and i wonder what your perception is of the progress that is being made in the facilities you know about toward addressing some of these short comings. >> there is no progress being made. people are still -- jackie was -- how many years ago in connecticut -- >> 2 001. >> okay, 2001. women and men are still dying. i received calls from family members that they were just notified that their family member died and they buried them. or they died and they can't give you any ashes. are you going to be able to make accommodations for your loved one or not? it's just point-blank like that.

they're still dying. all what i squus talked about, the young man with the abscess or the people coming home with hepatitis c and not knowing or the people that are in there very ill. d.c. gave up the rights to their inmates, but they closed our local prison. so all of our women are in a medical facility way down in florida, d.c. residents. and that's another thing. they're far away from home and they're sick. and they're far away from home. at least if they were in that vicinity, and they're supposed to be in a 500 mile radius, but they're not. they're all over the country. our inmates are spread all over the country. i collaborate with a lot of

different states for advocacy for reentry. anyway, if the family contact is very important -- it's very important that you're able to have contact with your family, especially if they're ill. just like i said. you're blind testing people, and they don't know, just like cancer, if his son is diagnosed, look at the people who go up to the doctor and tell you you have six months to live. but that cancer was in your body longer than that. it's like they're just forgotten because they're locked up. but when they come home, they have what they call the federal second chance act because they deserve a second chance. so these long, imposed sentences and then you're not going to take care of them. in oklahoma, you have a lot of elder ll lly ger riatric people.

i know this man, he's 70 years old. they said i got to get a job? they said i got to get a job. what is he going to do? he used to be your night watchman. all we could do is give him some gases. he didn't get proper treatment for his vision. so my colleague helped him to get glasses. but we couldn't help him find work. but, still, why hold somebody to 77 and 85 and they're sick and it's very expensive to take care of them. so i know that these reforms and they're talking about medicaid and all of that now, but they're going to have to go back and cover a lot of inmates because e because a lot of our people are suffering in prison.

and if you make too much noise about it or your family calls and advocates, you can get put in the hole. and imagine having a tooth ache and you're in a cell. you know you need to pace back and forth -- any pain, you need some type of release. but you're in a cell in agony. not in the infirmary. at least in the infirmary, you can lay down and you're getting seen and everything. a year to see a dentist. and you're paying for it now. you're paying for it. you work, and if your family is not sending you money, then you work in a detail. so you have money for commissary. but, now, you pay $5 for this, $5 is taken out of your money. you're paying for your service, but you can't be seen. it's -- no, there's no progress. is there is no progress. >> steve, please, can i frame

that? and i don't disagree with anything deborah is saying, but i want to frame it. traditionally, we send folks out to islands when they need to be incarcerated. devil's island, reicher's island, australia. we've always had this approach that folks who are in the justice system should be isolated and kept separate from folks. in that process of keeping folks separate, the kind of experiences that i'm hearing, deborah, you and jackie describe are not uncommon. the blessing is we're all in this room, in this very loly senate chambers today. now, we're in this room for this lovely senate chambers today because we have this bipartisan opportunity to change that. we have this bipartisan opportunity to change that because we recognize that keeping folks isolated on an island does not make sense in

the 21st century. we have to build brinls. those bridges are partly thinking differently about how we do sentencing for nonviolent, nonsexual offenders. but the poernt thinimportant th think, is the pony in this. we're sitting here in this beautiful room in the senate today because there are several hundred of you that are recognizing that public health and public safety are intertwined. >> pretty good frame. >> we're going to stop at this point and ask if you have questions for any of the panelists that are up here. let me remind you that you can go to a mile kra phone or fill

out a card to get your point across. and if you're twitter versed, you can use that, as well. there's another microphone right over here, sir. >> okay. and i would ask everybody who comes to a microphone to identify thems and fry to keep the question as brief as you can so we can get the most questions that we can. >> i'm a primary care physician. i have a quick comment about disability. i worked with social security disability in baltimore for a while. very often, we could not get prison health records. we had people who weren't in prison with no records at all. we had people who were in prison, but the state wouldn't send them. that would be something pretty easy, especially with electronic records. >> i want to say, now, we have in the district, made progress

in that area. i used to facilitate a federal partners meeting. it was u.s. parol -- the u.s. parol with our medical community. and we sat down and worked it out with all of our medical records. even when the inmate leaves the prison, they had trouble getting our record. so, now, all of the records follow them. they all go to unity and they're centrally low kated in unity. and that's one progress we had made in the district. >> one sentence. question, does the work that they do in prison, does that count towards medicare? ssz medicare? >> no, it does not.

