topAlaska Health Policy Review
comprehensive, authoritative, nonpartisan

August 18, 2011 - Vol 5, Issue 18
In This Issue
Important Information About this Newsletter
Interview with Carmen Gutierrez
Please Respect Our Copyright
ISER Reports Alaska's Health-Care Bill: $7.5 Billion and Climbing
New Health Care Commission Member Appointed
APHA Announces Public Health Newswire
Congressional Action Network Webinar Recording Available
Health Policy Calendar
AHPR Staff and Contributors
Subscribe Now to the Alaska Health Policy Review
Resources
From the Editor

Dear Reader,

I arrived back in Anchorage early last Saturday morning. I had been gone nearly a month and was very glad to get back. Spent a few days in Mundelein, Illinois with in-laws. Then a few days on the shore of Lake Michigan in a place with no cell phone connection -- in-laws again. Then off to Albuquerque for a couple of weeks to see friends and look after my mother's house. She passed away a couple of years ago but her companion of 30 years still lives there. Still riding motorcycles in his mid-80s. Quite a guy. Finally, off to Boise, Idaho for a Council meeting. I had never been to Boise and expected mountains and pine trees. I was surprised to find desert, but really enjoyed the town and the area. The geography reminded me a lot of New Mexico.

Now, about this Council meeting ... Early in July I received a letter from the Office of Minority Health in Washington D.C. It said in part:

Recently, the U.S. Department of Health and Human Services (HHS) released the National Stakeholder Strategy for Achieving Health Equity and the HHS Action Plan to Reduce Racial and Ethnic Health Disparities. Together, these documents represent the federal commitment for addressing health equity and closing the health gap for racial, ethnic, and underserved communities.

 

The National Stakeholder Strategy calls for ten Regional Health Equity Councils whose members will serve as leaders and catalysts to strengthen health equity and enhance collaboration between stakeholders, align initiatives and programs, and leverage assets to more effectively accomplish health disparity reduction goals. The Councils will include individuals from the public, non-profit, and private sectors who are knowledgeable about and possess expertise regarding the social determinants of health. Council members represent communities impacted by health disparities, state and local government agencies, tribes, healthcare providers and systems, health plans, businesses, academic and research institutions, foundations, and other organizations.

 

The Office of Minority Health, HHS, is pleased to confirm your membership to the Regional Health Equity Council for Region X.

 

I'll admit that it was not a total surprise getting this invitation. I had been to a couple of earlier preliminary meetings in 2008 and 2010. It wasn't clear to me at those meetings if the feds could really organize a sustained effort at the local and regional levels as they appeared to want to do, but I did meet lots of wonderful, committed people at these meetings. I saw some of those same faces at this latest meeting, and felt the great sense of caring and commitment from all the twenty or so participants as well as the fed staffers there.

 

The general attitude of the feds was that they were there to help get us off the ground as a cohesive regional body, and they would provide technical assistance in the future, but what we did from this point forward was basically up to us. Oh, and by the way, the feds would not provide any travel money in the future for this regional body. Oh. Well, that might be a problem. Some of the groups newly elected leadership charged forward with the best of intentions to develop a plan to raise money from other sources, but that may be quite difficult. I don't think the feds wanted to spin us off so abruptly, but I strongly suspect the national budget issues forced them to suddenly push us out of the nest.

Health disparities are a huge, growing, and important issue. We may get a little help from the feds in the future, but it looks to me like this will be a largely local effort in the future, with great colleagues across the region to collaborate with as best as we can. Anyway, please take a look at the documents I hyperlinked above, and most importantly take a look at the National Partnership for Action site.

There is so much work to do!
 
Lawrence D. Weiss PhD, MS
Editor, AHPR
[email protected]

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Interview with Carmen Gutierrez

Carmen GutierrezCarmen Gutierrez is deputy commissioner of Prisoner Rehabilitation and Re-entry with the Department of Corrections. She oversees human resources, inmate programs and education, PACE (Probationer Accountability with Certain Enforcement), re-entry, and serves as liaison to the court system and rural Alaska. Gutierrez was born and raised second generation Alaskan and spent 24 years practicing law in Alaska before coming to the department. In this interview she speaks frankly about widespread mental health problems among the prisoners, challenges faced by the Department of Corrections while providing medical care to an aging population, how health care is monitored among Alaska prisoners residing in out-of-state facilities, and numerous other issues of interest. This interview was conducted July 7, 2011 and has been edited for clarity and length.

linksLinks to selected topics 

 

Improving former prisoners' prospects for successful assimilation back into the community 

Capacity limited for substance abuse treatment while incarcerated 

Medical care in the prison system  

The path to deputy commissioner at the Department of Corrections    

Medical care in the prison system: part two    

Paying for inmate medical care in Alaska  

Monitoring the health of the inmate population    

Challenge to the community  

  

improvingImproving former prisoners' prospects for successful assimilation back the community

AHPR:
You are deputy commissioner of Prisoner Rehabilitation and Re-entry. Could you please tell us what exactly that means?

