Earlier this year, a 30-year-old Stillwater inmate complained of pain but was called a "faker'' and was left overnight in his bunk. The next morning, a blot clot requiring emergency surgery was discovered in his neck.

In 2010, a 27-year-old Rush City prisoner suffered seizures, but prison staff failed to call an ambulance. By the time they did, he had died.

A Nov. 11 story by the Star Tribune's Paul McEnroe described those tragic incidents. The cases were among at least nine involving inmates who died and 21 who suffered serious injuries after medical care was denied or delayed by corrections staff. These situations paint a disturbing picture of bad decisions and raise questions about how inmate health care is handled.

Should state Department of Corrections (DOC) medical staffing be increased -- especially during the overnight hours? Are nonmedical prison staffers properly trained to handle medical emergencies? Does the blended state/contractor system provide the best care?

Admittedly, meeting prison medical needs presents a difficult balance between providing treatment and watching the public purse. Prisoners tend to be sicker than the general population, and, as with medical care for the rest of us, costs have soared. And Minnesota prisons that once handled only a few thousand inmates now hold 9,500.

To address those rising costs, in 1998 the state hired Corizon Inc., a private, for-profit corporation based in Tennessee. The Department of Corrections pays Corizon $28 million annually to hire prison doctors. But prison nurses are state employees who often report to those doctors. That blended system can make it unclear who has the final word on the use of emergency services.

Corrections Department and Corizon officials say they provide the appropriate "community standard of care'' for prisoners. Yet there are questions about exactly what that "standard'' means. A citizen can get to an ER in the middle of the night. Prisoners can't make that choice alone.

Another problem in prison health is a culture in which some employees may withhold treatment simply because patients are criminals. Better to treat a few "fakers'' rather than turn some away and cause even one death.

An editorial writer's question about how the department handles these types of death and injury cases brought this statement: "DOC systematically reviews all cases involving death and significant injuries in our facilities. Actions are often taken based on those reviews: policies have been adjusted, additional training is provided to staff and in some cases discipline has been given out if policies and procedures were not followed.''

But the fact that these incidents continue to occur shows that more must be done -- whether it involves improved training, adjusted staffing, tougher discipline or submitting to additional outside review and evaluation of practices.

While it's important to control health care costs, it's equally important to provide adequate service. Minnesota's corrections department has been held liable for nearly $1.8 million in wrongful death and negligence cases.

According to federal law, inmates are "vulnerable'' adults who are entitled to health care. Legally, government is responsible for the people it convicts and puts in jail. And a civil society has a moral and ethical duty to treat those in its care humanely -- including providing timely medical care.