there's a statutory provision that if you're on parole or probation, you cannot receive a medicare ben if i would e fit. on the medicaid side, there's going back to the original finding. it states if you're the inmate of a public institution, then you cannot receive medicaid benefits ats all. so, gep, one of the challenges going back to my comment about islands, and what i'm hearing you say is we need to figure out creatively how we build bridges to those islands. obviously, medical records is a part of it. thinking about bringing standards of care that medicaid brings is another part of it. at this point, we are all very much in the process of understanding it is not in our benefit to maintain those islands. and the query becomes how do we build a bridge?

>>. >> one of the parts of your question was whether the work that was being done in prison was counted as a quarter to medicare in prison -- >> and the answer is no. >> okay. >> hi, civil right, urban affairs advocate and a few other civil rights law firm. deborah, i heard you mention a 500 mile law and we constantly let this government get away with it. we have a law established that any d.c. code offender or d.c. inmate could be moved no more than 500 miles, just to keep with your family member, your loved one. people in the district do get locked up, mostly because

they've been traumatized and i'm sure ms. rogue can identify with that. we have reciprocity going on here in d.c. 85% goes back within three years. so you celebrate. am i right, mrs. rogue? you celebrate because you've made it passed three years because it's a revolving door and it has been set up for that. in the prison industrial industry, they make a profit. when you don't get proper health care when you've been traumatized, post-traumatic stress disorder, you're coming back to prison and the private industry makes a lot of money. -- they don't spend that money on health care, mental or physical.

if you came in to the p.o. system and your p.o. cost a thousand dollars, or some 600, you're not going to get that in medication. 60% of any profits in the prison system, as far as private is concerned, is medical. a lot of people have been suffering. and they're going to suffer more. we need some advocacy and make sure that their discharge plan starts earlier than eight months. you need to send them to get healthy physically and mentally. people take drugs.

because they've been traumatized in these prisons. so it creates a criminal. they don't know how to deal with this mental health problem that they have. they haven't been treated correctly. you've got worst off than when you went in any system. so i'd like the panel to comment on any and all of that. >> i'd like to answer that question by framing it slightly differently. we have proprietary companies that provide medicaid services all through the united states. but those companies are regulated. those companies have performance measures that they need to meet contractually. the challenge with the correctional health system is, by enlarge, it's an unregular lated industry. and if you have an unregulated industry, then you have the opportunity for both the kind of

human suffering that we heard deborah and jackie describe, and the opportunity, sir, that i just heard you describe. and i think, again, that's partly where being in the room in this building points to smgs we don't allow in any other sector of spendings $8 builton on health care. do we allow it to be unregulated? do we allow it to operate without standards? without quality assurance? without any of the things that are statutorily required? so we now leave that under our federal suspect. we leave that up to states and counties to go ahead and regulate or not regulate as they see fit. so what i'm hearing you describe is an underlying challenge that our fralg system has allowed state localities to make their own determinations as to what regulatory quality assurance framework they're going to put down on correctional health. and in many jurisdictions, that's very nominal. >> ook. okay. we have two folks at a microphone. and we really need to get to our

second panel as well. >> my name is mary tyrnya, i'm a pediatrician and i've worked in correctional health before. i've had the privilege of getting a chipper 1 grant. we did outreach to youngsters who are coming out of the juvenile justice system. we got them on medicaid before -- or at least at the time they were discharged. we coached parents. we coached the youth and the two people who have been given credit, at the time, was the kansas medical director. he was magnificent.