Gutierrez: I'd be happy to. When I started my work with the Department of Corrections the commissioner changed the mission statement for the Department of Corrections from one that was primarily providing secure confinement for incarcerated individuals to one that provides safe, secure confinement, rehabilitative programs, and supervised community re-entry.

I started out as the commissioner special assistant and my focus was to be on the supervised community re-entry piece. He felt like the institution or department had a long history of providing safe, secure confinement. It had an on-and-off kind of approach to the rehabilitative program. He took over a department that in the prior administration had pretty much eliminated all rehabilitative programming but for one federally-funded substance abuse treatment program we had in the women's facility and in one of the men's facilities.

He implemented a whole new menu of programs that had been researched by our mental health clinician. These were evidence-based practices that had been proven to be effective in other institutions, and so the commissioner made it his goal to promote funding for the implementation of these programs. They included substance abuse, of course, parenting, anger management, criminal attitudes kind of programs -- the kind of programming to help people confront their own sort of criminal thinking errors and the like -- including a sex offender treatment program.

When I started my work as the special assistant, he had the first two prongs of the mission statement kind of in place, and my role was to look at community re-entry. How could we improve former prisoners' prospects for successful assimilation back into his or her community?  According to an Alaska Judicial Council study that came out in 2007, two out of three prisoners come back within three years of their release, and in fact, most of these people come back within the first six months. That really illustrated to the commissioner that Alaskans were not getting very good value for the dollar spent.

I mean, if you bought a car and it broke down within the first six months of ownership, you would say I did not get value for the dollar I spent. I think that is kind of analogous to the fact that people leaving prison break down, whatever, are re-incarcerated within first three years of their release.

My job was to focus on what does it take in order to have in place a system that will encourage a more successful re-entry into the community. I was in that position, doing a lot of community outreach. We started with many other state departments, community stakeholders and individuals, the Alaska Prisoner Re-entry Task Force, and really got a lot of community interest in this problem. In October of 2010, the commissioner decided that re-entry was such an important component of what his administration was trying to achieve that he created this new deputy commissioner position for prisoner rehabilitation and re-entry.

I'm responsible for overseeing all of the institutional rehabilitative programs, some of which I've just referred to, and then continuing to work on improving the other needed community-based elements for successful prisoner re-entry. It didn't take long for me to figure out -- because there's lots of other think tanks and non-profits nationally and on the federal level that have been working on these issues -- for an individual who is being released from prison to be successful, he or she needs access to safe, stable housing. They need a living wage job, they need sober and mental health supports in the community, and they need pro-social peer supports. They can't go back to the same peer groups that they were associating with.

These are the components required to improve re-entry, so in the institutions we have substance abuse treatment programs in all of our sentenced facilities. We have referral services for substance abuse in our pre-trial services, but there's way too much coming and going of individuals in the pre-trials to really have programs. Although I personally believe that we have a significant number of inmates -- particularly in the Anchorage Correctional Complex, which is a primarily pre-trial facility -- that are waiting for resolution of their pre-trial cases, and in some cases they're there for more than a year. In serious cases it can sometimes take that long for their case to be resolved.

... if you bought a car and it broke down within the first six months of ownership, you would say I did not get value for the dollar I spent. I think that is kind of analogous to the fact that people leaving prison break down, whatever, are re-incarcerated within first three years of their release. ...

 

One of my goals for the FY13 budget is to look at whether or not we could implement an actual substance abuse treatment program at the Anchorage complex as opposed to just doing referral services. We've had individuals in there that can't make bail. They're in there for a long time. We need to keep them productively engaged in rehabilitative programming, so that's the substance abuse.

Then we have our educational program, which consists of education -- GED, the adult basic education program that then prepares that individual to take the test to obtain their GED -- and then we also have various vocational programs throughout the state in our different facilities. The vocational programs available vary by institution. We have a sex offender treatment program -- it's in the Lemon Creek Facility. We have 24 convicted sex offenders in that program.

