Helping Ex-Offenders Manage Health Care Can Pay Off : Shots - Health News Each year, millions of Americans leave jail or prison. When they do, they're likely to have a hard time managing their health. Some clinics are trying to provide ex-inmates with better, cheaper care.

Helping Ex-Inmates Stay Out Of The ER Brings Multiple Benefits

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Each year, nearly 700,000 men and women leave prison. Millions more leave jail. It's a big portion of the U.S. population and one that suffers from high rates of chronic illness.


It is also a group, though, that is unlikely to see a doctor unless they are in the emergency room. NPR's Rae Ellen Bichell reports on an effort to get ex-inmates to see a doctor before it is too late.

RAE ELLEN BICHELL, BYLINE: The Washington, D.C., jail has big metal doors that slam shut behind you. But if you go down a hall in the medical wing where some people are not doing well...

UNIDENTIFIED MAN #1: Excuse me, I feel suicidal. I'm going to kill myself.

BICHELL: ...You eventually reach a room that looks like a normal doctor's office.

O. REGGIE EGINS: OK, deep breaths in and out for me.

BICHELL: Dr. O. Reggie Egins is checking up on his patient, Sean Horn. He's in his 40s and at the time, he was an inmate.

EGINS: And have you had any vision changes recently?

SEAN HORN: It's still the same. My eyes still get blurry.

EGINS: OK. I do want to send you to the - have the ophthalmologist see you again just to do another eye exam given the eye pressure

BICHELL: Horn says, before he arrived here, things were not looking good.

HORN: I looked real bad. I was homeless for one and not taking my medicine.

BICHELL: He has high blood pressure, depression, gout, hearing problems. 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: And that's when I had two heart attacks and then my gout flared up a whole lot of times when I was out there.

BICHELL: Horn is no outlier. People with a history of incarceration are really sick compared to other Americans. More than 80 percent have a chronic medical condition from addiction to asthma. Egins says a lot of it goes untreated.

EGINS: For the most part, he's, you know, a typical patient and we see patients come in all the time, uncontrolled diabetes, hypertension, HIV, asthma.

BICHELL: And each year, millions of them leave jail and prison. The next time they see a doctor is often in the emergency room with conditions that are a lot more expensive to treat and a lot worse than they could have been. 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. As soon as these patients leave, says Dr. Emily Wang, they enter risky territory.

EMILY WANG: Man, if there's any one single thing in the literature that's compelling is that there's a significantly high risk of dying in the first two weeks following release from a correctional facility.

BICHELL: Wang is a primary care doctor with the Yale School of Medicine. She says the main causes of death include overdose, heart disease, suicide and cancer - often treatable things if you catch them early enough. She says about 40 percent of people with a history of incarceration are diagnosed with a new chronic medical condition while incarcerated.

WANG: And so when they come home from prison, they have to learn how to use the pharmacy and learn to get a refill, learn to make their appointments on top of trying to get housing, get employed, figure out where to get food for the day.

BICHELL: Wang and her colleagues are trying to make it easier for ex-inmates to see doctors. They work at Transitions Clinic, which now has 14 sites across the country, including the one where Wang works in New Haven, Conn. The staff starts off the morning by running through a list of the patients coming in.

UNIDENTIFIED WOMAN: H.B., our gentlemen with an infection in his leg, has just seen orthopedics. That was a huge accomplishment.

UNIDENTIFIED MAN #2: Right, right, right.

UNIDENTIFIED WOMAN: So thank you for making that happen (laughter). Getting him to any appointment is a feat.

BICHELL: Because the staff at Transitions had to get the patients' trust first. The main reason they managed to do that is because of Jerry Smart.

JERRY SMART: This population, you know, they've been dealing with probation and parole, dealing with the correctional officer, so they don't trust people.

BICHELL: Smart is a community health worker. He's like the clinic's secret weapon because patients might not trust the doctors, but they do trust him. It's been 30 years since he did time, but Smart gets what these people are going through. He remembers feeling judged by doctors and thinking they didn't care about him.

SMART: A lot of guys feel the same way, but me, as a community health worker, when they meet me and I just let them know we have a great team. The physicians care about you, care about your needs. So once they buy into me, then they buy into everything else.

BICHELL: He says no one wants to be sick, but sometimes the whole health care system can be intimidating. So he'll go with patients to their appointments, check in with some of them regularly on the phone. He'll even take frantic calls at 2 a.m. about whether they should go to the emergency room or not. Mark Baskerville is one of the clinic's success stories. He's in his mid-50s and he's been in and out of prison four times.

MARK BASKERVILLE: Coming home, first it's anxieties that pick up. Man, am I going to do all right, or you're anticipating this or that.

BICHELL: Since re-entering the community, he's come for regular visits at the clinic, and he says he's doing better.

BASKERVILLE: It was easy. It was easy. I know what I got to do to take care of my diabetes. You got to work with your doctor.

BICHELL: If you don't, he says, you'll never be able to enjoy your freedom. Rae Ellen Bichell, NPR News.

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