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Dear Assembly Member Lowenthal:

We write to oppose AB 2590, as amended, which would permit nonconsensual disclosure of HIV+ Californians’ names and contact information to state contractors, such as the AIDS Healthcare Foundation, allowing medical service providers to market their services to this vulnerable population. The Center for Heatlh Justice opposes this unprecedented disclosure of confidential HIV information to facilitate unnecessary and unsolicited contact by an economically interested medical provider at precisely the time when a person recently diagnosed with HIV may be struggling with the many ramifications of the diagnosis.

As amended, AB 2590 will result in the disclosure of previously highly protected confidential medical information of Medi-Cal recipients for the purpose of allowing private entities to market to individuals living with HIV without their consent and in a way that may compromise confidentiality. There is the potential over time that any private HIV medical service providing individual or entity such as AHF could solicit individuals already under appropriate HIV medical care. This is a breach of the physician’s basic code of ethics and may result in interfering with the individual’s medical care. Unwanted medical solicitation including direct contact of potential patients without their consent is prohibited by both state and federal law.

The history of “cold call” marketing of medical services by managed care providers has led to strong regulation of this type of conduct by federal law. 42 U.S.C. § 1396u-2(d)(2)(E); 42 C.F.R. § 438.106(b). This bill is a step in the opposite direction, allowing state contractors of HIV medical services care may disrupt excellent care networks Medi-Cal beneficiaries have already established.
Specifically, with regard to AHF, there is a vested financial interest in being able to recruit patients for medical care and privately funded lucrative medical and pharmaceutical research.

Operationally, this bill will result in a list of HIV+ Californians who are Medi-Cal recipients being shared with people not involved in the individual’s medical care. Even in the best of circumstances, this is likely to result in increased instances of unauthorized disclosures of confidential medical information.
Furthermore, risk of unauthorized disclosure of HIV information undermines public health efforts aimed at encouraging HIV testing and early treatment. Individuals who are fearful of HIV such disclosure may forego testing altogether.

Based on the history of stigma and discrimination associated with HIV and the public health interest in encouraging testing, voluntary disclosure, and seeking appropriate health care, HIV information is highly protected under current California law, and should remain so. As advocates for individuals living with HIV and their rights to confidentiality, we vigorously oppose AB 2950 as an attempt by one entity to unnecessarily change the HIV confidentiality law of California and undermine public health advances in order to facilitate its marketing to HIV+ Medi-Cal clients.
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• $182.1 million by deportation of undocumented state prisoners to U.S. Immigration and Customs Enforcement for deportation.
• $175 million by decreasing in the number of programs for parolees. Programs that have been demonstrated to effectively reduce recidivism will be retained. The CDCR will also attempt to achieve this savings through more efficient delivery of programs.
• $147.6 million in “operational savings” by a one-time reduction in facility repairs, headquarter savings, additional efficiencies within the operations of the juvenile programs, and other operational savings.
• $50 million from establishing limits on contract reimbursement rates for medical services.

That’s a total of over $500 million in speculative savings, but it’s just the beginning. An additional $630.8 million will be achieved through various reforms intended to reduce prison and parole populations.

It's going to be interesting, and the political posturing has already begun:
http://blogs.kqed.org/capitalnotes/2009 ... bers-game/
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Morning Edition, July 15, 2009 · California is a mess financially, and one of its huge burdens is its prisons.

The state spends $10 billion a year on its prison system, which once was a model for states to follow but now is a model of what to avoid, NPR's Laura Sullivan tells Renee Montagne.

The prison population has grown from 25,000 to 175,000 since the early 1990s, not because of an increase in crime, Sullivan says, but because of the "tough-on-crime, three-strikes-and-you're-out" laws. But the growing population isn't the only prison-related challenge facing the state.

Unions are another factor. The prisons employ 33,000 people, including the nation's highest-paid correctional officers. The unions are a powerful political force, backing ballot measures for longer sentencing and punishment, for example.

Parole and probation represent another complicating factor. California has the country's toughest parole sanctions on the books. Each year the system releases 120,000 parolees, and each year 75,000 return to prison for violating their parole on technical terms, such as missing an appointment with a parole officer.

Texas used to have similar laws but found them too costly. So it slowly stopped returning parolees to prison for technical violations, and now Texas doesn't have the overcrowding and fiscal problems facing California, Sullivan says.

The three-strikes rule has returned as a ballot measure, but voters have not repealed it, she adds.

And yet another challenge is the rising cost of health care.