the resit vichl rate was dropped by 50%, in the the highest risk youth. i'm sorry i don't have a question, but it's a good model to think about. >> can i go ahead? >> yes, linda grant, go right ahead. >> thank you for this panel, it eelts been tremendous and i'm really learning a lot. it sounds as if it's cautious for the federal government in there not paying for things they need. and then if they get out there, if they're in a federal prison, they're in a state responsibility, whether or not there's a medicaid expansion and they become disabled and can get onto medicaid that way. so i'm wondering, first, there needs to be more data about the amount of money that is not

being sment on one end and how that translates to increased spending at the state level once moegs of these people get out of prison. i think that can be a powerful tool for states to use. the other thing is if you can figure out a way to cut the data bistate to show the value of doing the medicaid expansion chlts that you're going to save a lot of money on unanticipated costs.

i think you can beef this issue up a whole lot more. >> the federal bureau of prisons has just stuted a requirement in terms of doing substitute evaluation. i think we're starting to see that kind of process come down. on the medicaid expansion side, i i think the data that i gave you from washington state speaks very loudly to how there's a drekt relationship. so i don't think it's because of a lack of data that we haven't been able to make that push. i any, again, we have to realize that public health and public safety are intertwined and interconnected. it does not serve anyone's interest to keep someone on an island. what i am saying is the data is there and we're in the process

of trying to i were leapt the exact thing that you're talking about. we haven't made this conceptual leap. and that's what we're all here today to talk about. we haven't made this conceptual leap that says we need to figure out how to build as many and as sturdy bridges between community and corrections as we can. >> bob, last question. >> i remember when senator wolford ran for senator of pennsylvania and made the big case about prisoners being one of the only populations in the united states that have a right to health care. in fact, that was based on a supreme court decision. how does that precedent not create the kind of solutions that you're looking at? and haven't we learned anything

about the tuskeegee experiment? so where is that -- how does that fit into this? >> where are the lawyers? >> well, first, i have to be a nerd here. actually, native americans under treaty and incarcerated individuals are the two individuals in america that have health care as a right, not a privilege. what the supreme court ruled was not to be deliberately indifferent. so, for example, if you have a lawyer waiting to go back for a dental appointment, that dental appointment was made. i wasn't deliberately indifferent to that person's needs. and i go back to regulatory frameworks. if you think about how we do

managed care within a community setting, we require a certain number of dayings after which an appointment has been made. we require a certain level of credentialing to provide care within the context. we don't do that in correctional hemt at this point. >> all right. i don't want to cut people off, but i do want to give us the benefit of our last two panelists. if you're going to be sticking around, maybe we'll find some stray questions for the second panel. thank you so much. [ applause ] >> thank you.

>> that's good. thank you. >> all right. we are reconstituted, panel wise. dr. sharon lewis is a board certified pediatrician. and a nationally respected expert on quality assurance with more than 20 years of experience in hemtcare and managed care. right now, she's responsible for delivering adequate care in the georgia system. next to her is dr. asher attorney who is the medical director of centurion, tennes e

tennessee, which is a joint venture with which tennessee contracts to provide for its correctional system. dr. turney has a special interest in health workers. welcome to both of you. i would ask -- i guess we've -- we need to pass the clicker to the lady who is next. >> good afternoon. as you all heard, i am a board certified pediatrician. i tell folks that i have 55,000 bad kids under my care. what i'd like to do is give you an overview of the georgia correctional departments.

fortunately, we have had lottings of respects and fully respect the related health care. to start out, georgia has a little bit of difference here. we're the ninth largest state but fifth largest prison population. we have 145,000 probationers. 94 ppt of our population is male and 6% is female. i think that this is, again, a reflection of other states. the male population, unfortunately, has a predominance of african americans. 62 pnt of our population is age 25-45 chronologically and i'll speak a litting bit more about that in just a second.

50% is over 35. so you think about the population in the free world and we model what is in the free world. we also operate county and private prisons, transitional and daycare. and, again, we're spongsble for mandated health care. secondly, they have the right to care that is ord herbed. we can't have a dentist that tries to do an amen detectmy. so that's the third piece of it.

