The Washington, D.C., jail has big metal doors that slam shut. It looks and feels like a jail. But down a hall in the medical wing, past an inmate muttering about suicide, there’s a room that looks like an ordinary doctor’s office.
“OK, deep breaths in and out for me,” Dr. Reggie Egins says to his patient, Sean Horn, an inmate in his 40s. They talk about how his weight has changed in his six weeks in jail, how his medications are working out and whether he’s noticed anything different about his vision. Egins schedules an ophthalmology appointment for Horn.
Horn says before he arrived here, things were not looking good.
“I looked real bad. I was homeless, for one, and not taking my medicine,” says Horn, who has depression, high blood pressure and gout, among other things.
When he was out on the streets, Horn says, it was hard for him to get his medications or to see a doctor. So he just didn’t. He got sicker and sicker.
Horn is no outlier. People with a history of incarceration are typically much sickerthan the general population, especially returning inmates like Horn. Studies done primarily in Ohio and Texas have found that more than 8 in 10 returning prisoners have a chronic medical condition, from addiction to asthma. Egins says a lot of it has gone untreated, for a range of reasons — because the health care system is tough to navigate, because they’re homeless and don’t have insurance, or because they don’t trust doctors.
“The first thing is that they usually have no permanent address, which means that they cannot apply for health insurance and/or there’s nowhere to receive those documents if they do,” says Egins, a family doctor who does correctional health care, splitting each week between serving patients at the D.C. jail and at Unity Health Care, a network of community health centers.
Now, being in jail is not healthy. But for a lot of people, the best health care they’ll receive is what they get behind bars. About 40 percent of inmates are newly diagnosed with a chronic medical condition while incarcerated. Outside, many only interact with doctors when they’re in the emergency room.
And when they are released, as millions are each year, they enter a risky time, says Dr. Emily Wang, a primary care doctor with the Yale University School of Medicine.
“Man, if there is any one single thing in the literature that is compelling, it’s that there’s a significantly higher risk of dying in the first two weeks following release from a correctional facility,” she says.
Wang says the primary causes of death after incarceration include overdose, heart disease, suicide and cancer — often treatable things, if you catch them early enough.
It’s not just a matter of getting insurance. “Insurance is necessary, but it’s not sufficient,” says Wang. “Our patients will often come with insurance, but they don’t know the first thing about how to use the health care system to their benefit.”
Behind bars, patients get three meals a day and line up to get their daily medications handed to them by a nurse.