By and large virtually every sex offender who is sentenced for that kind of an offense is required by the court to undergo sex offender treatment, so our goal is to try to provide that to individuals while they're in custody. We've got over 700 sex offenders in prison right now, but we can only treat 24 of them. That's all we have the space and the money for. Everyone else then must get sex offender treatment in the community. Back to selected topics list

 

capacityCapacity limited for substance abuse treatment while incarcerated

 

AHPR: Excuse me, when you say "in the community," does that mean after they're released?

Gutierrez: Yes. After they're released individuals who -- if they didn't get the treatment in the facility and in prison, and mind you, that's only 24 individuals -- that means that the vast, vast majority are getting their treatment in our communities, and some of the waiting lists to actually get into sex offender community-based treatment are very long. For example, in Anchorage, it's a year.

We have a probation officer who's very specialized in working with this population. She will look to see if that individual can safely return to his -- primarily "his" -- community while waiting on the waitlist to get into the community-based sex offender treatment program. If that person does not have an appropriate place to live and a safety net in their remote Alaska community, they have to come to Anchorage in some cases, way fewer cases, or Fairbanks. They basically are in a big, urban environment, which many of these individuals are not accustomed to. They have no family support. They have no support of any kind other than their probation officer. They end up in a homeless shelter and they're basically sort of left to fend on their own in Anchorage while they wait for a year to get in to sex offender treatment.

By and large, most of these people are required to get substance abuse treatment -- hopefully they were able to get it in our facility. We now have the capacity to treat for substance abuse about 1,000 of our 5,600 prisoners, but if they weren't able to avail themselves of substance abuse treatment in the facility, they can't get the substance abuse treatment in the community until they first complete their sex offender treatment because that's just the way those programs work.

Some of those folks are supervised very strictly if there's proof by preponderance of the evidence that they've consumed alcohol. Their probation is revoked. They're arrested [and] put back in jail. They go to the bottom of the waiting list. So, what this means, is that most sex offenders are on probation for a significant period of time, and part of their prison sentence is suspended. They don't have to serve that suspended sentence, providing they do their conditions of probation. Some sex offenders end up doing all of their suspended time and they never end up getting the treatment. Once they've served all their suspended time, the probation is pretty much meaningless because there's no longer the hammer.

... if they weren't able to avail themselves of substance abuse treatment in the facility, they can't get the substance abuse treatment in the community until they first complete their sex offender treatment because that's just the way those programs work.

 

AHPR: Why are these waiting periods so long?

Gutierrez: Good question. It's because, unfortunately in Alaska, we just don't have the workforce. We don't have enough qualified, trained sex offender treatment providers to meet the demand. It's a workforce development issue, and it's something that we're really aware of. We're working on the problem from many different angles. I know the governor's office is very interested in trying to promote some of these workforce issues under the governor's initiative to eradicate domestic violence and sexual assault.

There are various components to that initiative, and one of the interests or goals identified is to try to encourage workforce development in this area. A lot of people who become psychologists or MSWs didn't become educated in their fields to work with this segment of our population, for whatever reason. That's the reason why we have the waiting lists. It's not so much we don't have the money to pay them, we can't identify enough qualified therapists. Back to selected topics list

careMedical care in the prison system

 

AHPR: Please give us an overview of medical care in the prison system. I understand that you also have some responsibility or some expertise on the mental health side.

Gutierrez: The Alaska Department of Corrections by statute is required to provide health care to all individuals under its jurisdiction, or in its institutions. We don't have to provide health care to people who are on probation, but for those who are in our institutions we're required to provide medically necessary health care. The Department of Corrections budget for the provisioning of health care has increased dramatically over the last several years. If my memory serves me correctly, our budget for health care in 2009 was close to $48 million. Every year we come up short and we need extra, we need a supplemental to cover our inmate health care costs.

In our institutions we have clinics. They're bigger in our larger institutions than they are in our smaller institutions, so we need to rely quite a bit on off-site health care professionals. As our population is aging and the cost of medical care in the community goes up and up and up, what it costs the department to provide health care to our inmates is also increasing every year, plus people come in - they're sicker. A lot of our inmates haven't been able for whatever reason to get appropriate health care in the community and when they come in to the institution I think our inmates are less healthy today than they were ten years ago. Back to selected topics list

pathThe path to deputy commissioner at the Department of Corrections

 

AHPR: I wonder if you could just tell us a little bit about yourself and your history, and how did you become the deputy commissioner at the Department of Corrections?

Gutierrez: Well, I come to this position in a not - probably -- typical fashion. I'm born and raised Alaskan, second generation, my mom was born here as well. I went to law school and realized early on that what I really wanted to do was be a criminal defense attorney. So that's what I did for about 24 years. And I also worked in the civil sector for a short while. It didn't appeal to me much. My real passion was working as a criminal defense attorney.