37% of the inmate population has chronic illness. four years ago, it was 33%. every state is challenged with this. the diseases that are most prevalent are h. ichlt v., aides, mental illness and cancer. 17% of the georgia population receives mental health servicings and there's some difference with that. and the female population, 50% is receiving mental health services, compared to about 12% in the male population.

most of their inmates -- their physiologic age exceeds their chronological age. they have minimal to no health care and have an accelerated listing of croppic diseases. we have an increased population of age blind. it trarns lates into the older population, which is about 36 years. so we're not getting more young people in that i call.

those that are over 50 years of age are 18% of the population and account for 47%. those that are over 35 account for 2% of the population. if you're looking at a $180 million budget, that's a lot of money. those that are over 65 years of age, their average claim cost is around $3500. versus 591.

each year, the department of corrections has been given a row deuced budget. we are continuously, you know, having an intake of chronic illness which includes those women that come into our population pregnant and we're responsible for all of their pre-natal care and delivery. so all of the services that we are required to provide, we have to be very creative. the population below represents our general population.

so, again, here's our creativity. some of the principles that those managed care organizations have used, we have applied in the department of corrections. the first one being, and i'm very proud of this, what we call the summary of health care benefits. it is the same document or similar document that you receive when you apply for your own insurance. it's basically what the insurance company will and will not pay for. but, for us, it lists out which services are eligible to the services and the ones that right-hand turn.

it puts everybody on the same playing field. to give you examplesings, we don't pay for umbilical hernias, acne or male pattern baldness. we don't pay for your sex change operation. or your sexual activities. all medically necessary treatments are approved by the office of the attorney general and provides the framework for constitutional health care. it gives us no benefit to deny

preventive services. and, fortunately, we have a locked up population. so the fact that they miss an appointment, that doesn't happen very much. we have a very active utilization management department that does pre-authorization and discharge planning. we have an active pharmacy and they are putices commit tell. we have a co-pay for $5 for prescriptions that patients come in and say i want.

i want this or i want that. that's a $5 co-pay. we actively manage our network for hospitals, physicians, ancillary services, physical therapy, occupational therapy and rehappen. we have a passionate release process so that any inmate who has a guesstimate life expectancy of less than 12 months from a terminal or chronic disease can be considered by our board of pardons and paroles within ga fwa to be considered for early release. we have television on site.

we have a modular surgical unit in one of the prisons where, for amulatory services, we're able to take the inmates to have the surgeries done. lastly, we have a surgical unit with 22 beds. it is cost effective and cost efficient. our challenges are the population.

all inmates are experiencing ageing. >> we find that we have to establish protocols of who will get treated for certain diseases because of the treatments being incredibly expensive. we have an increased mental health burden, and the cost of the psych troefic medications and then we experience barriers to reentry which include transition of medical care to

appropriate providers. you can imagine that a lot of providers out in the community are not necessarily opening their doors and welcoming someone who is just being released from prison to come in and provide care. oftentimes, they come with no benefits and no resources to help pay for their services. vocational certification and employment opportunities are basically a barrier. in georgia, we have a law that those who become certified nurse assistant, cna, that certification doesn't hold up once they are released. they are in the able to use that. thirdly, the residents restrictions, including those for sexual abuse and those that are confined under -- from a sexual sentencing.

so the recommendations that i have is 340 (b) pricing would be made available. we would establish affordablecare act so that we're not just kind of figuring it out as we go. thirdly, that we would promote e lelectronic health record exchange, meaning electronic health records would be exchanged from all venues from the prison system, through the jails on out into the community providers. and lastly, federal funding to offset some of the cost on the prison system. >> okay. thank you. let's turn to dr. turney.

good afternoon, everybody. i've been a doctor for about ten years. after hearing the discussion, i just want to say that we all could have a family member that could be inkars rated. in my experience, i have not had that same issue. as a medical director for tennessee, i work with department of corrections and we try to avoid some of those circumstances that we describe. so i don't think it's an overwhelming, across the board -- a pervasive issue. but there are certain situations

that i work every day to prevent. as i said, i completely empathize with anyone that has had a circumstance like that. our goal was to help the under-served. this group is the underserved. it's the same vulnerable population that, oftentimes, this is the same population that needs access. so it's the same job for me whether i'm behind the walls or not. so i just wanted to describe our situation in tennessee. i work with a company that has about 60 years experience in managed care, also in

correctional health care. our parent company provide us a lot of opportunity and tools. we provide local solutions to some of the most difficult situations our parter ins face. but we also use evidence-based solutions. predictive modelling to limit the incidence and severity of disease. so welcome to tennessee, everyone.

