Don't change LA prison doctor system if not broken

The soon-to-be thrice-weekly-printed New Orleans Times-Picayune recently got exercised over the quality of medical care provided to Louisiana state prisoners. Too exercised, in fact, to make anything but an overwrought case.

It turns out that over half of all physicians for prisoners, that is those who have committed some injury to society, themselves have been sanctioned by the state board that regulates physician behavior and some of these have been convicted of crimes associated with that. The high incidence of doctors with questionable pasts in the profession working in the prison system partly has to do with the fact that part of their penalties is that they can get hired only in institutional settings like prisons if they wish to continue to work in the medical profession. This leads the Times-Picayune to assert, via its headline, that inmates are not getting “good doctors.”

This complaint raises both normative and process questions. Regarding the former, is it necessary that the state provide “good” care for those who damaged it? Should not the moral obligation of society be to provide only “adequate” care to prisoners? Why must taxpayers be called upon to fund anything beyond competence in care to those who declared war on it? Especially when money is tight and other law-abiding, ethical members of society who may depend upon state resources for health care should have first call on scarce state resources?

Yet regarding the second question, the irony is that, because of the circumstances, prisoners may be getting very good quality care from these doctors. For example, one of those employed by the Department of Corrections with a checkered past I have known for over 20 years. By all accounts he was a good emergency room doctor but who had poor personal finance habits. Eventually, when an offer related to his profession came along that looked too good, his financial difficulties probably dulled his critical perspective and he went along with something that he should have regarded suspiciously from the start. Now he is restricted to working in institutions.

His medical abilities never have been called into question; the state refuses to hire for prisons any doctors who have issues of medical incompetency. He earned a far higher salary in the private sector, so in a sense the state is getting a bargain: good skills for a price well below market rate. Given the range of medical needs found in a prison, he’s probably better at this job than a lot of physicians would be, and might be providing better quality care than what law-abiding citizens on other government health programs like Medicaid might be getting.

This story likely exemplifies these kinds of hires into the system. They may have had legal and/or ethical problems in practicing their profession, but there’s no evidence that because of their missteps they then necessarily must provide inferior care, and care so poor that it isn’t even adequate. And so is it then up to the state to discharge them in favor of doctors with spotless records, with the likely significantly higher costs that could entail – if it even could find enough such doctors willing to work in the corrections system?

If often and thorough review confirms adequate care continues to come from these doctors, there is no reason to believe either prisoners or the state are being disserved by them. Nothing suggests getting overwrought and elevating taxpayer costs over a problem that doesn’t appear to exist.