Then for a number of reasons after 24 years, I decided that I wanted to take a break. So my husband and I had the good fortune of being able to build a home in Mexico and we did that. I was a part-time snowbird. I couldn't be a snowbird on a full-time basis, but I did that periodically, spending chunks of my winter down there. Then the time came when I realized that I was looking for something more. I have always been very interested in criminal justice reform. One of the things that frustrated me the very most about my work as a criminal defense attorney was that my clients would be incarcerated and in many cases they came out in worse shape than they were when I first met them, and I found that extraordinarily frustrating.

When we came back to live in Alaska full-time, I realized that I didn't want to go back into criminal defense work but was interested in seeing what kind of prospects there were for improving prisoner re-entry outcomes in Alaska. I had heard about the good work that was being done by Commissioner Schmidt. I called him up, invited him for coffee, we had a great conversation. I had done a fair amount of research on what was happening, what was going on with the department under his administration. It was one of these sort of synergistic conversations, and that cup of coffee led to my becoming his special assistant focusing on prisoner re-entry issues.

I have always been very interested in criminal justice reform. One of the things that frustrated me the very most about my work as a criminal defense attorney was that my clients would be incarcerated and in many cases they came out in worse shape than they were when I first met them,...

 

My passion -- I suppose would be a fair word -- for figuring out more cost effective ways for how we handle incarcerating individuals has only grown during the time that I've been in the job. Plus, because other states are dealing with such budgetary short falls, they've had no choice at all but to figure out more cost-effective ways for dealing with sanctioning people who've committed crimes. Many states have incarcerated huge numbers of people for drug offenses or crimes that are primarily due to drug addictions, and I think many states are recognizing they just simply can't afford to do that. The question is now being discussed, "Are we criminalizing what is, in some people's opinion, a public health issue?" It's an interesting question.

 

I don't really need to form an opinion as to whether or not this is a public health issue or not, but I do think that it's the Department of Correction's responsibility to figure out if there are more cost effective means for how we do business. After all, we're spending state dollars and I think the public ought to be getting good value for the dollar spent. I think if you look at our recent recidivism data -- which is two out of three people come back -- the state's not getting good value. I'm highly motivated to figure out how we can get better value for the dollar spent. And I was also very impressed with the commissioner when he said his goal was not to "grow the Department of Corrections," but rather figure out ways to "decrease the size of the department." His goal is not to build more and more jails and prisons.

 

If we keep growing at 200 prisoners per year as we are currently -- you just do the math -- you can figure out we open up a new 1,500 bed plus facility and in 8 to 10 years from now we'll be looking at building another one. They're very expensive to build and they're very expensive to operate, so if we don't want to do that we better figure out how to reduce the rate at which our prison population is growing. Back to selected topics list  

 

care2Medical care in the prison system: part two

 

AHPR: I wonder if you could give us an overall discussion of the magnitude of the mental and physical health issues in the Alaska prison system.

Gutierrez: The Alaska Mental Health Trust Authority did a study, I believe it was in 2008, and it showed conservatively that 43 percent of the department's population are Alaska Mental Health Trust beneficiaries, so the Department of Corrections has become the largest state-funded mental health provider in the state. That's not really what the department was originally intended to do, and the number of individuals who have significant mental health problems is growing dramatically every year.

So, this is a real challenge because treating these individuals in the Department of Corrections is costly. It costs $146 per day to incarcerate somebody, and that adds up to about $48,000 per year. Those that have significant mental health issues, it's even more expensive to incarcerate them.

AHPR: Is that figure for Alaska or is that a national figure?

Gutierrez: No, that's Alaska. That's based upon DOC, Alaska Department of Corrections data. We have two very good mental health re-entry programs, but the demand for those services has increased dramatically over the last few years, yet the staffing and the resources for those programs has not increased at all. I commented earlier regarding the challenges that the department faces in providing for the health care for our inmate population. It's a real fiscal challenge as well as a logistics challenge for the department because we need to have competent health care services available for people incarcerated in some fairly remote communities -- in Bethel, in Ketchikan -- where we have at times difficulties in finding providers who want to work with our population.

AHPR: And speaking of medical care: Is there some formal standard for prisoners that's legally required or that you voluntarily adhere to?

Gutierrez: No, we follow the standard that is provided by Alaska state statute, which is we must provide medically necessary treatment. We have a policy and procedure that outlines what that means, and with a number of different kinds of examples that outline what is "medically necessary."

