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From House of Fear to Home of Care: The future of imprisonment

Jonathan Simon, professor of law | August 3, 2012

The future of imprisonment in California, and likely much of the nation, was described in some detail this morning (Aug. 2, 2012) on KQED’s California Report. The California Report’s Julie Small toured the construction site for the new California Health Care Facility near Stockton, where contractors are building a specialized prison for more 1,700 prisoners in need of long-term health care. These prisoners, currently tying down care beds and staff in prisons all over the state, will be centralized here to optimize the efficiency and success of providing them the continuous health care they need, and which California must pay for.

The new facility (notice it does not call itself a prison) may operate as a paradigm-shifting model for prisons in a society where currently some 40 percent of state inmates suffer from one or more chronic illness (including mental illnesses). It is designed to hold all prisoners in single-story structures (most prisons built over the past 2 centuries have multiple tiers or floors, typically with no elevators (prisoners were supposed to be young, healthy, and capable of mayhem, they don’t need an elevator).

The cells are specially designed to bring natural light into rooms, to make life there more sustainable for prisoners whose disability and medical needs, rather than risk and security threats, determine that they must remain most or all of the time. The walls are wide to hold the arrays of complex medical technologies necessary to monitor and sustain them, not to assure they do not assault their neighbors or correctional officers. These cells will surround a control center staffed primarily with nurses.

While the state-of-the-art facility is estimated to cost close to a billion (and will no doubt really cost twice or thrice that), the spokesperson for California’s court-appointed correctional health care receiver estimates that it will ultimately save the state millions in annual health care costs (a rapidly growing sector of the correctional budget). That is because of the nature of the chronic illness burden facing the state’s prisoners and prisons. Chronic illnesses, slow-developing diseases that get steadily worse unless efforts are continuously made to monitor and check them, conditions like diabetes, hypertension, HIV, and importantly, mental illnesses, represent a fundamentally new kind of health care challenge, one that is facing our whole society as it ages.

Incarceration as traditionally practiced, with a generic healthy young inmate as its one-size-fits-all model of prisoners, is poorly configured to handle this threat. Mass incarceration — with its overcrowding, and long prison sentences that assure more prisoners will spend their chronic illness years incarcerated — made things far worse, leading to the correctional health care crisis and the Supreme Court’s Brown v. Plata decision.

The new prison represents a remarkable departure (but a necessary consequence) of a state whose extreme sentencing laws and vast warehouse prisons have made it the Mississippi of mass incarceration. The account of its construction, the scale, technology, and sense of a new order being born, call to mind a parallel prison constructed roughly 30 years ago in the mid-1980s, as California built the first wave of its massive prison boom. Pelican Bay State Prison’s notorious supermax-style SHU (for Secure Housing Unit) was also seen as a distinctive new style of prison whose use of architecture and technology would allow California to control the most dangerous of a vast new population of inmates the state’s correctional planners were clearly told to anticipate.

As Keramet Reiter shows in her brilliant dissertation on Pelican Bay State, “The Most Retrictive Alternative: The Origins, Functions, Control, and Ethical Implications of the Supermax Prison, 1976 – 2010 (Berkeley, JSP, 2012),” these mid-level correctional bureaucrats, their vision shaped by the nightmarish but largely unrepeated incidents of violence from the early 1970s, wanted prisons where they could potentially house thousands of prisoners so dangerous that they needed to be locked down permanently.

Pelican Bay’s huge costs and supersize were justified on the belief that it would ultimately hold down violence and permit the much-expanded general population to operate more successfully and at lower cost. In the name of security, the prison was designed to encase the prisoner either in a cell, or in a cell-like exercise or shower room, with no programming and virtually no contact with staff or other prisoners (unless double-celled in the same conditions).

Instead of measures to counteract the inevitable assault such an environment would make on mental and physical health, the designers chose to allow no natural light and no colors into the environment, and designed routines without any consideration of the humanity of the bodies they were locking up. The atrocious and degrading results (frequent cell extractions using tasers and chemical weapons on often deranged inmates) were documented in the historic Madrid v. Gomez decison in 1995, but California continues to rely heavily on the SHU even today.

Pelican Bay was the house that fear built. Shaped in nightmares, it became a monster factory turning its inmates and correctional officers into threatening simulacra of human beings. Ultimately it helped set the tone for an overall correctional regime that engaged in industrial-scale torture through deliberate indifference to the health care needs of its mass incarcerated and chronically ill population.

The California Health Care Facility reflects a care-based model rather than a fear-based model. Not completely. Despite the fact that most of its patients will be prisoners in need of longterm care, it will have electrified fencing just like any other prison in California. Indeed, serious questions should be raised about why anyone who needs that much care, poses that little risk, and has served enough time in prison to meet a modicum of penitence should be in prison at all.

Still, just as the ethics of fear amplified in Pelican Bay helped define the culture and character of California prisons in the torture years, an ethic of care may be pointing us to a more legitimate correctional model for the future of imprisonment.

Cross-posted from Jonathan Simon’s blog Governing Through Crime.

Comments to “From House of Fear to Home of Care: The future of imprisonment

  1. I don’t think so much money should be spent on criminal prisoners. All of these people are bad people they don’t deserve all of these facilities, i mean yes, they can have medical assistance, but on this high level?!! i don’t think so. Prison is an environnment made to teach them that what they did done was wrong.

  2. There is common ground here. We can all agree that when you are locked up, you become vulnerable in ways that are difficult to imagine for even the most deprived free person. If the water is rising, you can move to higher ground; but not if you are locked in a cell. I can go by and make sure my 80 year old mom has her medicines and is taking them. If she was locked up I’d be depending on the prison system to do that.