we have 21,000 inmates across the united states. we do have some challenges. each state has its own challenges and obstacles. we've really worked hard to make them more manageable. the population as a whole has those same issues. often times, it's mag any if i woulded. and we've tried to deliver solutions to the t.d.o.c. that improve those concerns.

centurion has officially decreased the number of admissions to the hospital and e.r. by treating on site. by getting in earlier with our preventive health model to try to set up programs where we get to patients before they have an exacerbation that requires an e.r. run. across the state, we've installed telehealth to essentially discuss with a professional on one side and an inmate on the other with a nurse.

it allows you to get to the patient much sooner. and it also decreases -- it reduces the rigsing of public transportation and security. >> i do want to say that managed care facility are helping to improve, at least in tennessee. so i just want to brief ly discuss a few mental health

disease. we have to bring an innovative, multihealth divisional care to make sure they get the help that they need. female parabllmale patients do complicated treatment pathways. as far as unique populations, we all have elderly populations. but the difference in corrections is the elderly population is physically older than their chronological age. the life expectancy of a patient

that's been incarcerated, you know, late 50s. whereas the general population is 70, 75. so they're showing up much sooner with whatever the worst case scenario they come in. it's a lot more difficult issue than probably has been previously discussed. and we also provide hospice care. we all understand that cancer presents an incident as we age.

we're trying to treat those humanely, respectfully on site. as far as our female population, females have a significant number of medical problems. it's a completely different environment to treat patients. we do try to provide innovation by providing centering. it shows that, essentially, you work with a group of patients instead of one patient. and their experiences can then be exchanged and they learn from the grouping.

so instead of one-on-one ratio, we have about five. we have less pre-term babies d larger birth weights. last thing is hepatitis c. that's a huge thing. it has surpassed hiv as the largest cause of death for a vierm illness. our population, 17% of the inmates that we have incarcerated have hepatitis c.

in tp tennessee, it's about 10 times. hepatitis is potentially curable. the new medication that's available may lead to that. but the medications are very, very costly and hard to get. woe don't talk about it often, but a large amoubt of inmates will be released. my goal is to provide health care for them, not to be judge and jury.

so as we talk about innovative programs, telehealth reduces the time of diagnosis and the public safety risk. we also go further beyond just the treatment model. we look for prevention. we, as an organization, go to a customer-driven model. if you like 20 years ago, when managed care first came around, 20 plus years, actually, but when it first came around, we were more focused on providers, net works, facilities.

now we're actually focused on patients. this is in position as we speak. we have a telephonic disease management program. a patient can actually, with a nurse, as a facilitator, speak with an expert. this goes above and beyond just having a doctor or a nurse practitioner on site but having an expert in whatever their illness. let's say it's diabetes. you'll have an expert talk to you and counsel you on mechanisms to improve your health. so it's been, outside the walls, shown to be very successful.

>> as far as the future, the future is reentry. and in those cases, we want to make sure that we provide a bridge. it provides the information in an efficient means. at this current moment, corrections, as a whole, doesn't have that opportunity. this is ultimately what we talked about. public health. if they can connect to when they

get in to when they get out and it be a complete pathway, that will ultimately help the patients in the lock term. and that's one of our goals. like i said, centurion is a company i'm completely in with taking care. >> find a mechanism to assist department of corrections in

developing a electronic health record so that we have an ease on communication. it helps decrease our necessary recuring medical visits. oftentimes, docs will reorder what the previous order has because they didn't recognize that it's been done. they have to make a decision then because of the liability on their shoulders. so i think it's very supportive. and then, lastly, to continue to develop the disciplined health care and to have medical r residency programs and other allied health department professionals and provide some type of funding to assist department of corrections and

through difficulty accessing health care. they allow moneys available to pay back loans. >> we have about 20 minutes now where we can get some interchange among our panelists. and give you a chance to ask some questions as we go forward. i'd like to get us started. if i could ask our panelists to talk about something earlier in the program.