AHPR: On the prevention side, for example, are there regular mammograms for female prisoners or blood pressure checks, or is there anything done on the prevention side?

Gutierrez: You know, I'm not the best person to answer that question. We have people -- Laura Brooks -- who is basically serving as the health care administrator right now. She's kind of in an acting capacity. [She] would be the better person to answer that question. I believe that we do provide mammograms, but I'd have to double check with her. When people are admitted into the facility they go through a comprehensive medical health care exam and if things are noted like low blood sugars or high blood pressure, then follow-up is provided. I would need to check with her to confirm what I believe to be true, which is that annual or bi-annual health care for long-term inmate exams is provided, but I would need to ask her just to be sure about how frequently that occurs.

AHPR: You mentioned a law that says you have to provide medically necessary care. Is there any comparable law that speaks to behavioral or mental health issues?

Gutierrez: Title 33, under Title 33 of the Alaska Statutes, it also provides that the commissioner shall provide for the mental health needs of individuals in our institutions.

I commented earlier regarding the challenges that the department faces in providing for the health care for our inmate population. It's a real fiscal challenge as well as a logistics challenge ... because we need to have competent health care services available for people incarcerated in some fairly remote communities ...

 

AHPR: Perhaps you spoke to this already, but I just wanted to make sure that we have asked about the future needs in terms of what will the demands be from an aging prisoner population. Is that an issue you're following?

Gutierrez: It is an issue that we're very well aware of. We say that 95 percent of Alaska's prisoners will be eventually released. That means five percent will not be and that's just a rough estimate. That excludes a great many inmates who have received sentences of 30 years or 60 years, who may be released but they may be so old that prior to that [time] they may have some serious medical care that the department will need to provide for. As we incarcerate more people, and the lengths of their sentences are increased -- and the lengths of sentences are routinely increased -- the sanctions for certain offenses continue to increase, they don't decrease.

It just means that the demands on the department to provide competent health care for an aging population will only grow. And, whether or not we end up having units that are devoted to aging populations, we may find ourselves in that position. I know, for example, at Spring Creek Correctional Center -- that is where many of our long-term prisoners are incarcerated -- they now have a complete wing that is designated for older inmates, people who are in their fifties or older. They probably are going to do a lot better and be a lot happier if they're not incarcerated with twenty-year-olds who have a whole different approach to how they're going to do their time. So, we're already making provisions for an aging population.

There's been talk about bringing some of our sicker inmates closer to an urban area where they have quicker, closer, more proximate access to medical care, but it all involves a lot of very complicated prison population management issues. Right now we're running anywhere between 104 and 106 percent -- we're over capacity. A top priority is just: How do we make the best use out of every prison bed that we have? We are so over capacity, we fill every bed but do we do it as efficiently as we might be able to do if we didn't have such capacity issues? Probably not. If Goose Creek is fully funded -- the new prison, and it opens -- then we'll have some leeway here to start looking at population management from a perspective other than just how can we fill every bed we have.

AHPR: I just wanted to jump back for a moment to that figure, $48 million a year for medical care. I'm assuming most of that is for contracting out to the private sector.

Gutierrez: It is. An inmate has a stroke, they need to be hospitalized. An inmate develops cancer -- esophageal cancer -- they require extensive treatment in a hospital. We have a contract with Alaska Regional Hospital for all the inmates that are hospitalized in southcentral Alaska. If it's going to be a long-term hospitalization, it is sometimes worth it for us to fly the individual from Nome, or of course, bring them up from Seward. In some very rare cases, but it has happened, we've been faced with situations where inmates were looking at being medevaced out because their treatment required very, very specialized care.

We have inmates who require dialysis and they need to be transported to a clinic where that can be performed. Every time an inmate is transported for a doctor's appointment outside the facility or for a hospitalization outside the facility, they have to be guarded 24/7. That means for prisoners who are hospitalized a guard must sit outside that individual's door 24/7. We're paying overtime and it becomes very expensive. Back to selected topics list

payingPaying for inmate medical care in Alaska

 

AHPR: My understanding is that Alaska Natives are disproportionately represented in the prison system, and I'm wondering about their health care. Do they still have the ability or opportunity to access the Alaska Native health care system?

Gutierrez: No. You raise an interesting point and for a lot of individuals this makes no sense. This is by federal statute -- we've researched this. Once an Alaska Native is incarcerated and under the jurisdiction of the state, Department of Corrections, we are solely responsible for their medical care. We have no ability to even have the treatment provided by the Alaska Native Hospital. It falls under the state's dime.