    When failure happens the results can be catastrophic, including death and torturous pain none of us want that carried out in our name (one of the profiled inmates in the Brown v. Plata case was a young inmate who complained for months of agonizing testicular pain before he finally saw a doctor, who diagnosed his cancer too late). When the state is deliberately indifferent to meeting those needs, as the Supreme Court found, they become culpable of torture and by vicarious liability so do we voters/citizens.

    Of course it is true that it would be sensible to move most of these prisoners out of prison into community hospices and hospitals where they would pose virtually no risk to anyone. But even if California gets smarter about releasing older, sicker prisoners, the long-term problem of chronic illness in prison is not going away. The fact that it gets worst the longer people stay in, and that it needs to be combated constantly to prevent costs from exploding later on (and remember, under both current and likely future health care systems, we tend to pay for those costs in either taxes or insurance premiums), will force a change in corrections.

    Prisons have to reshape themselves around a care-taking model that gets prisoners and correctional officers all focused on the individual needs and risks of the offender (long the goal of standard correctional thinking). We should be prioritizing the hiring of correctional officers with health care educational backgrounds. I do believe this could be corrective to offenders at all stages of the life course.

    The best research shows that repeat offenders who desist from crime are those who have learned to take responsibility for their own life story and have a narrative about where they have been and where they are going. Chronic illnesses, like HIV, diabetes, and high blood pressure, require patients to take the same kind of responsibility for their health care and to have an active view of themselves as a health maker as well as consumer.

    Crime, especially for the people who end up in prison for repeating offenses, is in an important sense a chronic disease. Notice that unlike the old medical model, this does not banish personal responsibility or the place of proportionate punishment. Crime, like a lot of chronic diseases, have their roots in both personal behavior and the environment.

  3. Well, the reason they have to provide medical care is because they choose to keep them in prison for ridiculous amounts of time for crimes other countries set limits of 10-15 years or less. If they would be rehabilitated, which there is none of in prison, and we had normal sentencing laws, they too would be out here paying for health care like us. They can’t get a job and pay for it. If the state chooses to own them, they are obligated to provide for their needs. They do a lousy job of it. If they ever do build that hospital only the half dead would be allowed to go to it. They leave people with stage 4 cancer in their cells with no pain meds or any comforts, sleeping on concrete beds to die in a windowless concrete coffin. After 20-30 years.

    I think it is time to release a terminally ill inmate. But the CCPOA [ed: California Correctional Peace Officers’ Association] lobby for more prisons, we have 33 of them. They get paid $58,000 a year for each healthy inmate. Those with chronic illnesses create revenue of $120,000 each. We spend about $8,000-10,000 per year for each student in K-12. It costs them $1.20 a day to feed an inmate. I can’t feed my family on that, so how good can the food be? They don’t give them vitamins, so they are making unhealthy inmates so they can charge more for each one.

    We pay for it. It is a money game; they will need more guards to work at that hospital, so it means more jobs for the CCPOA and more union dues. Having this hospital is mandated because the health care is so poor one person a day was dying needlessly. It has taken 20 yrs. to get here. For 20 yrs. the CCPOA had a free ride on the backs of the chronically and critically ill inmates. The convicts don’t want to be in there for 40-50 yrs. any more than you want to pay for them to be in there. Those 40yrs and older that have done 20 years should be paroled. They aren’t the same people they once were.

    Vote yes on prop 39 so that inmates that got life under 3-strikes for non-serious, non-violent, victimless crimes can be resentenced to double the sentence the crime would have carried. These are people that have done 18 years for petty thief, minor drug possessions, and things of that nature. No burglary, murder, rape, child molesters or those with major drug crimes are eligible. It is a very narrow group but we save $58K to $120K per inmate per year doing this. It saves millions. Right now the way our community colleges are 8 of them were not accepting applications because of cut backs. We would rather send your children to prison than college. What does that say about the tough on crime scare that we have given into for decades? It was a lie! I don’t like paying $500 a month for my health insurance and taxes that go to support healthy inmates that could get out and go to work.

    Back in the day the judge would tell some of these guys join the military or go to jail. They would join the military and become good productive citizens. But we stopped and started shoving them into prisons so that the CCPOA could make a fat living off of warehousing people that have committed crimes like stealing videos, golf clubs, diapers, etc.

    It isn’t just the prison guards union, you have the prison industrial complex, Walkenhorst, Union Supply, Access, J-Pay, the factories that use prison labor for pennies on the dollar. There is a whole industry built around using prisoners as a means to get rich. It is a form of slavery.

    So when you write your insurance check out each month, blame the politicians not the inmates. We use people that we have given life to that have gotten caught with drugs after doing a prior sentence for a felony it doesn’t have to be 2 prior prisons terms; it can be one with several counts. They have done their time for that. We should be sentencing them on what they do today not in the past. But there is more benefits to loading the prisons to triple capacity.

  4. Excuse the pun, but I find it rather “sick” that we are spending a billion plus dollars to provide convicted felons with the best possible medical care, whereas those who follow the rules and pays taxes are left to fend for themselves when it comes to having access to medical care.

    • Amen to Michael’s comment. I was horrified as I listened to this story on the radio. My siblings and I are spending thousands of dollars each month (actually, each week!) out of our own pockets to maintain our mother’s enfeebled existence. Where is the help from a state that’s pouring millions, billions, of my hard-earned tax dollars into the sustenance of felons? And “correctional model”? Long-term care is not corrective; it’s merely a holding time until death. The time for a correctional model is long before a prisoner has reached the need for end-of-life care, a time when s/he could be returned to society to fend for him/herself during those final days, like the rest of us law-abiding citizens to. This is a truly shocking state of affairs.

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