ash herb, you were talking about delivering the kind of quality-based care that is the standard as we go forward. and dr. lewis, as well, what kind of standards? we've talked about the need for regulation, for oversight of the proprietary providers in prisons. what kind of an oversight and what kind of standards are in place that you either have to impose or live up to? steve, you can talk about the broader picture to go beyond the specific states that were represented here. >> sure. and i think just part of it shows the alliance's gift in choosing what states to represent.

dr. lewis and dr. turney have demonstrated to us on what happens and the effectiveness of bringing managed care prings pls. the question, in both instances, it's the manner of self regulation that shows the kind of progress that both dr. lewis and dr. turney have created. i think the larger question i'm hearing you ask is should there be some other type of regulatory framework that would regulate correctional health within a different context and i'm not prepared to ask that question one way or another other than what we've heard them say is their personal managed care principles. that they've been crossing that bridge over to the island of corrections by using managed care, electronic records, telehealth has mechanisms to cross that bridge. as to whether there should be other mechanisms, i'm going to leave it up to those of you in congress to decide.

>> what do you do at those private prisons? what standards do you hold them to? >> they are held to the same standards with our sops, as all of my facilities within the state. we perform annual audits to make sure that they dlifer the health care of standards that we have outlined within our standard operating procedures within the department. >> yeah, we do -- the standard of care is no different inside or outside the walls. so we're held to that same level of care. we have to defend it in court, otherwise. what i will say is that, you know, we internally also do aut e audits. in addition to our agency partner, they do audits on a regular basis. but we do them internally to ensure quality measures. we are -- american correctional association certified. and some of our other contracts

are national commission on health care correction certified and those also have rigorous standards, similar to some of the quality commissions. >> is i part of your con trakts negotiations, actually, i was t terms of your negotiations with tennessee, in the case of dr. turney. >> i'm not as familiar with that portion. i can get that answer. but i'm not familiar with that portion. >> okay. steve, in addition to what we might do further, do you have observations about what the other 49 jurisdictions might look like? we've got the picture that maybe d.c. wasn't right up there at the top. >> not at the time that they were incarcerated for sure. again, i think this is part of the state, local and federal partnership. that up until now, we've allowed each jurisdiction to govern the island of correction and correctional health as they see fit. and if those who are blessed to

have dr. lewis, then you have organizational commitments from centurion and mhm that they bring forth. i think there is no national framework, if that's your question, ed, where we have made a societal decision that we're going to make sure that they follow the managed principles. we have not the typical medicaid protections that are available to consumers have not been available in a correctional health setting because they have not been subject to any of the cms standards or anything else that's required. frankly, in our experience, when you've seen one jurisdiction, you've seen one jurisdiction. >> okay. >> i do want to quickly -- i was thinking more about krl actual. we do have measures in place that the -- our vendor partner would look at regularly and charge what is called a liquidated damage. there are innocencives to make sure things are running very smoothly. as far as contractual. >> very good.

thank you. yes, go right ahead. >> thank you for having this today. specifically, dr. lewis, lots of strategies i'm curious about, once you're outside of the wire, i totally agree, trying to do the best you can inside makes a lot of sense, and that structure, never missing an appointment, that's real. once you're outside, unless you have a really strong community intervention and are able to really coordinate that care from inside to outside that wire, how do we encourage those strategies? what do we do other than create a better link with electronic medical records and things like that to ensure that those folks that are then suddenly thrown out in this community once again, freedom, and all this time where they were more successful in a structured environment, they made those appointments, how do we encourage and make sure that once they're out, they're a part of something? thank you. >> i think a couple of things.

