Soaring prescription prices threaten prison health budgets

One Minnesota prisoner is racking up a $324,000 bill every year for prescription drugs. For another, medications cost $210,000. One hundred prisoners — out of the roughly 10,000-inmate population — collectively run up about $5 million annually for pharmaceuticals alone, according to Department of Corrections data.

Prison officials say an unforeseen rise in prescription costs has played a major factor in the rapid depletion of the department's budget for inmate health care. On Wednesday, they told members of a state Senate committee that they need $9.2 million to fill the gap.

As of now, they're on track to run out of funding by April.

"We can't deny coverage to anyone," DOC Deputy Commissioner Terry Carlson told committee members, citing a constitutional obligation to treat prisoners.

Carlson said the department spent 80 percent more on medications in 2016 than it had budgeted for during the last contract negotiation cycle.

The funding bump would be in addition to Gov. Mark Dayton's budget request for $22.8 million to cover health care costs for 2018-19, which Dayton released last week. Other than medications, this money also covers such costs as on-site primary care, psychiatric services and infectious disease treatment.

The de­part­ment couldn't give spe­cifics because of medical privacy laws, but spokeswoman Sarah Fitzgerald said the most expensive medications are for ailments like cancer, hepatitis, HIV and diabetes.

Dayton is also asking for roughly $7 million to expand mental health services and reform solitary confinement. Most of that money would go toward funding 48 new positions over two years — such as security, behavioral health and caseworker staff — to provide more out-of-cell time for prisoners, cognitive treatment and classes designed to reduce rearrest rates.

The governor's request came in response to a December Star Tribune series illustrating how hundreds of inmates have spent a year or longer in solitary over the past decade — including those with serious psychiatric illnesses — and some deteriorated mentally while in isolation.

At Wednesday's hearing, DOC Commissioner Tom Roy said a significant portion of those who end up in the criminal justice system live with some type of mental illness, and acknowledged prisons aren't always ideal settings for these people.

"If all other systems fail," they usually end up in prison, he said. "I will admit that if I was to develop a model for these individuals, it would not be a prison. It may have prisonlike components, but it would certainly be staffed significantly different with many more mental health professionals."

But providing better treatment comes with a hefty price tag, Roy said.

Roy emphasized the importance of moving offenders out of solitary — officially called "restrictive housing" — and getting them into programming and on a path to succeed on the outside, noting the vast majority will eventually be released.

"Ninety-five percent are going to be on the sidewalk with us," he said.

Dayton's budget request also includes $2 million for the prisons to abide by standards set under the Prison Rape Elimination Act, a federal law designed to reduce sexual misconduct and harassment in prisons and jails.

In order to stay in compliance, the DOC will need to hire 10 correctional officers at its juvenile facility in Red Wing to maintain mandatory staff-to-inmate ratios set by the law.

If the department doesn't meet the PREA standards, the state could lose significant federal funding.