On May 1, Juan Martinez went to his fourth follow-up appointment since being diagnosed with hepatitis C (HCV) a little over a year ago. Martinez, whose name has been changed to protect his identity, doesn’t know how long he had the virus before his diagnosis. HCV often remains asymptomatic until its late stages, and it had been many years since he had last seen a doctor. The virus was discovered during intake at Hampden County Correctional Center, a jail in western Massachusetts, where he has been an inmate since April 2013.
Martinez looked much older than his 57 years. Wearing a green jumpsuit and government-issued sneakers, he sat as one of the jail’s doctors, Thomas Lincoln, asked him if anything had changed since the last time they saw each other. “I put on weight,” Martinez said in a raspy voice. “You told me to!” They both laugh.
Lincoln looked over Martinez’s file and glanced at a flat screen monitor displaying an electronic version. “You’ll be out in August?” he asked. Martinez nodded. “That’s about time we’ll need to check your blood again.”
Martinez is one of ten million people who enter the local jail system each year in the United States. In contrast to prisons, jails are used to detain people for short-term sentences and low-level offenses, or while awaiting trial for a more serious charge. The average stay in jail is three months and 96 percent of inmates return directly back to their community. Of the more than 1,400 inmates at Hampden, where Martinez was detained, somewhere between 20 and 30 percent carry the HCV virus. Many, like Martinez, are first diagnosed in jail.
As the US incarceration rate has skyrocketed over the last forty years, many healthcare professionals have come to recognize that jails offer an opportunity to identify and treat people who might not otherwise seek or have access to healthcare. “With more than 2.2 million men and women and children behind bars, the health of prisoners and jail detainees and the health of the public is becoming blurred,” says Gabriel Eber, staff counsel at the ACLU’s National Prison Project.
Jail inmates are disproportionately male, people of color and poor. This population suffers from higher rates of many health problems, including chronic and infectious disease, injuries, mental illness and substance abuse. And people are often at their sickest when detained. Eighty percent of detained individuals with a chronic medical condition have not received treatment in the community prior to arrest. “It’s like an emergency room,” says Ben Butler of Community Oriented Correctional Health Services (COCHS), a nonprofit promoting healthcare connectivity between jails and communities, of jail intake. In effect, jails have become the front line for health problems that plague underserved communities in America.
Exacerbating the problem, once in jail, what treatment happens there stays there. Health records are hard to transfer in and out, leaving patients who have received care prior to arriving in jail with siloed histories, creating inefficient, costly and potentially inconsistent treatment. There is little protocol mandating follow-up care once someone is released—in fact, according to a recent study by The Journal of Urban Health, nationwide only 10 percent of people who qualify for assistance with arranging mental or physical health treatment when they re-enter their community actually receive it.