It all adds up to a vicious cycle that California's prisons can't seem to pull out of: Tough laws mean more prison time, more prison time means overcrowding, and overcrowding means less money for health care and other programs to help rehabilitate people and keep them from coming back to prison.]]> http://www.healthjustice.net/blog/index.php?entry=entry090624-194759
California should be very careful when considering privatizing prisons. Proponents of privatizing prisons argue from the position that private enterprise does everything more cost-effectively than government, but recent analyses challenge this assumption. A report by the National Institute of Justice looked at wildly divergent assessments of the cost and performance analyses conducted of the same four prisons. When comparing the cost and performance of public and private prisons cost comparisons are complex and there is no standard way of accounting for “overhead costs” or measures of prison performance (i.e. drug use, escapes and other custody incidents). In short, the goal of justifying privatization may easily influence the analysis.

Privatizing prison services is extremely problematic. In the case of provision of prisoner healthcare – of particular concern in California where a federal judge oversees these services – privatization has been shown to cost more and result in more deaths: in a recent economic analysis out of UC San Diego a study found that those states that contracted out for prison medical care employed 13 percent more medical staff, cost more, and had a 1.8% higher mortality rate. Costs more, kills more.

The economic upside of prison privatization is far from clear, but there are other reasons we should be deeply concerned about an effort to privatize this public function. Prisons are intended to perform a public safety function: to remove those from society who are a danger to others, and to punish and/or rehabilitate (depending on your theory of incarceration) the rest. A private corporation’s only interest is to maximize profits, i.e. increase revenue and reduce expenses. A private corporation simply has no incentive to conduct the public functions of a prison in anything but the most minimally acceptable way, to meet contractual requirements. While the economic incentive is the root of the argument that privatization will increase efficiency, there is also the real, documented danger that prisoners will suffer. And, because the state cannot delegate its constitutional duties to treat prisoners properly, when injury occurs, the state will still be left liable.

There are other ways to meaningfully reduce the costs of prisons in California, without turning them over to the private sector, which will then, of self-interest, lobby for the system’s propagation. We can both reduce the cost of prisons and improve safety at the same time. As a report from the Pew Charitable Trust’s Center on the States highlights, Kansas and Texas – public systems – have found a solutions in combining incentives for reduced recidivism, community supervision of non-violent offenders and sanctions other than prison for minor parole violations. The goal of these measures is to encourage and support parolees in becoming become productive, taxpaying citizens instead of sending them back to prison at taxpayer expense.

Public safety and criminal justice activities are basic governmental functions. To delegate these to the private sector will solve none of the long term problems of California’s prison crisis. Let’s look further down the road and rethink our reliance on prisons to address public safety, with an eye towards fiscal control over our prison system. If we do, we’ll see that our current situation present opportunities to reduce costs over the long term.
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California incarcerates over 170,000 people. Our prisons are filled to twice their capacity and because little forethought is given to the implications of “tough on crime” sentencing laws including mandatory minimums and three strikes. Despite the dire fiscal situation in the state, we continue to send more people to prison and for longer periods of time at exorbitant cost to California’s taxpayers.

While H1N1 is a concern in the community, in California’s overcrowded prisons where basic hygiene and medical care are difficult to maintain, H1N1 and other infectious diseases are an even greater problem because of the increased likelihood that they will spread, and without proper medical response. We know that H1N1 is highly treatable, but in a prison setting concerns that early symptoms may go without attention are real.

Prisons concentrate people who are more likely to have serious health issues: the rate of HIV, Hepatitis C and MRSA to name a few is much higher among prisoners than in the community. In prison, people at high risk for disease are placed in environments where disease is likely to spread. Outbreaks of Norovirus, tuberculosis and MRSA have all occurred in correctional facilities in California in recent years. It’s therefore unsurprising that an early case of H1N1 has occurred there, too.

Because prisoners are frequently transferred throughout the system and more than 95% of prisoners return to our community after an average sentence of two years, we should be concerned, too. It’s not unreasonable that a prisoner outside of San Diego might have just come through San Quentin’s reception center, or had contact with someone sent to Vacaville or Sacramento or any one of the 33 prisons in the state. Any of these prisoners could have come in contact with hundreds of correctional service staff and others who work in prisons daily. And, given the period before symptoms present, it’s not unreasonable to conclude that H1N1 might have been spread to others throughout the state’s prison system. The same is true of any infectious disease in this environment.

This situation highlights yet another deleterious effect of incarcerating hundreds of thousands of Californians each year in a system that can neither prevent nor treat disease at the basic level required by our federal constitution. When you think about H1N1, consider the effect California’s criminal justice laws have on the health of the broader community. It’s time for a change.
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It’s the current economic situation that forces us to engage in a true re-thinking of our criminal justice system, rather that a concern for human rights. Regardless, it’s time to replace our “tough on crime” stance with a new one which is “smart on crime.” We need to think about how to reform the criminal justice system in California so that it does more and costs less.