Now, we do have the capacity, legally, to go after an individual's insurance, if they still have medical coverage, and some individuals do, but right now we do not have the infrastructure in place to actually go after an individual's insurance. There's a whole infrastructure -- and this is really kind of beyond my expertise -- but, Leslie Houston, our director of Administrative Services is very familiar with the challenges that would come in trying to go after an individual's insurance. There are companies that are in the business -- basically, a state would submit claims -- called pay and chase. So, we're looking at the possibility of utilizing the services of a third-party entity for this purpose [that] has the infrastructure in place to go after these third-party claims.

AHPR: They would take a big chunk.

Gutierrez: They would take a chunk, but, it would be better than what we have now.

AHPR: Tell me for a moment about Medicare. Are your older patients still eligible for Medicare?

Gutierrez: No. Same rationale that applies to the utilization of federal health, like for the Alaska Native individuals, is applicable to Medicare.

AHPR: My understanding is that patients on Medicaid lose their Medicaid when they enter the prison system. Is that correct?

Gutierrez: That is correct.

AHPR: The question is when they get out of prison -- the day they get out -- can they still get back on Medicaid? Or [do they] have to wait months to get on it? I don't recall the details of that.

Gutierrez: Well we have a program in place called APIC -- Assess Plan Identify and Coordinate is what that stands for -- where we have caseworkers who identify individuals who would be Medicaid-eligible upon their release and they try to get them set up to get their supplemental disability funds, or try to get them back on Medicaid. We can do that. We have the staffing available to do that for some of our inmates. These are mentally ill inmates that we try to do that with, but I don't know how long it takes individuals to get back on Medicaid. In large part it depends upon how proactive they are and tenacious they are in dealing with the bureaucracy. You know the reality is that many individuals who have been incarcerated don't have the follow-through skills required to work themselves through those kinds of bureaucracies.

AHPR: What impact, if any, will the Affordable Care Act have on the prison medical care issues?

Gutierrez: We're just starting to look at that, but my understanding is that it makes many individuals in prison Medicaid eligible. If that's the case then it would be very beneficial to try and hook people up with their benefits quickly upon their release, but I quite frankly don't know enough about this right now. I am kind of waiting to see what happens before I get well-versed in it. Back to selected topics list

monitoringMonitoring the health of the inmate population

 

AHPR: Many prisoners from Alaska are in prisons outside of the state. My question is, how do you -- or even do you -- regulate or monitor the mental and physical health they receive?

Gutierrez: We have approximately 1,000 prisoners incarcerated in Hudson, Colorado, which is just outside of Denver. This is a private facility, meaning its run by a private entity as opposed to the state of Colorado -- run by GEO [The GEO Group]. When we made the decision to move our prisoners from another private facility in Red Rock, Arizona, we had to submit an RFP [request for proposal]. That was done and there are many requirements under the contract that regulate the kind of medical care and mental health care that those inmates receive. The fact of the matter is, GEO will not accept inmates with significant mental health impairments, and they won't accept inmates that are seriously ill. They're just not going to be eligible for that kind of facility.

But, by contract GEO is required to provide for the physical care requirements of those individuals as they come up, and we monitor that. We have a monitor. She's not an employee of the state. She's actually a former warden out of the state of Washington. She's very bright [and] very, very knowledgeable. She understands each and every term and provision of that contract and her job is to go to Hudson every month and make sure that Hudson is living up to its terms of its contract. In addition to that, Laura Brooks -- who I mentioned earlier -- she's made a number of trips to Hudson, Colorado to ensure that the required medical care is being provided to inmates, and she addresses issues when she sees them, and we monitor that very closely.

AHPR: The CDC has a number of recommendations for the screening process for physical health issues, if I am not mistaken. Do you follow the CDC guidelines?

Gutierrez: With some of these standardized processes, yes, we do. For example, MRSA  [Methicillin-resistant Staphylococcus aureus is a bacterial infection that is highly resistant to some antibiotics] is always an issue of concern, and we have attempted to follow all the CDC guidelines with regards to making sure we prevent any kind of MRSA outbreaks in our facility -- and if we suspect them -- how to address them.

... we understand how hardworking individuals who don't have medical health care could feel resentful about how people who violated the law are getting a benefit that they can't get. We must walk a very narrow line here, ... we want to provide what's medically necessary and attempt to be good stewards of the state dollar and not provide what's not medically necessary.

 

AHPR: Are you aware of the situation where a person in the community might deliberately commit an offense or otherwise try to get into the prison system in order to get medical care?