one is that we can do a better job at trying to educate the inmates about their illnesses during our chronic care visits, so that they have an appreciation for the severity of the illness. secondly is identifying public health providers that are going to be willing to accept those discharged inmates into -- under their care. we have some difficulty with that. but it's hard to say, but the more catastrophic an illness is for an inmate, we have discharge planners who try to coordinate the care upon discharge. for someone who simply has hypertension or diabetes that's well managed, unfortunately we're probably not doing as good a job to hook the links up on the outside. but those patients who have cancer and major chronic diseases, we try really, really hard to coordinate the care with

appointments, at least in the beginning. we give them 30 days of medication, to get them started. we try probably starting six months ahead of time to identify and research what benefits that are available for them with medicare, medicaid, veterans, et cetera, and try to get the paperwork started so that those resources are in place by the time they actually get discharged. >> frankly, i would say we're seeing a major difference between expansion and non-expansion states on this. these folks are being able to come out with insurance, the non-expansion states i think dr. lewis and dr. turney can speak to the challenges they're having, and having community providers see what is basically a no-pay patient. >> go right ahead. >> i'm a longtime, lifetime public health official. and in an expansion state.

it seems to me that a real lever is certainly consumer education, but also with the state contracting. pause in an expansion state, the state is paying for corrections and the state is paying for medicaid. in order to coordinate those benefits, on the hospital side, we're looking at accountable care organizations. so that hospitals are coming out and working with community providers to make that transition after discharge meaningful to avert unnecessary readmissions. maybe someone on the panel is aware of those kinds of innovations with following the individual outside of the facility into the community, in a contractual relationship so there's risk sharing or savings sharing by the corrections officer, as well as by the public health officer. i ask really on the panel if there's any example of that innovation. >> there is an example of that in oregon, in part of their cco. they actually have set up a separate post-incarceration cco contractually, which has a risk sharing arrangement with that.

that's the only one that i can think of off the top of my head that the state has done that. i think that's a great model, and a great example we want to do. again, i think the question is, that given our federal system, the question is, how do you stimulate and how do you encourage those kinds of programs. is that a federal grant program, initiative program, how do we do that. but yes, i think that's an excellent panel. >> thanks. it's a great panel. thank you. >> you have a question right there. >> oh, yes, here we go, thank you. >> hi. my name is r irgs ka and

criminal. and there are financial and systemic incentives for keeping it that way. in your success at building the partnerships at the community level, i'm wondering if you have any words of wisdom and lessons learned that you can share for us at nac while we're at this national level, but then have these local member health centers that could potentially want to reach out and create these partnerships, but might not even know where to start or who to contact? >> the first thing i want to do is identify a huge obstacle, which hrsa up until now has been unwilling to have a change in their scope of service for care behind bars. while you have these health centers that may be actually the number one appropriate provider to be going out and providing

care behind bars, hrsa up until now has not been willing to allow that change for scope of service. for those of you here on the hill, i want to point out that's not an insignificant issue. in lessons going forward, the number one thing is understanding having a community board member, community health centers, 51% user boards. having that community board understand and identify that the folks behind bars are members of their community who are temporarily displaced. and i think that is a huge educational process within the community health center movement. i think that if you look at the work of sheriff ash, one of our board members in hampton county, massachusetts, who started this model, he started it by him identifying that the folks in his county jail were community members temporarily displaced. he reached out to his local community health centers and invited them into his facility to provide care. that came from the correctional side. i think the challenge is from the health center side, having

an absolutely educational understanding that these are the fathers, brothers, uncles, of the women and children we primarily serve, and that they are part of our community and as such, we want to reach out into behind those barbed wires and steel walls and guard towers, to figure out how we create integrative care. the smsa and hrsa terms of care are a good model for reaching out to health centers. >> yes, ma'am? >> hi. my name is amy thomas, and i work for the association of community affiliated plans. we represent 58 nonprofit managed care organizations throughout the country. we have one in particular in rhode island who's working with their department, their health services department, as well as with the prisons to help with that handoff between, you know, the prisons and then coming outside. and i particularly was curious if you have any research about the return on investment.

you know, we're looking at this in rhode island, but any research that's been done about how the handoff actually saves medicaid -- state medicaid programs money? >> the answer is, no, because of data sources. though the washington state data, i was able to describe to you, is unique, because they merged their jail booking data, their medicaid data and mental health utilization data. they have an index that allows them to tie that data. no other state has that data at this point in order to do that research. in rhode island you've been very blessed, a neighbor health plan as a leader, and a correctional leader who has understood and working with trying to figure that out. i think we have something similar happening in the state of vermont in an effort to try to link those systems. unfortunately without the master patient index or tying that data together, we have no way to do