There’s no question about what needs to be done. The “Little Hoover Commission” – a non-partisan state oversight agency of people appointed by the Governor and legislative leaders – conducted an exhaustive review of the California prison system and reported over two years ago that “California’s prisons are out of space and running out of time.” Among their top recommendations were to establish a sentencing commission. The American Law Institute which drafts model criminal laws that are frequently used as the basis for states’ law is developing new sentencing provisions and recommends establishing permanent state sentencing commissions.

This is not a novel approach: sentencing commissions exist in more than 20 states. Their goal is to reduce prison population growth, provide rationale to support effective and evidence-based programs and to tie policies to financial analysis. Speaker of the Assembly Karen Bass has proposed legislation declaring the intent of the Legislature to crease such a commission as “an independent multijurisdictional body to, among other things, develop sentencing guidelines and provide a nonpartisan forum for sentencing policy development.” This is an important first step, but the California Legislature should next create the commission – not to merely express its intent.

We should support the development of a Sentencing Commission if we don't want to spend another $8 billion on prisoner healthcare; if we want to stop locking up marijuana user with members of the Mexican Mafia; if we think California would be better served by funding drug treatment facilities with social workers who earn $45,000 a year, instead of funding giant prison facilities with correctional officers who earn $90,000 a year; and if we think California should spend more educating than imprisoning our fellow citizens.

We need to stop the rhetoric that has created a steady increase of offenses and prison terms, and choose instead – through the creation of a Sentencing Commission – to be "smart on crime."
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The editorial can be found at http://www.marinij.com/marinnews/ci_121 ... arinij.com

Reduce the prison population

Thanks to the IJ editorial board for recognizing the complexity of issues in California's current prison crisis.

Closing San Quentin is not the answer, nor is building more prisons in remote rural areas, as has been our trend over the past few decades.

The answer to California's prison crisis - all experts agree - is to sensibly reduce the number of people we send to prison through sentencing and parole reform.

There are many suggestions as to how the California Legislature can do this including from the non-partisan Little Hoover Commission, former San Quentin Warden Jeanne Woodford and nationally renowned criminal justice expert Joan Petersilia, who just accepted a faculty position at Stanford University.

I encourage the IJ and its readers to research what these experts have to say about common-sense solutions that will reduce prison population and reduce crime here in California, and to support legislation and policy choices that reduce the number of people sent to prison, without compromising public safety.

It's a much better alternative than the costly contentious litigation that has, for decades, resulted in little improvement in the conditions of California's prisons.

Mary Sylla, DIRECTOR OF POLICY AND ADVOCACY,

CENTER FOR HEALTH JUSTICE,

LARKSPUR
]]> http://www.healthjustice.net/blog/index.php?entry=entry090413-145417 Addiction Behind Bars
Published: April 13, 2009

The United States must do more to curb the spread of diseases like AIDS and hepatitis C in prison, where infection rates are high and inmates can easily spread disease through unprotected sex or by sharing needles.

Drug treatment in prison is clearly part of the solution. But by some estimates, fewer than one in five inmates who need formal treatment are actually getting it. That’s alarming, given that about half the prison population suffers from drug abuse or dependency problems.

Addicted prisoners cause problems outside the walls. After they’re freed, addicts with H.I.V. or AIDS can infect spouses and lovers. They feed their addictions by returning to crime, which lands them back in prison and starts the terrible cycle over again.

The most effective programs provide inmates with high-quality treatment in prison and continue that treatment when prisoners return to their communities. Such programs have been shown to reduce both drug use and recidivism.

But good programs are rare, according to a report earlier this year in The Journal of the American Medical Association. Prisons typically rely on the abstinence-only model, which fails miserably with heroin addicts. Moreover, prison officials are notoriously hostile to methadone maintenance and other chemically based therapies that have long been a standard for people addicted to opiates.

Prison treatment is particularly disastrous in New York, according to a new report from Human Rights Watch. Imprisoned addicts, the authors say, are typically shut out of treatment until their sentences are nearly over because of ill-conceived policies that give priority to those who are about to be released.

New rules created earlier this month should help address these problems. The rules give oversight responsibility for prison treatment programs to the State Office of Alcoholism and Substance Abuse Services, an agency that develops treatment programs and licenses treatment providers.

The agency will be required to make sure that prison drug treatments are tailored to inmates’ needs. It will also monitor the programs, filing annual reports to the governor and Legislature. Drug-policy advocates hope that the new arrangement will improve treatment and provide timely help for addicted inmates. That would be good for public health. It could reduce crime, too.
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