Gutierrez: I can't say to what extent an individual might be motivated to come back to prison in order to get the medical care that he or she couldn't get in the community. I have heard anecdotally of cases where people have committed some kind of silly offense but I don't really know how true that is. I talk to assistant public defenders who talk about individuals who are incarcerated in the winters simply because it provides them with a warm place to sleep and three square meals. It wouldn't surprise me but I can't tell you of any real examples of this that I know from my own first-hand conversations with individuals. It is kind of common knowledge that wardens, our superintendents, will tell you that there are those that come back in order to have a warm bed and three squares.

AHPR: It's interesting, I mean just as a side comment, that if you're a prisoner there is the social obligation to provide health care, but if you're not a prisoner, it doesn't exist in this country.

Gutierrez: Exactly, and quite frankly the department is mindful of that. We want to provide what's medically necessary and we understand why we're obligated to do that and it's the right thing to do. But we understand how hardworking individuals who don't have medical health care could feel resentful about how people who violated the law are getting a benefit that they can't get. We must walk a very narrow line here, because we can understand why law abiding hardworking individuals could feel resentful, so we want to provide what's medically necessary and attempt to be good stewards of the state dollar and not provide what's not medically necessary. Back to selected topics list

challengeChallenge to the community

 

AHPR: My last question to you is, is there anything else you would like to say to the readers of Alaska Health Policy Review that perhaps we didn't cover or didn't cover long enough?

Gutierrez: I guess my closing comments would be that, I think often we look to our government to solve a lot of problems that really can only be solved by the communities making a commitment to maybe reexamine the way they look -- in this case -- at somebody who is in custody who's now attempting to re-assimilate him or herself back into their community. I think that we need to challenge ourselves to look at these people as not wearing the scarlet letter, and using prudence and common sense, ask ourselves, "What is it that we can do as employers, landlords, and such to help this person get a second chance?"

I'm not talking about a hand-up, I'm just talking about giving them a chance. We, as employers and landlords can often stigmatize these individuals and make it very difficult for them to find a suitable place to live or a living-wage job. So I challenge all of our communities to re-examine the way we look at people who've done prison time, and ask ourselves, you know, wouldn't it really promote the health and safety of our communities, to try to work with that individual to be successful in the community?

AHPR: Thank you. Thank you very much. Back to selected topics list

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Alaska Health Policy Review
is sent to individual and group subscribers for their exclusive use. Please contact us for information regarding significant discounts for multiple subscriptions within a single organization. Distributing copies of the Alaska Health Policy Review is prohibited under copyright restrictions without written permission from the editor; however, we encourage the use of a few sentences from an issue for reviews and other "Fair Use."

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For all related matters, please contact the editor, Lawrence D. Weiss, at [email protected].

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ISER Reports Alaska's Health Care Bill: $7.5 Billion and Climbing


Health care spending in Alaska reached about $7.5 billion in 2010, according to new estimates by Scott Goldsmith of UAA's Institute of Social and Economic Research (ISER) and Mark Foster of Mark A. Foster and Associates. The definition of health care spending is broad, including not only spending for hospitals, doctors, and medical tests, but also prescriptions, nursing homes, medical equipment, and more. The researchers found:
  • Health care spending in Alaska increased 40 percent between 2005 and 2010, up from $5.3 billion to $7.5 billion.
  • Individual Alaskans directly paid about 20 percent of the health care bill, state and federal health programs 40 percent, and private and government employers 40 percent.
  • A combination of things is driving health care spending in Alaska and nationwide: new technology, income growth, medical-price inflation, changing insurance coverage, and a growing, aging population.
  • At current trends, health care spending in Alaska could nearly double by 2020, climbing to more than $14 billion. Controlling that growth will be a big challenge.
Visit ISER to see the 12-page report.

For questions contact Scott Goldsmith or Mark Foster.

 

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New Health Care Commission Member Appointed


Governor Parnell recently appointed Allen Hippler to the Alaska Health Care Commission. Read more about Mr. Hippler and his appointment in the governor's press release. For more information contact Deborah Erickson by email or phone at 907-334-2474.

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APHA Announces Public Health Newswire


American Public Health Association recently launched a new portal, the Public Health Newswire, an essential resource for up-to-date information and opinions about the top issues affecting public health. The portal includes:
  • News and events from a wide range of leading publications and events across the industry.
  • The latest research from the American Journal of Public Health and other top scientific publications.
  • Timely commentary with authors and key leaders in the public health community.
  • Lively discussions! Post your opinion, read comments from others and get involved.
Public Health Newswire is the place to discover what's happening, who's making it happen and how you can get involved. We invite you to bookmark Public Health Newswire, join the conversation and help us grow as a community so that we may better ensure the public's health.

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Congressional Action Network Webinar Recording Available


The August Congressional recess lasts until Labor Day and there is still time to communicate with your members of Congress. As John Wiesman, National Association of County and City Health Officials (NACCHO) president-elect, said on the webinar, "Public health is a non-partisan issue." Everyone wants to be healthy and safe and this is a critical time to highlight the work of your local health department. NACCHO's at home advocacy toolkit, with talking points and sample letters, is available for your use.

The slides and a recording of the Congressional Action Network (CAN) webinar about at-home advocacy, held on August 9, are available for viewing.

Actions carried out by Congress over the remaining months of this year will have an impact on local health departments and public health programs for years to come. NACCHO has provided a slide show on the Budget Control Act and the debt reduction process and a timeline of Congressional action.
 
A complete update of recent developments in debt reduction and other legislative and regulatory action is available here.

For more information, please contact Eli Briggs, NACCHO director of Government Affairs by email or by phone at 202-507-4194.

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Health Policy Calendar 


Friday, August 19, 2011 9:00 am

What: National Health Reform Teleconference
Where: Register online.

Other information: The Center on Budget and Policy Priorities, the Georgetown Center for Children and Families, Community Catalyst and Families host a conference about the super committee, what it means for health care reform, and what we can do. Materials for the conference include: Center on Budget and Policy Priorities Paper: "How the Potential Across-the-Board Cuts in the Debt Limit Deal Would Occur;" Families USA's "Medicaid, the Budget, and Deficit Reduction: The Threat Continues;" and Community Catalyst's blog "Debt-Ceiling Compromise Kicks Medicaid Fight Down the Road." For more information contact Reena Singh at 617-275-2854.

 

Thursday, August 25, 2011 7:00 am - 9:00 am 


What: Commonwealth North Health Care Action Coalition
Where: Frontier Building, Suite 1404, 3601 C Street, Anchorage
Other information: DHSS Commissioner Bill Streur and DOLWD Commissioner Click Bishop will discuss Alaska's need for additional qualified medical professionals and the state's plan to address the issue. Teleconference number is 907-276-4900. For more information contact Joshua Wilson, program director, Commonwealth North at 907-258-9522.

 

Thursday and Friday, August 25 and 26, 2011 

 

What: Alaska Health Care Commission
Where: Frontier Building, Room 896, 3601 C Street, Anchorage
Other information: The agenda for the next meeting of the Alaska Health Care Commission is available on the Commission's website. For more information contact Deborah Erickson by email or phone at 907-334-2474.

 

Tuesday through Thursday, September 13 - 15, 2011

 

What: Alaska Primary Care Association (APCA) Legislative Priority Planning Summit and Emergency Preparedness sessions
Where: Millennium Hotel, 4800 Spenard Road, Anchorage
Other information: Emergency Preparedness sessions are September 13 and 14. The Department of Health and Social Services, Preparedness Division will join us to ensure you have all the tools necessary to prepare for catastrophic events that can affect your community. The sessions are designed to help you understand the emergency health system and how best to integrate the tools you learn at this conference into your emergency plans. The Legislative Priority Planning Summit is September 15. Members will have a chance to weigh in on state and federal legislative priorities for 2012. Register online. For more information contact APCA at 907-929-APCA (2722).    

 

Wednesday, September 14, 2011 noon  

   

What: HB 78 Subcommittee Meeting
Where: Millennium Hotel, 4800 Spenard Road, Anchorage
Other information: A public comment period about HB 78 Loan Repayments & Incentives for Certain Health Professionals is anticipated at the subcommittee meeting chaired by Rep. Stolze. HB 78 is in an interim subcommittee to address a few technical concerns with the bill. Prepare for public comment by viewing a summary of the bill and talking points. For more information contact Mary C. Sullivan, state affairs coordinator, Alaska Primary Care Association, by email or phone at 907-727-8773.

 

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AHPR Staff and Contributors

Lawrence D. Weiss,
PhD, MS, Editor
Jacqueline Yeagle, Newsletter design and editing
Jeri Kopet, Proofreader

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Subscribe Now to the Alaska Health Policy Review

The Alaska Health Policy Review is issued electronically, weekly during the regular legislative session and monthly the rest of the year.
 
A standard 12-month subscription to the Alaska Health Policy Review is available for $850. Please inquire about discount rates for multiple recipients in the same organization, legislators, and small nonprofit organizations.
 
Don't miss an issue! Send orders, comments, and inquiries to Lawrence D. Weiss at [email protected], or call (907) 276-2277.

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